We are now more than a year into the pandemic, and an end to this global debacle is coming into greater focus. What are some lessons we have learned from the experience of the pandemic’s impact on older adults and their caregivers, and how do we apply those lessons going forward?
 
Physical distancing, while a necessary feature of infection prevention and control protocols, results in social isolation, loneliness and depression, all of which are either risk factors for dementia or can exacerbate the condition. Ensuring access to healthcare services and sustained social connection for those living with dementia who can no longer be visited or treated in person must always be paramount. In fact, physical distancing measures have necessitated the rapid adoption of remote care technologies, and at Baycrest, we have embraced innovative approaches for the provision of care at an extraordinarily rapid pace. Hastened by the pandemic, clinicians and caregivers have welcomed the expansion of electronic access to care for older adults living in the community as well as within care facilities. These gains must continue as a staple of best practice long after the pandemic comes to an end.
 
 
THE VIRTUAL SOLUTION
One innovative technology-enabled service that emerged as a direct consequence of the pandemic is the Virtual Behavioural Medicine (VBM) program.
 
Persons living with dementia can demonstrate challenging responsive behaviours, such as physical and verbal aggression, agitation, hallucinations and paranoia. Historically, such patients needed to be examined in person or sent from a long-term care facility to a hospital emergency room for evaluation. In the VBM program, such patients are assessed virtually and receive pharmacological and non-pharmacological interventions to address these clinical challenges. This has helped to reduce transfers to acute care hospitals, trimmed wait times for referral to dementia care specialists and enabled effective behavioural support of patients in the setting in which they live. 
 
It is also now commonplace to see more flexible therapy modalities being delivered by different specialties, such as adapting occupational and recreational therapy programs to address isolation through remote video interventions.
 
BUILDINGS OF THE FUTURE
We are beginning to see the benefits of constructing congregate and long-term care homes using “intelligent design” principles. We know, for instance, that a nursing home that consists of all private rooms (like Baycrest) provides a critical advantage in being able to control outbreaks. Managing and caring for older adults with cognitive impairments or dementia in these times has been remarkably challenging — particularly so in facilities that aren’t equipped to separate residents sufficiently to reduce risk of contagion. Dementia patients tend to wander into other peoples’ spaces; and they might not understand what is being done with personal protective equipment. Contemplating these realities in new and retrofitted design will be imperative for optimizing residential care. Long-term care facilities in the future will be designed with larger common spaces, private rooms and more resident access to secure, outdoor areas. They will be equipped with next-generation surface materials for flooring, handrails, walls and furniture that are better able to be treated with stronger disinfectants.
 
INCLUSIVENESS & OUTREACH
We are hopeful that the pandemic has highlighted the need to substantially revise the present-day approach to long-term care. This will include offering more choices for older adults and their families to receive care in the setting they prefer, developing and scaling novel methods to deliver healthcare and other supports by leveraging technology, and equipping congregate care facilities with architectural and related design approaches that better support the safety and well-being of residents and staff. With these measures, we can make important inroads to continue reducing the fears that may otherwise accompany the aging journey.
 
RENEWED HOPE & POSSIBILITIES
In the face of the hardships collectively experienced throughout the pandemic, we have seen the dawn of a new vision for aging care: one that embraces technology and networks of best practices to help us pave the way for better outcomes. Research currently underway in our own Rotman Research Institute will help us to better understand the long-term neurocognitive and psychological effects of COVID-19.
 
As sector leaders, we remain resolute in finding every available path to better aging by helping older adults enjoy a life of purpose, inspiration
and fulfilment.