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Infection control in elderly congregate living and care settings in the US

Be resourceful, use common sense, and show empathy

There is little question that the COVID-19 pandemic has forced care providers and designers of senior living environments to re-evaluate how these facilities are operated and designed. This is not necessarily a bad thing as we have long been complacently building and operating senior care facilities in the same ways as that of the archaic 1950’s models which had been generally designed without regard to infection control or resident dignity for that matter.

Although COVID-19 vaccine is now available, the pandemic is far from over. A year after the disease found its way to the United States, it still rages throughout the country, fueled by political agendas and a disarray of approaches as numerous as the 50 states, to mitigate the spread of the disease and minimize the death toll.

Designers and care providers have discovered a new urgency in addressing both short-term and long-term solutions to their built environments for the purpose of mitigating the spread of infection. These solutions often include innovative ways to maintain “normalcy” within the facilities, but have also initiated discussions regarding a restructuring of design and care provision approaches.

Elderly residents sitting around a table fire in a central courtyard while others play mini golf in the background

Using common sense
For existing environments there are some easy remedies that help in preventing the spread of infectious diseases. These include intensive staff training regarding the efficacy of wearing personal protective equipment and maintaining social distancing both for themselves and residents. Another simple approach is to recruit a delegated “clean crew” on staff who are responsible for disinfecting surfaces on a regular and periodic basis. This crew can keep a displayed record of who cleaned what area of the building and when they accomplished that task. This builds confidence from other staff members as well as residents, knowing that there is attention being paid to reduce the spread of diseases.

Creating a protocol for resident interaction with each other and with staff and visitors is critical to the prevention of disease spread. Setting aside a specific room designated only for residents and visitors so that the visitor does not penetrate deeply into the environment is one way to minimize the introduction of infection into the community. This room should be near the building entry and should be sanitized after each use as well as scheduled to prevent user overlap. Setting aside a specific room for telemedicine in order that residents do not have to travel to doctor’s appointments can also help from bringing new infection into the building. Most effective short-term solutions result from simple common sense, adherence to social distancing and mask usage as well as the dedication and thoughtfulness of care providers.

Elderly residents sitting in a bistro setting.

Environmental modifications
The pandemic has forced care providers and designers to consider relatively low-cost environmental efficacies to maximize infection control. Using UVGI (Ultraviolet Germicidal Lighting) can serve to eliminate some, if not most, airborne coronavirus germs within the area that the lighting covers. UVGI lights can be placed primarily in an upper room location to effectively scrub that room of airborne virus. However, caution should be used as to where and when these lights are used for occupant protection. These lights can also be installed within a forced air heating system to scrub the air traveling through that system. This solution is obviously only effective if the COVID virus has been introduced into the environment’s air. Preventing this introduction would be the first line of defense. To minimize that introduction, a strict personnel entry protocol can be effective. There are numerous manufacturers of immediate body scan temperature devices that can readily screen those who are presenting with elevated temperatures indicating an illness as they enter the building.

Within forced air mechanical systems, HEPA filters can be utilized with little or no modification to that system. Alternatively, stand-alone HEPA air scrubbers can be placed within the environment to accomplish the same thing, particularly if a radiant heating system has been designed for that environment.

Long-term solutions
It is incumbent on designers and care providers to radically re-think congregate care environments for the elderly. It is obvious that what has been acceptable design in the past will not protect our older population from disease contracted within those environments. Replacing medical model care environments with small-house resident oriented approaches that include private rooms with en-suite bathrooms is an effective way to at least minimize any rampant spread of disease. This approach also provides a higher level of resident independence, dignity and diminishes loneliness.

Providing residents an ease of safely accessing exterior spaces can serve to promote resident interaction while safely distancing and enjoying benefits of the outdoors. Designing a more controlled entry for visitors and staff complete with effective monitoring and readily available masks for visitors can be a major step in preventing the introduction of new diseases to the facility. Other areas to consider would be fully equipped telemedicine rooms, sanitized visitor rooms, larger social rooms to accommodate appropriate distancing, and contemporary effective mechanical systems. Additionally, implementing effective and on-going protocols for residents, visitor, and staff beyond the pandemic can protect both today’s and future residents.

Lobby with two couches and decorative wall column in the middle.

One of the most important, and easiest, approaches to prevent the kind of rampant spread of infections like the COVID-19 virus in senior living environments in the US is a change in attitude toward our most vulnerable population cohort. Seniors in the US are exposed to both subtle and overt ageism discrimination, relegated to a forgotten and forgettable place in our society. There is little consistency in financial resources or even operational regulation from state to state to either pay for long-term health care or to provide living wage for the staff that work in these facilities.

As designers and care providers we can, and should, learn from the experiences of this pandemic in order to provide a more meaningful life for our elders. There are many ways we can put into practice those experiences, only a few of which have been shared here. Be resourceful, use common sense and provide empathy for those for whom we care.

Jeffrey Anderzhon, FAIA, NCARB
Holland Magazine

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