Before Allan Dugas moved into long-term care, he feared heB次元官网网址檇 be forced to share a bedroom in an impersonal, institutional building, where a regimented schedule would dictate when he ate and what time a staff member would B次元官网网址渂arge inB次元官网网址� to get him out of bed early every morning.

So after he was hospitalized for a fall, he chose to be discharged to a facility that health-care workers told him theyB次元官网网址檇 be comfortable placing their own parents B次元官网网址� a B次元官网网址渟mall care homeB次元官网网址� in Digby, N.S., made up of 10 houses, each with nine residents and a small group of designated staff.

Dugas called the last four years of his life at Tideview Terrace B次元官网网址渨onderful.B次元官网网址�

He has his own bedroom and bathroom, and the freedom to get up and go to bed when he wants. He even has a drum set in his bedroom, where his only roommate is his cat, Jones.

Dugas shares a kitchen and living room with eight other housemates, and said B次元官网网址漷hereB次元官网网址檚 a lot of laughter here.B次元官网网址�

B次元官网网址淟ife isnB次元官网网址檛 over, itB次元官网网址檚 just a different chapter,B次元官网网址� said 59-year-old Dugas.

B次元官网网址滻tB次元官网网址檚 about respect and autonomy and making this our home.B次元官网网址�

Dugas was born with spina bifida that weakened him as he got older to the point he needed full-time care. HeB次元官网网址檚 the youngest resident of the home and estimates the majority are between 65 and 95 years of age.

Tideview Terrace is a complex divided into interconnected but separate houses but the small care home model can be applied in different ways, ranging from single houses integrated into residential neighbourhoods to larger buildings, where a floor might be designated a single B次元官网网址渉ouseholdB次元官网网址� for several residents.

However theyB次元官网网址檙e designed, their hallmark is having just 10 to 12 residents per household and a more comfortable home-like environment, instead of the more commonly seen hospital-like institutions.

Each resident in a small care home has their own bedroom and bathroom, and their household group shares a kitchen and living area.

In a report released last week, the National Institute on Ageing called on all levels of government to make small care homes the standard across Canada, pointing to a survey it did in 2021 that found nearly all respondents said theyB次元官网网址檇 B次元官网网址渄o everything they couldB次元官网网址� to avoid living in an LTC home.

Co-author Dr. Samir Sinha said that since itB次元官网网址檚 not realistic for all seniors to remain in their own homes, the next best thing would be better quality long-term care in home-like settings B次元官网网址� especially since the majority of residents are likely to have some form of cognitive impairment.

B次元官网网址淲hen you start thinking about whatB次元官网网址檚 ideal for a person living with dementia, itB次元官网网址檚 not living on a unit with 32 other people and staff B次元官网网址� a whole bunch of different faces all the time,B次元官网网址� said Sinha, a geriatric specialist at Sinai Health in Toronto and the NIAB次元官网网址檚 director of health policy research.

Small care homes in Europe, the United States, and the handful that exist in Canada report more one-on-one care for residents, as well as greater staff satisfaction that leads to less employee turnover, the report said.

The U.K. and Europe have largely shifted to developing small care homes, while B次元官网网址淣orth America has emerged as an outlierB次元官网网址� in its preference for B次元官网网址渓arge institutional care settings that resemble lower acuity hospitals rather than home-like settings,B次元官网网址� it said.

In small care homes, each resident largely follows their own daily sleep schedule and has flexibility around meals and activities, in contrast with traditional B次元官网网址渢ask-orientedB次元官网网址� homes that seek efficiencies through regimented wake and sleep times and mass meals delivered in large dining rooms, Sinha said.

In addition, each household has a small, dedicated staff of personal support workers and other front-line workers, providing consistency and more personal care based on knowing each residentB次元官网网址檚 likes, dislikes and habits.

Everyday tasks such as cooking and cleaning in smaller settings are often split between staff members and can serve as opportunities for more interaction with residents, Sinha said. For example, residents can help prepare meals if theyB次元官网网址檙e willing and able.

More specialized staff B次元官网网址� including registered nurses, physiotherapists and dietitians B次元官网网址� are shared by all the households.

The National Institute on AgeingB次元官网网址檚 report said more research is required to determine if small care homes are actually more cost-effective than traditional long-term care homes, but said B次元官网网址渢he initial studies are promising.B次元官网网址�

Debra Boudreau, Tideview TerraceB次元官网网址檚 administrator, said thatB次元官网网址檚 been the case at her facility, which transformed into a small care home from a traditional institution in 2011, a few years after Nova Scotia became the first province in Canada to incorporate small care home design.

Boudreau, who has worked there for almost 20 years, said the small care home structure doesnB次元官网网址檛 cost any more to build and run than other public long-term care facilities in the province, since all homes are allocated the same funding per resident B次元官网网址� itB次元官网网址檚 just used differently.

B次元官网网址淲e had a certain footprint that we needed to work within in order to meet the design guidelines, and so we really maximized as much resident space as we could,B次元官网网址� Boudreau said.

That meant allocating less space to administration offices and more to living space.

B次元官网网址淵es, we work here, but the primary purpose of the facility is to be a residentB次元官网网址檚 home,B次元官网网址� she said.

The small care home model also excels at infection control, which became very clear during the COVID-19 pandemic, Boudreau said.

While the virus tore through many long-term care homes and killed thousands across Canada, Tideview Terrace was largely spared because B次元官网网址渨e could close a house, isolate everybody, keep consistent staffing,B次元官网网址� she said.

The home didnB次元官网网址檛 have a COVID outbreak until two years after the pandemic began and ultimately had three deaths.

In addition to Nova Scotia, six other Canadian jurisdictions B次元官网网址� Alberta, Manitoba, Prince Edward Island, Quebec, the Northwest Territories and Nunavut B次元官网网址� have supported the B次元官网网址渕ass developmentB次元官网网址� of small care homes, the National Institute on Ageing report said. Other jurisdictions have made varying commitments to the model.

Ontario is the only province where B次元官网网址渘o current initiatives have been identified supporting the development of small care homes,B次元官网网址� the report said.

The provinceB次元官网网址檚 ministry of long-term care said in an email that it B次元官网网址減rovides flexibility to operators to propose smaller scale projects as there is no minimum bed requirement for a new or redeveloped long-term care home in Ontario.B次元官网网址�

B次元官网网址淥ntario will continue to encourage construction of projects, while providing operators with the flexibility to meet the needs of their communities, that meets the demands of OntarioB次元官网网址檚 growing population,B次元官网网址� spokesperson Mark Nesbitt said on Friday.

Advocates argue provinces and territories have an obligation to actively prioritize small care homes.

B次元官网网址淪omehow we need to change peopleB次元官网网址檚 mindset on what it means to age when somebody can no longer live (at home),B次元官网网址� Boudreau said.

B次元官网网址淚tB次元官网网址檚 not OK to just keep warehousing people in traditional institutions.B次元官网网址�