Small Homes, Big Ideas: Montgomery Sisam’s Small Home Model for Long-Term Care Featured in Canadian Architect

We are at a crossroads when it comes to long-term care design in Canada. As we emerge from the COVID-19 pandemic, where long-term care homes took the brunt of the virus, a critical eye is being cast on our decision-making processes, funding, design, and operations of eldercare facilities. The current legislative and design framework favours larger, leaner buildings, aimed at providing care in the most efficient way possible to the greatest number of people possible using the limited resources at our disposal. This, however, runs contrary to what current research and lived experience has taught us: the smaller the home, the better the care, and the better the quality of life for its residents.

In this feature article for Canadian Architect, Montgomery Sisam advocates for a small home model of long-term care design. This involves limiting the number of residents per Resident Home Area (RHA); decentralizing services and rethinking operations; establishing a strong, home-like social heart in each RHA; and designing the building around the day-to-day life of its residents and staff. This approach, however, is difficult to achieve in our current legislative framework in terms of funding, staffing, and prescribed design standards. The article delves into this current dilemma facing eldercare facility design, what we can do about it, and what the best way forward should be.4

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