A NEW STANDARD FOR LONG-TERM CARE

CSA Z8004 addresses shortcomings exposed by pandemic

By Alex Mihailidis

The pandemic taught many hard lessons but few so heartbreaking as the need to improve long-term care (LTC) in Canada. Too many vulnerable people died, became sick or suffered terribly because they were isolated from loved ones. The deficiencies in LTC were known for years; however, COVID-19 laid them bare for all to see. It became clear there was a pressing need for standards to address the challenges facing LTC.

In early 2021, CSA Group and the Health Standards Organization (HSO) were called upon by the Standards Council of Canada to develop two complementary LTC standards. HSO’s standard focuses on the delivery of high-quality LTC services, while CSA Group’s standard focuses on creating safer physical environments.

In December 2022, CSA Z8004, LongTerm Care Home Operations and Infection Prevention and Control, was published after a 21-month development process that involved consultation with those most affected: residents, families, caregivers, staff, academics and owners of LTC facilities.

The standard seeks to address some of the most troubling shortcomings exposed by the pandemic. Facilities were inadequately designed to support residents, not only in stopping and containing infections but in dealing with the consequences of outbreaks, too. Residents suffered from social isolation during lockdowns. There were gaps in care due to short staffing as well as gaps in procedures, leaving frontline workers with insufficient knowledge of how to provide care while also preventing the spread of COVID-19.

CSA Z8004 covers many aspects of LTC. Yes, there are sections on the most obvious areas, such as the physical plans, along with heating and ventilation. And there are procedures for hand-washing and other types of cleaning to prevent the spread of infection. But the standard goes deeper and wider.

What separates Z8004 from standards for other healthcare facilities is the recognition that LTC facilities are people’s homes — often their final homes. These facilities must not be viewed the same as hospitals. People live there and the design should reflect this reality. The atmosphere must be home-like, not institutional. The standard sets out design parameters to facilitate the containment of infection and how residents can be safely isolated to protect others. But those isolation areas must retain elements of comfort and home, with a way of safely facilitating contact with loved ones.

The standard also addresses technological advancements and the need to leverage currently available technology, such as tablets, to facilitate social interaction, while reaching for the vast potential of future innovations, including robotics and arti- ficial intelligence. Nothing can replace human interaction but technology can do much to ease the burdens on overworked staff.

Cultural issues were explored, too. In consulting with Indigenous people, for example, the deep significance surrounding the preparation of food and sharing meals was revealed. Facility operators and caregiving staff should be sensitive to these kinds of concerns.

In developing the standard, there was awareness of the challenges and limitations facing facility operators. It is one thing to incorporate the latest best practices in a new building; it is quite another to retrofit a facility that is 20 to 30 years old. Rural facilities often have different issues than those in an urban setting. While CSA Z8004 is the standard to which all should aspire, older buildings cannot be expected to adopt everything.

While the standard is now available, the work is not over. The larger task at hand is adoption and implementation. CSA Group intends to work with operators, community groups and all levels of government to help them understand the standard and put it into practice. There is already a substantial amount of formal outreach underway, with a series of workshops and training programs.

After the tragedies of the pandemic, there is an extraordinary opportunity to improve the care of Canada’s most vulnerable citizens, while making an investment in everyone’s future well-being. CSA Z8004 can play an important role. Now is the time to seize the moment and work together to make a difference.