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A downtown Toronto long-term care home is rebuilding with a new design that considers lessons learned from the COVID-19 pandemic, going beyond the province’s standards — but some say those standards are out of date.
Right down to the placement of garbage cans, the new design of the Rekai Centre’s Cherry Place aims to prevent the spread of viruses and prioritize residents’ emotional and social needs, according to the centre’s CEO, Sue Graham-Nutter.
“We never wanted our residents to go through this ever again,” she said.
Traditional long-term care homes saw over three times as many COVID-19 deaths and twice as many cases in 2020 than small care homes, according to data from a 2025 study by the National Institute on Aging (NIA).
Many of the planned updates at the 13-storey facility on Cherry Street were brainstormed during the pandemic as shortfalls were brought to light, said Graham-Nutter.
“I would go into the stairwell, in my full PPE, and I would text [the architect] with, ‘We need to think about this, we need to think about that,’ because I didn’t want to forget the minor details,” she said.
The redesigned facility will have infection control zones with sealed doors, improved oxygen access and 348 beds.
Ontario requires facilities to have a maximum of two residents per room and patients must be divided into self-contained cohorts of 32 people maximum, called “resident home areas,” according to the latest Ontario long-term care home design manual from 2015.
The changes made by the Rekai Centre are a good start, according to Dr. Samir Sinha, a geriatrician, clinician scientist and the director of health Policy Research at NIA.
But Ontario’s standards for long-term care homes are falling behind the latest best-practice research, he said.
In Ontario homes, long-term care patients are grouped into ‘resident home areas’ of up to 32 residents but,at Cherry Place, some groups will be half that, according to the project’s architect, Dustin Hooper. (Submitted by the Rekai Centre)
“If you think about palliative care hospices, if you think about group homes for younger people … we often don’t have them living in large institutional settings,” Sinha said. “So why is it that in North America we only do this with frail, older people?”
Sinha said long-term care should be moving towards a “small care homes” model of 10 to 12 people, each with their own private bedroom and bathroom. Larger buildings can be broken up into multiple 12-person households and still follow the model, he said.
Smaller cohorts, more privacy
Some resident home areas at Cherry Place are being built for 14 or 18 beds for a more home-like feel, said project architect Dustin Hooper with the firm Montgomery Sisam.
It will also have suites for families to stay while visiting a loved one and multiple terraces with green spaces sandboxes, according to the project’s architect, said Hooper.
“A really important aspect of long-term care is providing those communal outdoor spaces where residents can gather with other residents, but also with loved ones when they come to visit,” said Hooper.
Individual rooms, like the one depicted in the rendering above, help reduce the spread of infectious diseases, according to report by the National Institute on Aging. The report also says at the beginning of the pandemic, smaller-model care homes saw significantly fewer COVID-19 cases and deaths, compared to traditional care homes. (Submitted by the Rekai Centre)
Residents will each have their own bedroom, Graham-Nutter said, and their own bathroom, where possible, to reduce the spread of disease in the event of an outbreak.
Graham-Nutter said when assigning rooms with shared bathrooms, residents who are able to use the bathroom will be paired with someone who does not have the mobility. “So, in effect, the washroom is private,” she said.
‘Small care homes’ best practice, expert says
A smaller scale model increases residents’ emotional wellbeing and staff retention and better prevents the spread of disease, according to the NIA’s study.
It recommends health care and other services like housekeeping, laundry and cooking be done by a consistent team of people who stick to working in that household community.
“This is not just a nice thing to do, it actually saves lives,” said Sinha. “People in these models are less likely to end up going to hospitals, to emergency departments.”
Sinha said the province should work to provide a better standard of care rather than trying to fit as many people as possible into rooms because of the long wait list. (There’s No Place Like Home report/National Institute on Ageing)
Sinha said care homes in Ontario need more support from the government to make the change.
The province allows facilities to implement smaller-scale models, according to a statement from the Ministry of Long Term Care.
Though not updated, the 2015 design requirement standards make sure the province is “supporting the demands of Ontario’s growing population,” the statement said.
Over 49,000 people were on the wait list for a long-term care bed in Ontario, as of early 2023.
The province is aiming to create or renew 58,000 long-term care beds by 2028 and, so far, 6,700 have been built with another 18,000 in the works.
Cherry Place is expected to open in June 2028, Graham-Nutter said, and the wait list will open in January that year.
