Long-term care: inside and out

Institutional long-term care (LTC) settings have been acknowledged as environments that detract from older adults’ health and well-being; diminish resident dignity, personal autonomy, and choice; and result in loss of personhood. However, the neighborhood surrounding a LTC residence can also influence the health and well-being of older adults and their caregivers and therefore requires consideration. To explore perceptions of the neighbourhood context of two institutional settings located in a downtown urban setting, we collected and thematically analysed in-depth interviews from 21 older residents, 22 of their family members, and 32 care staff. Participants reported both positive and negative features of the urban neighbourhood setting. On the one hand, the neighbourhood was described as noisy, dirty, and rough, with the presence of drug use; on the other, the LTC residences benefited from close proximity to cafes and restaurants. Participants suggested that the downsides to being located in the downtown core have negative implications for residents’ independence and safety. For instance, the ability of staff and family members to walk with the residents around the neighbourhood is limited by safety concerns. Instead, resident activities are largely confined to the indoor spaces of the LTC residence. The lack of mobility of LTC residents to areas outside has implications for both city planning and public health, which will be discussed in this presentation. In order to optimize the experience of living in a LTC setting, and thus improving the health and well-being of residents, both indoor and outdoor spaces need to be considered.