Overheating in Ontario’s Long-Term Care Facilities

Senior suffering through a heatwave

Over the summer, Ontario Premier Doug Ford brought the lack of air conditioning in Ontario’s long-term care facilities to the spotlight, calling it unacceptable. Hot summers are not unusual in Ontario. Weeks of heat waves can be very common in July and August. So how did this problem get so out of hand and why are we only talking about it now?

Each year, we hear reports of increasing numbers of heat-related deaths. The elderly are particularly
at risk of problems due to lack of space cooling in homes.

In July, Ford vowed to make air conditioning mandatory in all of the province’s long-term care homes and the government is looking to allocate some funding to support this mandate. New design standards will necessitate that all new and newly renovated facilities must have air conditioning.

“No longer will the seniors and the staff in long-term care homes have to suffer through the summer heat. We will provide them with the dignity and comfort they deserve.”

Prior to Ford’s announcement, the Ontario Long-Term Care Act stated that facilities were not required to be air conditioned.  Only common cooling areas were required to provide respite for residents during hot weather.  While there has been legislation in place to maintain homes at a minimum temperature of 22 C, there was no maximum threshold.  The Canadian Standards Association suggests that resident rooms be maintained between 22 to 24 deg C with relative humidity between 30-60%, but this is only a recommendation.

Cooling rooms can provide respite from the heat but must be accessible to the residents.  Residents confined to bed and those with certain medical conditions require personalized in-bedroom measures. Others with mobility impairments may need to wait for staff availability to be transferred to the space.   And those with dementia or other mental ailments may not even recognize that they are overheating and in need of a trip to the cooling station.  

On top of all of this, COVID-19 made it even more difficult to access the cooling rooms in the heat of the summer. Infection control measures put in place to keep the residents safe had resulted in residents being isolated in their rooms to prevent the virus’s spread. The social distancing measures that were effective in the summer meant that the cooling rooms were not being used to their full capacity. Oftentimes, where no A/C is available, natural ventilation, dehumidifiers, portable fans and window shades, can be used to reduce heat build-up, but in some cases these techniques weren’t utilized.

Although the “Congregate Care” model underlies all our Long Term Care homes, the threat of infection is very real in Congregate Care environments. The spread of infection is challenging to control at the best of times; and a highly contagious virus alerts us to the extent of the risk. Most building air circulation systems are now inadequate to filter out the pathogen.

The lack of air conditioning in our long-term care homes is an urgent matter and needs to be addressed system wide; not only for staff and resident comfort, but to prevent unnecessary heat related deaths in the future.  Unfortunately, introducing air conditioning into older homes will be a challenge. A whole-building retrofit may include new rooftop equipment and ductwork; or a room by room approach. Considerations will include capital cost; age of existing equipment; configuration of the Resident Home Areas; and suitability for ductwork installation. New roof top units would require structural modification to support the equipment and duct work would need to be retrofitted into the rooms.  Alternatively, smaller ductless units could be used, similar to hotels.  Both existing A/C systems and new systems must increase the filtration quality and increase the fresh air quantity, in order to minimize infection spread through indoor air circulation.

Whichever route is taken to provide air conditioning to residents’ rooms, the process needs to start now to ensure our elders are protected against future heat stress!

Image Credit: Portalgreece.gr


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