Creating a home in long-term care: a conversation with architects Neda Basharat and Tony Ross

How does architectural design impact the quality of life for residents in long-term care? And how does design influence a palliative approach to care? We spoke with two architects at Montgomery Sisam Architects who have a particular passion for thoughtful design in long-term care.

Neda Basharat has been focused on creating home-like environments for seniors within the long-term care sector for over a decade. Her recent work explores innovative models in long-term care, which supports and promotes autonomy for residents, as well as prioritizing both improved resident quality of life and staff wellness.

For almost two decades, Tony Ross has been focused on projects that create a home and provide care for the elderly. A large portion of this work has been supporting innovation in long-term care, working and learning with others to create buildings that pursue normal and the highest quality of life for residents. 

Learn more about their work: https://www.montgomerysisam.com/

Learn more about the Strengthening a Palliative Approach to Long-Term Care project at: https://spaltc.ca/

Transcript

SPEAKER_00 0:00

Welcome to the Strengthening a Palliative Approach in Long-Term Care Alliance podcast, exploring challenges and best practices and palliative care approaches for individuals in long-term care.

SPEAKER_02 0:15

Today on the podcast, we're speaking with two principals from Montgomery Sasson Architects in Toronto, who are creating spaces for our elder population and our innovators in long-term care design to improve resident quality of life. Netta Charlotte has been focused on creating home-like environments for seniors within the long-term care sector for over a decade. Her recent work explores innovative models in long-term care, which supports and promotes autonomy for residents, as well as prioritizing both improved resident quality of life and staff wellness. For almost two decades, Tommy Ross has been focused on projects that create a home and provide care for the elderly. A large portion of this work has been supporting innovation in long-term care, working and learning with others to create buildings that pursue normal and the highest quality of life for residents. Welcome to the podcast. Thanks very much, Missie. Thanks for having us. I would really like to begin by having you both tell me a little bit about your background and how you came to focus on the long-term care sector. And Neta, I guess I'll start with you.

SPEAKER_03 1:25

So architecturally, I've always been interested in institutional work, giving back to the public, that type of thing, working on schools, higher education, shelter work, but a big chunk of my personal portfolio is long-term care. We're finding that our clients and our interest as well is looking at what's a better way of designing these buildings to create to create kind of smaller groupings, more innovative models. So my recent focus has been exploring that smaller scale living that's a bit more humane and feels like your actual home rather than your living in an institution.

SPEAKER_02 2:09

And Tony, what about you? Tell me a bit about your journey.

SPEAKER_01 2:12

Thanks, Nancy. Um there's like three for me, there's like three formative kind of pieces that brought me here and to this sort of area of where I watched as my grandmother was diagnosed a long time ago with dementia when I was very young, my kind of formative years. And eventually she needed full-time care. And I remember watching the process of that take place. And I think it sort of ingrained in my mind the change in the needs of a person as they age and as they experience different things. I do remember the home where she she received care, and I remember being impressed because it it was an innovative building that allowed my grandfather to co-locate with her. The second thing, of course, I went to architecture school as part as part of my studies there. I did a thesis. And the thesis was focused on providing support and accommodation for the vulnerable and the elderly in a kind of urban project setting. And I think the third thing was, of course, the opportunity to come and work for Montgomery-sized Marchitex because I think this is a place that had a history and a legacy of doing work that has amazing social value. And the firm had a history, you know, going back all the way to the founding principles of promoting innovation and doing better in long-term care. We've been really lucky to be part of that.

SPEAKER_02 3:30

That's great. And I think sometimes people think of architects as being, you know, these people come up with wild designs and maybe not efficient, but they look really cool. I don't think you could do that in long-term care. I wonder if you can speak a little bit to the impact on the quality of life in general that architecture and design has.

SPEAKER_03 3:50

Architecture is extremely impactful, of course, especially when you talk about something like long-term care. In Canada, at least, this population, they spend 80% of their time in one kind of zone building. And so things like views to the outdoors, daylight, making sure that there's enough space, but it doesn't feel, you know, vast and institutional, like it feels comfortable. There's places of interest, there's places for socialization, but there's places to sort of get away from other people as well that are really impactful to one's psychology.

SPEAKER_01 4:28

And I think architecture has the ability to influence the successful outcome of all those things. And the idea of promote purpose and promote a sense of normal and familiar. We like to think that those choices can reduce agitation, make a place that's compassionate. We're starting to understand that it's really in the details. So there's a whole set of architectural moves that are big, that are kind of around the placement of spaces and the adjacency of spaces. And there's the sort of big moves and there's the sort of architectural pieces. But then there's also the sort of all the details that go with that. And I think we're learning through exploration that the details at those finer points about what comes the closest to a resident are the things that are most impactful. You know, how do we create personalization? How do we promote purpose and normal and familiar? It all happens at a very detailed level, very close to the resident. Yeah, architecture. Architecture, sometimes you think about it as these sort of big gestures and, you know, wild creatives and whatnot. It's like it's actually a much more intimate kind of process than that.

SPEAKER_03 5:29

Everyone, you know, as architects, every one of our clients has a different kind of goals or set of goals for their projects and motivations. We we're we're privileged to work with a lot of clients and operators who are innovative and they really care a lot about the residents in their building and they want to start creating spaces that are more non-traditional, have a lot of life in them. So a lot of what we do is we kind of go in with no expectations. Like there are requirements that the ministries we work with have that of course we're gonna have to meet, but we go with open eyes and sort of help the client interpret what they need. Some homes have some cultural components, like a large indigenous population. They have they have different aspects to them that influence our design. And we're sort of right sizing or creating these spaces that are very unique. And we learn a lot through that experience.

SPEAKER_01 6:28

I think that the process of making architecture is sometimes not what you'd expect. I think there's a whole piece out in front of you know what you see in the movies where really we're just listening, we're we're having these hundreds of conversations, listening to people and trying to establish some fundamental principles and priorities, really understanding the goals. After you've spent all that time immersing in that conversation, you start to come out of that with a determination of the functional needs and the preferences of different groups. And we never come into that with a preconceived idea of what it is. I mean, and even the process of exploring design options is you know sometimes not what you would think. I think it's often that we're sharing things that we've seen, we're sharing experiences from others, and it's really our clients who are making design choices and we're simply facilitating those conversations. And then there's the technical solution and all of the technical resolution that comes after that. But for us, that front-end process is really essential to get the right sort of custom solution to things.

SPEAKER_02 7:33

And I would think another sort of really important component for long-term care would be the clinical requirements. Yes. So, you know, Nata, you mentioned, you know, you're making it a home and that personalization, but at the same time, you need to be able to adapt for wheelchairs and clinical components, right? Yeah, exactly. How do you balance that?

SPEAKER_01 7:53

You know, a lot of our day is spent trying to reconcile the functional and practical needs while supporting and protecting the resident's strongest qualitative experience. There's a way to achieve both and have a building that achieves all of the clinical and operational focus that it needs to, both to beat regulation and to be practical and functional, but never at the compromise of what the resident's experience.

SPEAKER_03 8:20

So outside each resident's room, typically there's a threshold area, and sometimes we'll add a memory box sort of cabinet that's built in that they can put some of their treasured items or photographs so they can identify this as their room. And underneath that, we'll build in a cabinet that stores PPE items, for example, for staff. So it's kind of integrating the two things so they feel seamless.

SPEAKER_01 8:49

It's back to that, it's back to that conversation about the details. So it's this kind of push and pull around the qualitative experience. If those things that Ned is describing are not well considered, they can pull you back in the direction of something that feels not great.

SPEAKER_02 9:05

Yeah, yeah. And we and we've been talking about the resident, but I can imagine part of the design is also around the family that comes to visit and their participation in this environment, right?

SPEAKER_01 9:16

Yeah, absolutely. I love that our clients bring the family experience. It's very common for us in interactions to enjoy the input of family members. And even some of the policies, like in Nova Scotia, the sort of family is an integral part of the design standard.

SPEAKER_03 9:30

I think I think all of our designs, there are spaces for family members, you know, a little like little kitchen area where they can prepare coffee when they come to visit their family member. Common areas within the building, often it's called a main street or a beautiful outdoor space. Um, it is not just about an isolated resident, but it's their wider kind of network outside the home itself as well.

SPEAKER_02 10:01

I wonder if you can tell me a little bit about how design really helps to inform or influence that palliative approach to care and long-term care.

SPEAKER_01 10:11

I I think the ability of the design and the spaces and the architecture to promote a sense of wellness and consideration for the person at the center of the reason that the place exists. I think it's really about a continuation of one's life in the home through the entire stay and about being, you know, careful and considerate and supportive for that whole duration.

SPEAKER_03 10:37

A lot of homes and operators, they integrate for in the instance when the resident is, you know, in the last stages of life, a resident suite. So family can come and really be with their family member at that time. A lot of these residents maybe don't have the ability to be out within the social spaces a lot of the time. So, how can we allow for connection? Interesting. So kind of so kind of thinking outside the box sometimes and putting yourself in these people's shoes is part of it.

SPEAKER_02 11:09

What are some of the new features and things that you've seen that excite you for the future of long-term care design?

SPEAKER_01 11:17

I mean, I think for me, for sure, is a real push toward resident-centered thinking and design and a kind of rebalancing of operations and resident at the center of all things. It's not to say that operations and the clinical focus is not there, but it's really to just try to rebalance the two and have them find this place where all things are met. And I think there's just an awful lot more conversation these days happening around resident-centered thinking, emotion-based thinking and things where the resident is at the center of all conversations. And I think that's exciting. I think tied into that is this whole push around renewed conversation around innovations, innovation and long-term care. And my sense is our clients are continuing to ask us to explore change with them. You know, tied to that, I think is the residential scale and care. We talked about smallness and residential scale and character. As soon as you're thinking about those concepts, you're ultimately leading the project toward a slightly different direction where those attributes become fundamental to the design choices that you make. Or I think our buildings are more community focused and thinking all the time about community partnerships and community coming into long-term care as part of the program in a way that's front of mind for a lot of people delivering new long-term care.

SPEAKER_03 12:40

I mean, I agree, I agree with that, Tony. I think there's also some really interesting sort of practical aspects that we're introducing toward designs as well. In terms of the resident bedroom itself, you know, when you look at older buildings, there used to be multiple people in a room. They would all be sharing one washroom, and people are wanting to move towards more private rooms, or at least everybody having their own washroom, which is great for a sort of dignity privacy perspective, but also for infection prevention and control. Also, I find that clients are thinking about things like mechanical systems, and we're discussing that a lot about resident comfort. You know, is there a draft with this system versus another? A project Tony and I worked on together that's under construction, they put in-floor heating because that's more comfortable and more pleasant. So there's the practical aspects I think that are being pushed on projects as well that are improving quality of life for these residents and staff and the other people in the building on a more practical level as well.

SPEAKER_01 13:48

You mentioned the staff piece. I think that's a really important point. More than more than 10 years ago, our clients are asking us to consider staff in a way that's unprecedented. Our clients are really concerned with staff wellness, staff attraction, staff retention. There's a whole conversation, so many user group interactions where groups are laying out their fundamental principles for a project and they're saying our top fundamental principle is the resident, but a really close second to staff is an acknowledgement of the great care and attention and importance of staff within long-term care as a, you know, ultimately the care of the resident is so directly connected to the staff. And I think there was always staff respite space, but now it's like, let's make a staff wellness center with, you know, physical activity and let's promote all this sort of health and well-being for our staff.

SPEAKER_03 14:42

It's actually introduced some interesting opportunities and synergies. Like childcare is a big concern for staff. So we've hear a lot of our clients, they would like to have a daycare integrated as part of the facility. And that introduces opportunities for programming between the children and the residents. So there's like intergenerational programming, giving these opportunities for a better quality of life and more activation for the residents as well. Oh, that's wonderful.

SPEAKER_01 15:10

Even larger scale conversations, like many clients are thinking about accommodation for staff. Is there a place for staff to come to our community to live? Do I have the ability to, is there transit connected, or is there enough parking that I can drive there in parking? You're almost talking about a completely separate project that's needed to support the infrastructure of the care home and the staff that are needed there to deliver that first primary function. Becomes becomes a big conversation.

SPEAKER_02 15:37

Absolutely. I love hearing that because staff, of course, develop such intimate relationships with residents and long-term care.

SPEAKER_03 16:03

Like the best, the best compliment I've ever gotten from a client. We were standing in the building at the end and she was like, You really understood my vision and you delivered it. Um, and that was the nicest thing. And I was like, Yeah, that's what I like. What Tony mentioned before about architects being the master and having a grand vision and having their own agenda for things? I don't really believe in that. Like for me, it's really about delivering to the user what they need, what they want, maybe interpreting what they need and creating a really lovely space that I'm proud of, but it's not for me. It's for the users.

SPEAKER_02 16:43

And Tony, same question for you. What's a favorite part of your work?

SPEAKER_01 16:47

I enjoy the client interaction a lot. I think we find so much of our inspiration and energy and excitement from our clients. I really enjoy the way that we explore different regional areas, different geography, different cultures through the work, and that the design is a reflection of what we understand through those conversations. But I think the most important thing is the sort of natural progress of our work these days is moving it more into a focus on innovation, research, and a broader discussion around the industry. I think Ned, I think Ned and I, we both we both love the project level of work. But I think there's this wider conversation that comes with just years of marinating and thinking about these things. Um, it starts to evolve into a bigger conversation. And the research piece, speaking at a larger level, talking with talking with different groups, understanding what others are doing, bigger picture, and bringing that back for discussion. You begin to think about the sum of those explorations and how they begin to inform. We learn from our work, and then we put those learnings out for others to understand for the greater benefit and to the improvement of a resident's life.

SPEAKER_02 18:01

Thank you both for speaking with me today. Thank you. It's a great conversation.

SPEAKER_00 18:05

Thanks very much, Nancy. You've been listening to the strengthening a palliative approach in long-term care podcast. For more information about our project, visit spawnltc.ca