Findings

This research focuses on the design of residential long-term care (RLTC) and the role of the built environment, in terms of creating a balanced approach to COVID-19 infection control and quality of life. The key findings and recommendations set out in this report apply both to the retrofit of existing settings and the design of new-build settings. The research largely shows how well-designed environments create a convergence between good infection control and a higher quality of life, while also contributing to greater resilience for residents and staff. 

To understand the key issues that influence the planning, design, and operation of RLTC settings, and to identify how these shape care models and the physical environment of RLTC, we embarked on a wide-ranging study involving a review of Irish policy, stakeholder engagement, Irish case studies, literature review, and international case studies.  

The policy review has examined key RLTC regulation and national standards, along with more recent findings from the COVID-19 Expert Panel, to inform the overall research. The stakeholder engagement process drew in the experience from a range of Irish RLTC settings while also capturing perspectives and expertise from diverse stakeholders within the sector.  

The literature review distilled peer reviewed expertise and evidence from over 170 documents, while the international case studies illustrate good practice design from several countries to reveal innovations and potential design measures that may be applicable to the Irish context. 

From these studies we have drawn out a set of key findings and recommendations broken down into a number of themes including: 

• Underpinning Issues that refer to: Ageing in Place; Quality of Life; Infection Control; Resident Diversity; and Universal Design. 

• Overarching Design Characteristics, Features, or Approaches such as: Model of Care; Scale and Size; and Mixed-use and Co-Location of settings. 

• Built environment issues across key spatial scales including: Site Location; Site Design; Overall Building Layout and Circulation; Key Internal and External Spaces; Building Elements and Components; Internal Environment; and Assistive Technology and ICT. 

• Planning Policy, Regulation, and Design Guidance that include: Planning Policies; Space standards and minimum floor area requirements; Building Regulations; and present and future design guidance.  

• Barriers, Challenges and Opportunities including: Barriers such as funding models or policy fragmentation; and Challenges such as ageism, and climate change. The key Opportunities refer to a growing appetite for design innovation, key international initiatives, and future standards, evolving government policy, and the emerging appreciation of co-creation with older people. 

While the report provides specific recommendations in relation to all the themes and topics outlined above, there are several issues that are worth reiterating. 

A review of the literature, international and national policy, and key stakeholder feedback emphasises that RLTC is a vital part of our health and social care infrastructure for older people with high levels of care needs, and those who are unable to live independently at home or in supported housing.  

Voice of residents and cocreations: To ensure that RLTC continues to evolve with societal needs, the voice of residents, family members, staff, and health and social care professionals should inform planning and design through co-research and co-creation processes.  

Integration of RLTC with the overall housing spectrum: The development of home supports, the growth of supported housing, and the recognition of RLTC as an integral part of the housing-with-care continuum, means that greater consideration should be given to the integration of RLTC with the overall housing spectrum.  

RLTC and ageing in the community: Ageing in place is more than continuing to live at home in your own house. To a large extent, it is also about continuing to live in your own community. Where appropriate and desired, this can be supported using suitably located and well-designed RLTC settings that are integrated with the community.  

The importance of design: The impact of design and the built environment on long-term residential care is a critical yet under-researched area. This needs further research and should also be factored into future RLTC quality of life surveys through the addition of some basic spatial and built environment related questions in these surveys.  

Understanding resident diversity: RLTC planning, and design should be informed by current and future resident diversity including the spectrum of care needs and level of independence that may be experienced in these settings. This can be achieved through data arising from future assessment processes such as interRAI. This will also support collaboration between healthcare and design professionals in terms of space programming and design brief development.  

Universal Design: This diversity of resident care needs and independence, coupled with the diversity of visiting family members and staff requires a Universal Design approach to create environments for all people regardless of age, size, ability, or disability.   

Design for resilience: COVID-19 has demonstrated the need for greater resilience in the RLTC sector. This experience should be used to design for current and future challenges such as climate change, future pandemics, and other unforeseen events and shocks.   

Convergence between infection control and quality of life: Finally, this research shows that many of the measures that support infection control greatly improve quality of life, some of which include: a more homelike and human-scale setting; maintaining connections and relationships, providing privacy and dignity; enabling greater access to the outdoors and nature, improving air quality, and providing greater inclusion through appropriate technology.