The rise of multi-generational housing in Canada has been trending for a while now, particularly in cities like Toronto and Vancouver where a lack of supply and high housing prices have forced homebuyers to look for creative solutions to achieve their homeownership dreams. There are practical familial considerations as well. With aging parents requiring assistance and the cost of child care both very high, having multiple generations under one roof can be more economically and emotionally beneficial to the whole family unit.
I first explored multi-generational housing at the request of a client, as part of my Dear Urbaneer series: What Are The Important Considerations Surrounding Multi-Generational Housing? and then incorporated it into a piece on my Canadian shelter site Houseporn.ca about housing options which were growing in popularity: Multi-Generational Living, Co-Housing, & Laneway Dwellings Are Trending In Canada.
And Then The COVID-19 Pandemic Hit
There is no question that the impact on our society of COVID-19 over the last few months has been substantial. Although there are various different schools of thought on how and when we will resume commerce and our social lives, there is one common point of view. Life as we knew it before COVID-19 will be altered substantially in almost every way - at least until a vaccine is discovered - and possibly beyond.
One of the most significant issues exposed in the path of COVID-19 is the complexity and inherent vulnerabilities present in long term care facilities and retirement homes. In fact, the government has just deemed the situation in some long-term care facilities so severe that they will intervene. Premier Doug Ford, who previously attempted to call in the military to help control COVID-19 at 5 long-term care facilities, has issued a new emergency order as of May 13, 2020.
The order allows management of long-term care facilities to be taken over by a government-appointed manager; if the facility has a high number of infections or deaths, or if it’s facing a staffing shortage, the province could hand over control to a person, a hospital, or a corporation. Ford says that they will “support the use of rapid, immediate and effective management alternatives".
As of the writing of this article, the vast majority of all COVID-19 deaths in the country have involved residents of LTC or assisted living facilities: "82% Of Canada’s COVID-19 Deaths Have Been In Long-Term Care".
... Just let that sink in for a moment. 82 per cent?! It’s a shocking statistic that very well might have the impetus to change our sociological perspective on aging, the infrastructure we created to deal with our elders (which didn't exist previous to the mid-19th century), and, more broadly, the ways in which we care for our families and our homes.
The Issues Plaguing Long Term Care
Undeniably our nation’s senior population and their caregivers have seen the vast amount of outbreaks, and sadly, deaths, from COVID-19 - mostly in long term care facilities. Other facilities that house a number of people in close settings have also presented challenges in stopping the spread of COVID-19, like shelters, for instance, but it is the long term care facility - and to a lesser extent retirement homes where the population are most vulnerable, and sadly most likely to die.
Retirement homes have been hit hard as well, but as the residents of these facilities tend to be more independent and mobile, there are more opportunities for social distancing and hence the lower infection rates. Make no mistake though - they are vulnerable as well.
With a death toll that is alarming in LTC, an unavoidably bright light has revealed the weaknesses in the system that has contributed heavily to these losses. Doug Ford has already made changes in response to this senior care crisis, increasing worker wages and requiring that workers not work out of multiple homes, so as to limit contact and spread. The federal government has deployed the military to assist. Screening processes for people that enter the homes are vigorous, checking for signs of illness and testing for COVID-19 has increased.
It’s important to curb the spread in these institutions, not just because of how it poses a threat to the residents and staff, but the proliferation and presence of the disease in our community threatens us all - directly or indirectly.
Hats off to Kingston, where they reacted quickly to protect their most vulnerable population with dynamic policy changes. As restaurants closed mid-March, the city redeployed health inspectors from that sector to retirement and LTC homes for frequent and random inspections of buildings, staff and resident protocol, with hefty fines on the line if standards were not met. And it's working. As of the writing of this piece, Kingston’s care homes have largely been spared from COVID-19. Click here to read "With An Early Focus On Seniors’ Residences, Kingston Has So Far Avoided The Brunt Of COVID-19".
Given what is clearly at stake, it will give seniors and their families pause to consider their care options moving forward, which will most certainly have impact on our physical housing and the way in which we live in our homes.
Denmark: A Case Study
What happens if a society collectively decides to shift how they care for their elders? Denmark is a good example. In 1987, Denmark decided to move away from building long term care facilities, and instead decided to focus their funding and efforts on other care models. They build co-op type living arrangements for seniors to age in place.
Long term care facilities are used only when medical need is too great, usually near end of life.
Here's a great supplementary read: "Time To Stop Building Massive Long-Term-Care Homes And Rethink Models, Says Seniors' Advocate".
This article talks about the challenges facing the current long term care models in Canada, and also references successes achieved in Denmark: "Time To Re-think Seniors’ Housing And Long-Term Care In Canada". According to this article, when Denmark chooses to build new seniors facility, they build small apartments, connected to a common kitchen and garden. The idea is that they are protected in a smaller, user-friendly environment with access to care. There are municipal laws in place that require a proactive health visit from a professional every year for every person.
Under this model, the lion’s share of funding goes towards onsite care and small group home construction, with a smaller amount of funding going towards traditional institutions. It’s the reverse in Canada.
The Need For Medical Intervention
It’s only fair to point out that these models are only viable (and safe) if proper medical care is able to be accessed in a timely manner. It’s one thing to create a physical environment that promotes aging in place in a more benign, less institutional setting, but you can also create a whole subset of dangers by placing a vulnerable population without the necessary health and safety support.
For example, if your loved one has dementia or Alzheimer’s, there is a danger of wandering, aggressive behaviour and possible self-harm from typical household items if they are placed in home that isn’t equipped to handle these special needs.
And what if your senior has a propensity to fall? The benefit of retirement residences, where seniors are often more independent, is that these residences are physically designed to mitigate these risks, with smarter layouts, less tripping hazards, wide doorways, safer bathrooms and more.
To the government’s credit (current and prior), even pre-pandemic, there has been a concerted push towards developing programs that will let seniors age in place. There are things available from tax credits for renovations that allow for medical modifications to a bevy of medical and social programs to provide support to seniors and their caregivers.
However, funding is limited and the system is beyond mired in red tape. Between challenges getting benefits paid out from insurance companies and need that surpasses public funding, support (and the level of support) is not always easily accessible. The onus of proving “need” falls to seniors, their caregivers and families already burdened with the stress of caregiving at home.
As we try to learn lessons from COVID-19 and improving living and care conditions for our elders, the solution may very well be multi-generational housing, combined with the necessary medical support able to be delivered to seniors at home in order to make this approach sustainable and possible.
Building Homes That Safely Support Aging In Place
There needs to be a focus on creating more housing that is suitable for multiple generations; layouts that respect privacy for all members, but designed in an accessible way that facilitates safety and care as older family members age. If you are considering building, buying, or renovating a home to suit aging in place, there are certain design principles that should be kept in mind, in order to permit the elders of your multi-generational home to stay at home for as long as possible.
Ideally, there should be a room on the main floor can serve a number of purposes as a family grows through stages, like a nanny suite, home office or in-law suite as family members age. Also on the main floor, are there enough washroom facilities available, or could you create them easily enough?
Consider movement through connected rooms and within the space itself. Seniors need to be able to move freely without obstruction. Navigating many walls or might present challenges. Clear the path for them - literally! This may mean designing the home for open concept living as much as possible.
Hallways and doorways need to be extra wide to allow for walkers, wheelchairs or scooters to pass through easily. It’s even helpful to have extra wide doorways if you are walking side by side with your senior, offering them a hand to get from point A to point B. Make sure that doorway transitions are level.
Washrooms are notoriously dangerous for seniors. You need to have the capacity to install grab bars for the shower and toilet. Showers should be 'walk-in' with a removable wand thta makes it easier to bathe in a shower chair. (Bathtubs are not a good idea.) Also ensure the washroom is configured in such a way that a senior could manoeuver around easily with a walker or cane while in the space. Ideally, having access to an ensuite will minimize steps.
In the kitchen, an efficient space and intelligent layout is key. Ensure there is enough room to move between an island and cabinetry, say. A triangle configuration with the sink within easy reach is ideal as well. Slide-out drawers within cabinetry are easier to access. Levers instead of knobs are easier to pull. If you can incorporate a seat in the kitchen for prep, even better.
Indirect lighting is preferable, as it reduces shadows - which can increase trip hazards. Similarly, flat, smooth flooring choices are preferable, like cork or linoleum. These materials are more ergonomic and less likely to cause tripping, like carpet does.
For design tips to facilitate aging in place, check out these two posts: "Multigen Homes Need Space for Aging in Place" and "Everything You Should Know About Designing a Home for Aging In Place".
It’s worth noting that, creating multi-generational homes allows families to care for each other, but the living arrangements won’t necessarily block transmission of highly contagious diseases like COVID-19. For example, in Italy, where multi-generational housing is common and LTC facilities are much fewer, the senior population was hit devastatingly hard in past months, even though many seniors were being cared for at home.
In Italy, it is common for the younger generations to be living at home with parents and grandparents in rural areas, but commuting into urban locales for work, which extended the geographical reach and speed of the spread of the virus as it travelled to the countryside when people returned home from work.
This article, "Multi-Generational Households Face Unique Challenges In Battling Spread Of Coronavirus" shows how Canadian multi-generational households acknowledged that extra precautions needed be taken - within their own walls to protect the elderly members of their families. That means keeping social distancing at home, keeping bathrooms separate, changing clothes and showering every time someone goes out and comes home and other measures.
Physical environment can help, but the way in which homeowners use their built environment will really make the difference. The good news is that, from the experience of this pandemic, families that need to can change their approach to home ownership proactively and preventatively.
Building Smarter, Kinder Institutional Spaces
Even if we do gravitate towards multi-generational housing and aging in place, there will still exist a need for care institutions for the elderly. Status quo around our concept of these built environments will have to change though, particularly as physical design has been a major culprit in COVID-19 outbreaks.
This article "Open Letter to Policy Makers: Architecture—A Critical Ingredient of Pandemic Medicine" (which looks mostly at industrial care buildings, most notably hospitals), says that the “built environment is a critical part of pandemic solutions and emergency preparedness”. This has good information as well "Planning In An Era Of COVID-19 And High Density Living".
This Calgary designer "Her Brother Spent 20 Years In A Care Home, Now She’s Determined To Change The System talks about the success in designing smaller care spaces for those who require hands-on help. She called out design flaws in existing homes like narrow hallways and overcrowded common areas. Frequently, designs - mostly from the 1960s and 1970s - are outdated with an eye towards profitable use of space over quality of care. The design also does little to stop the spread of disease.
For hospitals and long term care facilities, that will mean rethinking mechanical systems, common areas, room layouts and medical access. It may mean that with new construction, facilities will need to be smaller in order to limit outbreaks of COVID-19 or other diseases.
Are you considering housing that could help multiple generations of your family today, tomorrow, and in the foreseeable future?
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