Long-term care home HVAC

Long-term care homes house some of the most vulnerable people in Canada: older adults, many with dementia, chronic illness and limited mobility, who live in the building full-time and depend on staff for most of their care. The HVAC system in a long-term care home is part home comfort system, part health care infrastructure.

The COVID-19 pandemic and recent extreme heat events exposed weaknesses in many older homes, including shared rooms without adequate ventilation and buildings without air conditioning. Design expectations and provincial requirements have changed significantly as a result.

Which standards apply

Long-term care homes are regulated provincially, both through building codes and through the provincial ministry responsible for long-term care. Relevant documents include:

• The National Building Code and provincial building codes, which classify most long-term care homes as care occupancies (Group B, Division 3) with specific fire safety and HVAC implications.
• CSA Z8004, Long-term care home operations and infection prevention and control, published in 2022, which addresses operations and infection control in long-term care, including the built environment.
• CSA Z317.2, Special requirements for heating, ventilation, and air-conditioning (HVAC) systems in health care facilities. Its scope covers health care facilities generally, and many provinces and funders apply it, in whole or in part, to long-term care. See hospital HVAC and CSA Z317.2.
• Provincial design manuals, such as Ontario's long-term care home design manual, which set expectations for room configuration, ventilation and environmental conditions for funded homes.
• ASHRAE 62.1 and ASHRAE 170, referenced for ventilation in some jurisdictions and projects.

Requirements differ considerably by province and by funding program. The first step on any project is confirming which documents the ministry, the authority having jurisdiction and the owner require.

Thermal comfort for older adults

Older adults tend to be less able to regulate body temperature, may not feel heat or cold reliably, and may be unable to communicate discomfort. Many residents prefer warmer conditions than typical office occupants, while staff doing physical care work often prefer cooler conditions.

Design considerations include:

• Winter temperatures typically in the range of 22 to 24 C (72 to 75 F) in resident areas, with local control where practical.
• Avoiding drafts, especially from windows and supply diffusers aimed at beds and seating areas.
• Radiant or perimeter heating to counter cold window surfaces.
• Separate zones for resident rooms, dining and activity areas, and staff work areas.

ASHRAE Standard 55 provides the comfort framework, though its models are based largely on healthy adults. See thermal comfort and ASHRAE 55.

Cooling is now essential

Heat is a serious health risk for older adults. Several deadly heat events, including the 2021 western heat dome, highlighted the danger of uncooled buildings. Some provinces now require air conditioning in resident rooms and common areas of long-term care homes, and others have tightened their maximum indoor temperature expectations. Ontario, for example, has set cooling requirements for resident bedrooms in its long-term care regulations. Owners should confirm current provincial requirements.

Retrofitting cooling into older homes is challenging. Common approaches include:

Ventilation and infection control

Residents share dining rooms, lounges and, in older homes, bedrooms. Infectious respiratory diseases such as influenza and COVID-19 spread readily in these settings. HVAC cannot replace infection prevention practices, but it can reduce airborne transmission risk.

Good practices include:

1. Providing outdoor air directly to each resident room rather than relying on corridor transfer air.
2. Exhausting washrooms and soiled utility rooms continuously, keeping them negative to adjacent spaces.
3. Using higher-efficiency filtration, typically MERV 13 or better on central air handlers where the system can accommodate it.
4. Avoiding recirculation of air from resident rooms to other rooms where possible, or filtering it well.
5. Planning for outbreak conditions, such as the ability to increase outdoor air or create temporary negative-pressure zones for an affected wing.

Some homes now include one or more airborne infection isolation rooms. See isolation rooms: negative and positive pressure and airborne infection control in commercial HVAC.

Odour control

Odour is a constant concern in long-term care because of incontinence care and soiled linen. Continuous exhaust from washrooms, tub rooms and soiled utility rooms, balanced so these spaces stay negative, is the main defence. Corridor and resident room air should flow toward these exhaust points, never the other way.

Humidity

Winter air in much of Canada is very dry. Low humidity can contribute to discomfort, dry skin and irritation. Some homes humidify to around 30 to 40 percent RH in winter, but this must be balanced against condensation risk on windows and in the building envelope. In summer, dehumidification keeps resident rooms from feeling clammy and reduces mould risk.

Resilience and emergency power

Residents cannot easily be evacuated, so HVAC resilience matters:

• Emergency power to critical HVAC functions, such as heating circulation pumps, ventilation for key areas and cooling for designated refuge areas. Requirements vary by province and by CSA Z32 for electrical safety and essential electrical systems in health care.
• Freeze protection for coils and piping if heating fails during a winter outage.
• Redundancy in boilers, pumps and cooling equipment so a single failure does not leave residents without heat or cooling.
• Clear manual override procedures for staff.

Maintenance and verification

Long-term care homes often have small maintenance teams. Systems should be simple to operate, with accessible filters and equipment. Regular verification of room pressure relationships, exhaust airflows and outdoor air quantities confirms the system still performs as designed. Building commissioning during new construction or major renovation establishes the baseline.

Key takeaways

• Long-term care homes are regulated provincially, with CSA Z8004, CSA Z317.2 and provincial design manuals often applying.
• Cooling is now considered essential, and several provinces require it in resident areas.
• Older adults need warmer, draft-free conditions with careful zoning.
• Direct outdoor air to rooms, continuous exhaust from soiled spaces and good filtration reduce infection and odour risks.
• Plan for outbreaks, power outages and equipment failure, since residents cannot easily relocate.