How Spaces and Routines Shape Long-Term Care
To change how care is provided in our complex health care systems, we must first understand the underlying systems and routines that make certain ways of working seem necessary, inevitable, or even invisible. Work in long-term care (and anywhere else!) happens through a structured web of objects, routines, institutional and accreditation requirements, and social norms that determine what is possible and what is not. I am committed to identifying and analyzing these hidden structures—because it is often in the most mundane, everyday details, the ones that seem too obvious to question, that the deeper workings of a system reveal themselves.
One way to see these hidden structures in action is by looking closely at the spaces where care happens and the routines that unfold within them. The nurses’ room, for example, is more than just a functional workspace—it actively shapes how care is organized, communicated, and prioritized.
Far from being a neutral space, this kind of everyday infrastructure structure prefigures certain activities while limiting others. It creates the conditions under which work unfolds. In the case of the nurses’ room, its setup—both physical and institutional—determines how care work is organized and prioritized. The objects and the routines embedded in each practice arrangement reflects institutional values and priorities. This post will take you along to what the rhythm of a LTC floor is like.
Within the Long-Term care facility (LTCF) many tasks are enacted in a time-anchored matter. While residents live in the LTCF 24 hours a day, the staff comes in and out, marked by 8- or 12-hour shifts. The nursing shift is between 7:00 and 15:00, while Licensed practical Nurses (LPN’s) are present during all shifts. Residents spend 168 hrs a week (7x24 hours, or all of their time) in the LTCF, while LPNs and nurses upwards of 40 hours and physicians approximately 3 to 4 hours (per floor). Both resident and staff activities are tethered to the institutional routines (or calendaring 24 hours in a day). Eating, too, is time specific (breakfast, lunch, dinner), and a substantial amount, but not all, of the distribution of medications is routinized around meal times, in the dining space or sometimes in the residents’ room. Time specific medications are provided around their earmarked times and PRNs as needed.
Even though all people in this institution have significant medical needs, the preferred term is ‘resident’ not patient. They are called residents because they live in a 24 hours-a-day medicalized home. For nearly all, this institution will be their final home. It is generally accepted that these days residents coming into LTC are ‘older and sicker’. One of government’s goals is to keep ailing people in their own homes longer.
All floors in the LTCF have very similar design and spatial characteristics. Most floors have up to 33 residents with beds in single, double and triple rooms. These rooms are located on the outer edges of the building with various views of the city or the harbour. There are small nooks for doing puzzles or other leisure activities. I notice modest attempts at trying to make it more home-like with plants and art or posters on the wall.
Several central hubs are embedded on each floor and these include the dining room and kitchen area, a TV space or room, a large bathing room, storage spaces, and the nurses’ room. The hallways are wide and the equipment in them, such as wheel chairs, mobile floor lifts, and walkers, reveal something about the fragility and dependency of the residents who live here 24/7.
In upcoming posts, I will explore how work unfolds within these structured spaces. Next, I’ll take a closer look at the nurses’ room—an often-overlooked space that plays a central role in shaping care.