Before the pandemic began, Grace Su already knew the senior care industry wasn’t doing enough.
Sitting in Su’s temporary office seems a world away from the early days of March 2020. As the executive director for Trico LivingWell, she is shepherding an army of staff and tradespeople to put the final touches on Trico LivingWell: a new senior living community that is currently under construction on Macleod Trail.
The facility is working towards the WELL v2 certification, which would be a first for any retirement community in Canada.
The certification represents a significant investment in health and wellness—and the exact opposite of the warehousing model that was identified as the source of so suffering throughout the first year-and-a-half of the Covid-19 pandemic.
“Before the pandemic, we already felt like the industry was not doing enough to be honest. There have been challenges that we felt that the industry should address better,” she said.
“But the pandemic highlighted that. And a lot of times before the pandemic people were trying to—I hate to say—that they were looking at efficiency and management, and easiness to manage the situation.”
Trico sums up the value for its residents through the slogan “Build WELL, Live WELL, Age Well.”
Getting certified, and staying certified, means creating and maintaining a building that meets internationally and independently-created wellness standards. From the cleanliness of the air through the use of HEPA and MERV13 filters, low emitting paints, carpets and furniture, to other anti-viral and anti-microbial considerations to keep residents and staff safe.
The WELL v2 health and safety rating is specifically targeted toward a post-Covid world. Operators must meet 15 out of 20 criteria, which includes removing respiratory disease-causing pathogens and pollution, emergency preparedness programs, and health entry requirements.
It also means meeting standards that provide for the general well being of building occupants, including staff and residents. Lots of light, including significant natural light, green spaces and plant use, thermal comfort like being cool in the summer and warm in the winter, along with nutritional and mental health.
When the facility is complete and opened in August of this year, it will have 249 units: 121 for independent living, 104 for assisted living, and 24 for dementia care. They are also targeting between 10 to 50 per cent below monthly rates for similar facilities elsewhere in Alberta.
Independent evaluation of the WELLS v2 criteria is expected to take place in October, after residents have begun living in LivingWell.
Safety built into the design
At the forefront of the LivingWelldesign is an understanding of how to keep residents and staff safe from Covid now, and in the future. But as Cathy Lockhart, LivingWell’s clinical lead and a registered nurse, said during a tour of the construction, it isn’t the only disease the team is trying to keep residents safe from.
The facility has independent HVAC systems with MERV13 and HEPA filters to address respiratory diseases. All of the residents apartments have their own industrial-grade HVAC filtration system with a MERV13 filter. Each floor also has 100 per cent fresh air intake, with negative air pressure inside suites versus hallways, thus keeping any infections from spreading to other rooms.
Su likens the design to that of the safety of an infectious disease control unit at a hospital.
“We know Covid is airborne, so how do you of control that? The air handling system has to be very, very sophisticated,” she said.
Altogether, said Su, Trico LivingWell will be circulating all of the air within the building for fresh air within 15 minutes, which puts it above the CDC’s air changes per hour guidelines for patient care areas.
Staff working at the facility will have to prove they have been fully vaccinated.
“We are very strict on that one,” said Su.
“I think it’s so critical for us to support older adults. We know that through science it is going to help them, so we are very persistent on that.”
For patients on the dementia care ward, as part of patient care best practices, which also meet WELL v2 standards, circadian lighting has been installed. Lockhart said that this would help patients affected by sundowning, also known as late-day confusion, avoid becoming restless and agitated, and also improving their health outcomes.
Two outdoor balconies with eight-foot safety glass barriers have also been installed to allow dementia patients year-round access to natural light and outdoor air.
Limiting exposure to disease means letting people live normal lives
Special measures are also being taken to limit the exposure of unvaccinated guests to residents and staff. Fully-vaccinated guests will be able to visit family members throughout the facility, while special areas with their own HVAC system and negative air pressure have been set aside for unvaccinated guests and their families.
Significant attention is also being paid to also ensuring that influenza, norovirus, and other types of bacterial and fungal diseases are prevented. Paint, furniture, carpet, and other building design elements have been selected to be able to be cleaned easily and frequently. This will include the use of electrostatic spray and ultraviolet sanitation.
Numerous hand-washing stations will be provided, including directly at entrances, and UV sanitation stations for smaller items will be placed for staff use on items like phones and keys.
And although residents have to yet to occupy the building, during construction visitors are given sterilized PPE to wear and procedures are in place to re-sterilize them post use. This even included Su’s keys to some of the show suites.
All together—both as a design value and as a corporate value—it allows individuals to be safely isolated from illness, preventing the spread of disease, and allowing those sick to heal faster.
“I think its added safety for our staff and visitors, but also for the residents, knowing that if someone is sick—which from time to time we will have—that we’ll have the ability to isolate the problem, and let and support the rest of the community to live life as normal,” said Su.
Lessons learned from the front lines
Su and Lockhart were both on the front lines as the initial wave of Covid-19 surged into a series of outbreaks across the province at supportive and long-term care facilities.
Lockhart was serving as the director of health and wellness for a supportive living facility, one that included a memory care unit, when it became Calgary’s first Covid-19 outbreak. Su was also serving as the executive director at a different supportive living care facility in Calgary, managing the pressure of trying to help residents live through the pandemic.
“Stress was (at an) all-time high because nobody really knew what was to come. Nobody really knew what to do, including the the professionals because Coronavirus and COVID-19 was still so new,” said Lockhart.
These initial uncertainties were highlighted in a KPMG report commissioned by the Government of Alberta regarding provincial responses, including in care facilities. The report didn’t directly address individual operators performances.
Reconceptualizing seniors care
They both spoke passionately about what it meant to go back to the drawing board, to re-conceptualize how to improve senior care, and then to turn that into reality. What this meant was creating a facility that was resilient—for residents, staff, and the facility operator. A resiliency that would mean that even in the event of a worst-case scenario, that the community would be supported with a design that would allow them to remain in control.
“It’s absolutely critical to maintain a safe environment for the residents, the staff, and the visitors. I think the technologies and the innovation that is going into Trico LivingWell is phenomenal,” said Lockhart.
Lockhart talked about how quickly older adults can become seriously ill, and why even just having fresh air makes a difference in speeding up their recovery. But she also spoke about how important it would be to create a situation where seniors who are ill can still have access to their families.
“The hope is is that their families can then come and visit sooner which is a huge critical piece for people to become well, because I personally have seen the impact that the social isolation from Covid has had on older adults and it’s it’s heartbreaking,” she said.
It would be hard to forget the images from early on in the pandemic when families lined up outside of the windows of long-term care facilities, seeing but not being able to speak to their loved ones.
“We are also thinking about people who were isolated. How do we get the services to them, and get them to be able to communicate with the outside world while they’re isolated,” said Su.
Ensuring patient care, with the right people
This means ensuring residents have the ability to make video calls using their televisions or through iPads. This also means that residents will be able to continue to have face-to-face conversations with staff through a press of a button rather than having to make a phone call.
Tele-health is also going to be integrated directly into patient care. Within long-term care facilities, according to the Canadian Institute for Health Information, Alberta saw on average a six per cent decrease in the number of long-term care patients assessed for health issues during the first year-and-a-half of the pandemic.
The number of physician visits also fell by 12 per cent, with staggering 33 and 25 per cent decreases during April and May of 2020.
LivingWell will have two Registered Nurses on staff, along with a dedicated LPN and HCA health care team. Staff who are assigned to the dementia ward will also not be rotated amongst other areas, ensuring continuity and quality of care.
They have also made a commitment to ensuring the right staff are in place for providing health care, emphatically stating that these professionals would be solely dedicated to treating and caring for residents.
An entirely separate staff would be employed for cleaning and janitorial services, eliminating the overlap seen in some supportive living care and long-term care facilities elsewhere.
What residents will get is the ability to live well
Keeping people healthy ultimately means that emphasis can also be placed on other aspects of creating quality living spaces for seniors.
Su said that they would be employing the World Health Organization’s seven dimensions of wellness. They will have woodworking, a craft space, a movie and presentation theatre, social gathering rooms, and a fitness facility. Significant patio space outside will also be offered for diners and for general enjoyment, along with a large courtyard and park which will also be accessible to Kingsland community members.
Trico LivingWell has also made partnerships with local businesses including a pharmacy, a larger fitness business, and restaurants, along with the Kingsland community association to provide amenities and volunteer opportunities for residents.
“The sky is the limit to support the new older adults in the way to address different kinds of wellness,” said Su.
It is also reflective of the type of people that Trico is targeting to live at LivingWell. Solidly middle class, with professional backgrounds from teaching to engineering to even physicians. Su laughed when she said that already they had interest from a pair of Calgary physicians to move in, after having them consult on the project.
Executive chef food and staff wellness
LivingWell has recruited celebrated Calgary Chef Liana Robberecht, who served as the executive chef for the Petroleum Club and WinSport, to oversee culinary operations. And in a LiveWire Calgary exclusive not yet told to the LivingWell team, Su and Lockhart were able to reveal that Robberecht would also be working to create high quality meals for staff to be provided free of charge in the staff lounge.
This would complement the staff amenities, which include a quiet space to find calm or take a nap to recharge. The emphasis on staff wellbeing, said Su, was likely to ensure that they have less staff turnover, but also that staff actually enjoy the work they do.
“Staff wellness is a fundamental piece of our culture. It speaks so much about our culture, and also what we truly believe is a formula to really have a ‘love your days community.'”
Lockhart said that these were all things that would allow staff to provide the best possible care.
“I believe that when they come here, they’re going to be very excited to work in a place that really, really values them and their time,” she said.
In the end, it’s about providing the best possible experience for their residents. One that, echoing the namesake of their community, allows them to live well.
“We want people to see that life goes on, and goes on really well with purpose in here,” said Su.