Designing Health Care Facilities to Help Address Climate Resilience and Improve Long-Term Care

From preventative care and treatment to emergency care, health care facilities (HCF) play an important role in every community. To fulfill this role and support the needs of communities they serve, HCFs must be designed and built to operate efficiently and create a safe, secure, accessible, and inclusive space for patients, staff, and visitors. Further, HCFs need to respond to the evolving societal challenges, including sustainability, climate change, and increased digitalization and adoption of new technologies.

The standard CSA Z8000, Canadian health care facilities, has been providing evidence-based guidance to support the key objectives of HCF design for more than ten years. The new edition of the standard, expected to be published in late 2024, aims to build on its legacy as a foundational element of HCF design in Canada. The updated guidance for HSF design will help lead the health care sector toward sustainability and climate resilience and contribute to better health outcomes and the well-being of patients and health care workers.

Challenging accepted design practices for better health outcomes

Rising hospital-acquired infection rates and the SARS crises of the early 2000s highlighted the need for a nationwide standard that would help improve the safety and well-being of patients and staff across Canada. When CSA Z8000 was first published in 2011, the requirements for single patient rooms, one washroom with sink and toilet per patient, and better-designed hand hygiene sinks challenged the accepted design practices at the time. Later research confirmed the positive impact of these changes on clinical outcomes.

The 2018 edition of the standard further updated infection, prevention, and control requirements, brought more focus on person-centred care, especially in infant and pediatric care, and addressed long-term care (LTC) facilities.

The proposed updates in the upcoming 2024 edition reflect not only the recent innovations in health care but also the lessons learned during the COVID-19 pandemic and the increasingly pronounced impacts of climate change on health and well-being in Canadian communities.

Improving the quality of life in long-term care homes through design

The new standard CSA Z8004:22, developed in response to the tragic outcomes of the COVID pandemic in LTC homes, has addressed the need to improve operations and infection prevention and control in these settings. However, many experiences of LTC residents, their families, and staff pointed to the design of LTC homes and how it can support the care environment for residents of varying ages, diverse backgrounds and cultures, and different cognitive and physical abilities.

The design of LTC homes, outlined in the proposed 2024 edition of CSA Z8000, considers programs and the range of services provided by an LTC facility to create an environment suitable to each resident’s individual needs. LTC home design should support residents in living to their full capabilities while incorporating the necessary safety and security features. It should also promote a home-like, residential-style environment rather than an institutional setting, provide privacy, security, comfort, reasonable independence, and maximize opportunities for self-care and socialization. That means, for example, creating spaces where residents can congregate, prepare food together, or enjoy a private dinner with their families.

CSA Z8000 also highlights the importance of natural light, ambiance, and outdoor spaces while providing guidance regarding the design of staff areas and support spaces for services such as food, laundry, and housekeeping functions.

Adapting to climate change requires resilient health care infrastructure

With the increasing frequency and intensity of extreme weather events in our country, the impacts of climate change on the health of Canadians are intensifying as well. Chronic stressors, such as warming temperatures, and acute shocks, including heat waves, wildfires, smoke, or severe storms, challenge health care service delivery, damage health care infrastructure, impact energy systems, and interrupt supply chains.

In order to provide continuous service to the population during and after extreme weather events, it is essential that Canada’s HCFs and their infrastructure are climate-resilient. The new edition of CSA Z8000 aims to address the importance of integrating climate change resilience in the planning, design, construction, and operation of HCFs. The updates include requirements for developing and implementing a Climate Resilience Plan, including assessing climate change-related hazards and risks during the planning stages of an HCF project. This assessment should lead to embedding climate-resilience measures and strategies, such as using heat pumps, integrating renewable energy sources and microgrids, or contingency planning for extreme weather and supply shortages, to name a few, in the design and operation of HCFs.

Reducing environmental impacts of health care facilities

According to research, the health care sector is responsible for approximately 4.6%

of Canada’s greenhouse gas (GHG) emissions. Reducing the environmental impacts of HCFs requires them to become more efficient and lower their embodied and operational GHGs with the ultimate goal of achieving net zero lifetime emissions. Applying sustainability principles, including responsible use of water, energy, and other resources, and business continuity and adaptive capacity can help ensure that an HCF is integrated into the surrounding community and has a positive environmental impact.

The new edition of CSA Z8000 provides guidance on developing a structured, performance-based sustainability program for HCFs, outlining the elements that integrate health care, energy efficiency, and climate change policies and actions in a holistic and coherent manner.

Balancing design approaches with practical realities of Northern, small, and remote communities

The 2024 edition of CSA Z8000 also acknowledges the realities of providing health care services in northern, small, and remote HCFs. Logistical challenges, including the harsh climate, building on permafrost, and access to material, may make it difficult and expensive to comply with some of the requirements of CSA standards. To address these challenges, an ethical design framework should be used in engaging the community to understand better how the HCF can best serve the community and asses if modifications or adaptations of CSA Z8000 are necessary to accommodate the unique community needs in addition to the geographic, climatic, and environmental conditions.

Developing health care facilities for future needs

When published later this year, CSA Z8000:24 is expected to bring many more updates reflecting advances in science, technology, and society. These updates include requirements for infection prevention and control, updates to medical device reprocessing and medical laboratories, and architectural requirements to accommodate newer building designs, technologies, and construction practices while also underscoring the need for resilient, adaptive, and sustainable HCF.

Behind the enormous task of updating the standard are more than 100 experts – volunteer CSA Group members who dedicate their time and knowledge to creating a document that can help make Canadian health care facilities safer, more resilient, and capable of adapting to the future needs of Canadians.

To learn more about CSA Z8000 and other CSA Group standards and research that address health care facilities and the complex systems and processes within them, visit CSA Group’s website.