Design for aged care WORDS TONE WHEELER
ARCHITECTURE & DESIGN
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PEOPLE
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JUL-SEP 2021
OPPOSITE Photo by Dean Mitchell on iStock.
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The eight-volume final report of the Royal Commission into Aged Care Quality and Safety was handed down in March.
Sadly, it got somewhat lost, being overtaken by the government’s imbroglio over a lack of respect for women and a farrago of issues about sexual assaults. It wasn’t helped by the government refusing to release advanced copies of the report for review before the press conference. Nevertheless, the report is extremely important. It highlights the almost total failure of current aged care, and it lays much of the blame on the Howard government’s decision in 1997 to effectively privatise the sector and leave it to market forces. The report makes 148 recommendations that touch on all aspects of remedies for the current malaise, and two of those are directly targeted at the design of future aged care buildings. One way of summarising the vast amount of research and proposals in the report is contained in changing just two words: no longer nursing homes but now RACF’s or residential aged care facilities; changed because current facilities no longer employ nurses and no longer resemble homes. It is the second of those two words that are parsed in Chapter 6, leading to the two recommendations that concern us here. The commissioners assert the importance
of design: “Where older people live affects their sense of security and their quality of life. Accommodation that is well designed to meet people’s needs can improve their lives and their wellbeing.” They lament that was once a ‘home’ is now an ‘institution’, citing an increase in facilities with 60+ persons from 39% in 2008 to 60% in 2019. They favour smaller facilities that more closely resemble homes: “…good design in residential aged care, particularly for people living with dementia, usually involves smaller, lower-density congregate living arrangements rather than larger, more institutional settings. Smaller, lower-density congregate living arrangements generally promote better quality of life for everyone. Large, noisy institutional environments can worsen the adverse consequences of dementia.” In part 1.3.6, ‘Designing accommodation for Quality of Life’, (p105) they propose that: …the Australian Government should develop and publish a comprehensive set of national aged care design principles and guidelines on accessible and dementia-friendly design for residential aged care. The National Aged Care Design Principles and Guidelines
should permit flexibility in their application in different circumstances. This leads to the later recommendation #45 on design, with a timetable for implementation. They also heard about the restrictive nature of the NCC building codes on innovative design and have suggested that the NCC be re-visited at the highest level to ensure that the new approach is facilitated. Here’s one example, where the NCC defines the class according to the means of escape: “Class 9c… are aged care buildings… defined as residential accommodation for elderly people who… are provided with personal care services and 24-hour staff assistance to evacuate the building in an emergency. Sprinklers yes but no more smoke doors and fire curtains. Further on, the commissioners recommend financial support for this design transformation: “The Australian Government should actively promote and encourage their adoption by approved providers, builders, architects and others. Financial incentives should be paid to providers that demonstrate the adoption of the Design Principles and Guidelines for their residential aged care buildings.” This leads to recommendation 46 on financing.
