Pandemic shows it's time to rethink shared rooms in Manitoba personal care homes, experts say
As COVID-19 exposes problems in care homes, 'it's obvious now that shared rooms aren't the way forward'
The COVID-19 pandemic is leading to calls for change in personal care homes where residents share a room with one or more other people.
All five of Manitoba's health regions have some personal care homes with multi-bed rooms, according to numbers provided by the province.
There are 9,725 licensed beds across the province, with 736 rooms that are shared by two people, and another 39 rooms shared by three or more residents.
The figures from March 2019 — long before the COVID-19 pandemic — are the most recent available.
The pandemic has raised new concerns about shared rooms in long-term care homes, as Manitobans look at the situation in other provinces. In Quebec and Ontario, thousands of people at seniors' residences or care homes have died from COVID-19 — close to 4,000 in Quebec and nearly 2,000 in Ontario, as of June 7.
WATCH | Rethinking shared rooms in personal care homes:
One of the seven COVID-19-related deaths in Manitoba involved a personal care home resident.
"I think COVID has changed our world.… It's obvious now that shared rooms aren't the way forward," said Jan Legeros, executive director of the Long Term & Continuing Care Association of Manitoba.
"We certainly can't isolate one resident from another using a curtain. So I think the future for long-term care is single rooms."
Legeros notes that a strong case can be made in favour of shared rooms for some residents — for example, if a couple is living together, or for some residents who simply enjoy the company.
The challenge, though, is the cost of making changes. Legeros estimates eliminating shared rooms in long-term care homes across the country would cost billions.
New builds don't have shared rooms
The province of Manitoba says although there's no regulatory requirement to eliminate shared rooms, plans for new builds in Manitoba do not have multi-bed rooms, in keeping with personal care home design guidelines.
"Manitoba's current [personal care home] design guidelines provide for residents to have their own room and bathroom. All new PCHs plans have been developed and built to support single-bed rooms," the province said in an email.
The Winnipeg Regional Health Authority, meanwhile, looks "for any opportunities as program changes/enhancements occur, or when renovations occur at PCHs, to decrease the number of multi-bedded or double-occupancy spaces," said spokesperson Paul Turenne.
One example is the Holy Family Home in Winnipeg, which completed a major renovation in 2019. CEO Jean Piché says the expansion did away with shared rooms.
"When we did have shared accommodations, the preference of people being admitted to our facility was to not go into a shared room. They all wanted private accommodations," Piché said.
Although the project was planned years ago, he said during a pandemic or a flu outbreak, having residents in single rooms would be much better if people needed to be in isolation.
Dr. Nathan Stall, an Ontario geriatrician at Sinai Health System in Toronto, said shared rooms are "not great from an infection control perspective."
"I've certainly seen firsthand how shared rooms can certainly lead to widespread transmission of COVID-19," said Stall, who has been involved with caring for older adults affected by a severe COVID-19 outbreak.
Single-bed rooms allow for distancing and isolation if people have been exposed to an illness, he said.
He notes that multi-bed rooms also involve shared bathrooms.
"So certainly there are multiple contact points where if you have a pathogen like COVID-19 introduced into the homes, this can promote faster spread of the virus through the home," he said.
"If someone were asking me what to do and someone were designing and building a new home, I'd recommend moving forward with only private rooms."
Some residents 'would love to be roommates'
Bev Dueck makes the case in favour of shared rooms if residents can be paired with a roommate who has a compatible personality.
Her mother, at age 96, has lived at three different personal care homes and has experienced both being in a room by herself and in a shared room.
"She's confined to a bed or a wheelchair, and she can't get up and do things," Dueck said.
"There are some residents that they get to know one another and they would love to be roommates, to become good friends."
She says her mother currently has a roommate with whom she's able to enjoy a friendship and share her love of music.
Dueck says personal care homes should help residents resist contagious illnesses by making sure their health is as good as possible — something she says doesn't always happen.
University of Manitoba associate professor Malcolm Doupe says there are discussions around the world about how to ensure the best medical care for long-term care residents, while also recognizing the facility is their home.
"I don't think it's as simple as saying … 'every bedroom should have one person,'" said Doupe, whose research includes investigating risk factors at nursing homes.
"I think there needs to be a good look at what residents want."
However, he says "we should work towards having as many residents as possible having their own room … a place that they can call their own."
While that comes with "a huge financial impact," it's "a goal to work towards," he said.
In cases where there are multiple people in a room, he says enhanced sanitation is needed.
Doupe says the tragedy in nursing homes in places like Quebec and Ontario has shed light on problems people have been talking about for years.
"We need to have a very serious look at staffing levels," he said. "Do we have enough staff to care for these people adequately?"
People are now coming into care homes later in life than they used to, he said.
"So the complexity of care that's required is continually growing, and we need to ensure that the staff levels grow with that to make sure that the quality of care doesn't change."
The president of the union that represents workers at many personal care homes in Manitoba advocates for private rooms.
"I believe that they all should be private rooms," says CUPE Local 204 president Debbie Boissonneault, who worked in a care home for five years.
She says employees have to be concerned with the level of cleaning required when rooms are shared, including shared bathrooms.
During a pandemic, she adds, staff need to do a lot more cleaning — whether or not the rooms are shared.
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Corrections
- A photo caption initially stated Manitoba design guidelines call for new care homes to be built without single-bed rooms. In fact, the guidelines say new care homes should be built with single-bed rooms.Jun 10, 2020 9:32 AM CT