Futureproofing: Residential Aged Care Facilities
Health crisis readiness and adaptability in Aged Care facilities through ‘protective’ architectural design
Kalliopi Patros
“The built environment can shape and provide preventative measures through pre-emptive design solutions to provide hospital grade precautions and care in a domesticated environment”
Residential Aged Care - RAC Residential Aged Care Facility/s -RACF
Prophylactic preparedness must be a core design
that architecture is capable to eradicate a pathogen,
objective for residential aged care as a seamlessly
but rather suggesting that a better standard for
integrated building typology. A commitment and
aged care can be achieved to prevent untimely
focus on this preclusive topic is crucial as the
fatalities. As the population increases and natural
global Covid-19 pandemic which hit Victoria’s
declination of immune health with age, protection
RAC sector greatly, has underlined the tremendous
of society’s most vulnerable members is essential.
gaps in its health emergency management and
Legislative bodies must take some responsibility
futureproofing.
to
in ensuring a standard in Victoria. Architects can
how infection containment and prevention of
act as agents in creating the paradigm for the
premature
built
future by implementing a building typology which
environment can shape and provide preventative
fosters programmatic and spatial sequences. Thus,
measures through pre-emptive design solutions
allowing for the most successful living and working
to provide hospital grade precautions and care in
environment for RACF.
This,
death
may
leaving
be
questions
possible.
The
as
a domesticated environment. This is not to assume
2
Historically, the ties between the built environment
spatial openness.3 Architects such as Le Corbusier,
and health go as far back as the mid 1850’s when
Arthur Stephenson, Richard Neutra, Alvar Aalto,
Florence Nightingale became aware that sanitation
Adolf Loo’s and Ignazio Gardella, to name a few,
had a role in preventative deaths on war patients
were influenced by these ideas.
during the 1853-56 Crimean War1
Nightingale
reached The International Congresses of Modern
released her ‘Rose Diagram’ proving that nutrition,
Architecture (CIAM 1928-1959) for discussions
ventilation and shelter were all contributing factors
which implied a necessary re-education of public
to health improvement or deterioration. Toward
opinion around the moral and hygienic significance
the 20th century, many architects were fuelled by
of architecture.4 Undeniably, these theories of the
these links from the rise of tuberculosis, which
past come back as a precedent to follow. The aged
dappled between the concepts of spatial impacts
care system sits in between with the convergence
psychologically and physically on both the urban
of the warm and comforting domesticated home
and domestic scale. Thus, the evolution of some of
and a hospital grade care giving experience.
2
the most experimental schemes and philosophies which made a powerful rhetorical statement about health, linking it to sunlight, physical exercise, and
3
It eventually
FLORENCE NIGHTINGALE ‘ROSE DIAGRAM’ 1859
01 A contribution to the Sanitary History of the British Army During the Late War with Russia. Nightingale highlighted the connections between disease and the built environment . Proving that deaths may have been prevented if the correct measures were in place.
4
CHILDREN’S ROOM - ADOLF LOOS, VILLA MULLER 1930, CZECH REPUBLIC
02 Inclusion of a ‘sick quarters’ for the children of the Muller residence.
5
03 Le Corbusier’s Modernist Villa Savoye, designed to taking health into the home with the inclusion of a hand wash basin at the entrance space. This, establishing a new practice for cleanliness and hygiene in the domestic sphere.
ENTRANCE HALL - LE CORBUSIER, VILLA SAVOYE 1929, FRANCE.
6
PATIENT BALCONY- ALVAR AALTO, PAIMIO SANATORIUM 1933, FINLAND
04 Aalto carefully designed the building to offer patients a more ‘healing’ way of life through connection to nature. The patient rooms included private rooms with basins, addressed furniture requirements and provided a particular connection to the exterior.
7
05 To make this building as un-hospital like as possible, Gardella articulated the program through a psychological behavioural study. This was undertaken to grasp the needs of the patients, visitors, and staff. Gardella concluded that the implementation of natural elements such as solar therapy and natural ventilation were important for healing and health.
EXTERIOR AND INTERNAL VIEW IGNAZIO GARDELLA, ANTITUBERCULAR DISPENSARY 1938, ALESSANDRIA ITALY.
8
EXTERNAL VIEW - RICHARD NEUTRA, LOVELL HEALTH HOUSE 1929, LOS ANGELES CA
06 Neutra’s Modernist Lovell Health House derives from the intent to heal the human body through architectural articulation. The emphasis on nature and solar connection is achieved through the oversized windows which provide views to the surrounding landscape.
9
‘protective design’ an issue of design and policy
Measures must be taken to protect our society’s
one quarter of all Australians will be aged 65 and
most vulnerable members, and this cannot be
over, with the proportion of younger Australians
achieved if the quality in RACF is not drastically
declining.8 According to the Australian Institute of
raised in several areas. The Victorian Planning
Health and Welfare (2019), 41% of residential aged
Provisions for Residential Aged Care Buildings as
care places are managed by for-profit providers.9
per clause 53.175 are only relevant for building
This allows individual facilities to freely self-govern
envelope and neighbourhood planning issues. The
and decide their staffing mix or ratios10 which has
Australian Government Aged Care Quality and
proven to be lacking in the provision of infection
Safety Commission has attempted to provide criteria
control,
in their ‘8 Standards of Care’. Bizarrely, without
communication with families.11
any mention of futureproofing and protection
the architectural spectrum, the NCC has provided
tactics throughout the entire 198pg document.
6
little detail in supplying specific and tailored
These documents pertaining to action and protection
standards for RACF for optimal built environment
were produced after the fact. Furthermore, the RAC
conditions. Generic policies are in place pertaining
sector is highly lucrative with facilities run by
to fire, lighting, HVAC, acoustics and so on with
state governments, not-for profits and for profit
brief mention of minimum standards for self-
organisations.
This intermingled governance and
contained rooms. It is evident this is both an
ownership has resulted in no formal standards of
issue of design and policy. The inconsistencies in
quality and care to ensure RACF are expected to
measures are accentuating the need to provide the
perform appropriately. Australia currently has over
rightful respect and care to appropriately safeguard
3000 aged care providers, and it’s expected this
senior’s welfare.
7
number will substantially grow by 2050, where
10
and
in
effective
and
compassionate Furthermore, on
8 AGED CARE QUALITY STANDARDS
addition: Health emergency, adaptability, and preparedness
07
Australian Government Aged Care Quality and Safety Commission, 2020. 8 Aged Care Quality Standards.
11
“Residents have the right to maintain their dignity, with staff able to perform their duties of care in all settings to provide a seamless level of caretaking.”
The absence of measures can lead to a plethora of
unable to maintain contact with their families
undesired health consequences. RACF are prone to
for weeks or months. This isolation can further
outbreaks such as gastroenteritis and respiratory
deteriorate someone’s already compromised health
illness, with older adults being more at risk
as feeling depressed, feeling lonely or stressed,
of acquiring infections because of close living
can impact and weaken your immune system.14
proximity and frequent contact between residents
In an interview with a health care worker15 of a
and staff.12
Furthermore, 80% of people aged 75
facility hit by Covid-19, June Chiong has stressed
years or above, have two or more diseases13 which
the alarming and unsustainable measures taken
create further complications. Hence, a protective
to maintain viral spread both in the light of the
approach with a goal to ‘separate’ over ‘isolate’
pandemic and past influenza outbreaks. Extreme
should be taken and implemented. This cannot
lengths such as nailing shut doorways with timber,
be successfully achieved if staff and residents do
infected residents moved from their ‘homes’ to a
not have the adequate built environment to do
‘red zone’, strictly no family visitation or window
so. Evidently, RACF were so underprepared for
visits, makeshift staff quarters in dining rooms
a health crisis that drastic, unsustainable, and
and foyers and adoption of unintended entry/
arguably unhealthy measures were put in place to
exit ways for staff. Consequently, futureproofing
‘protect’ building users. These responses resulted
for RACF must spatially provide a seamless and
in immediate isolation and disruption to living
unabrupt delivery of quarantine and separation in
standards and fatalities. Residents restricted, and
the required instances.
12
Traditional framework of aged care planning must
quarantine. By providing these outlines, it should
be rethought for future facilities on a statutory
ensure that even with budget constraints, architects,
and architectural level. Residents have the right to
with their training should be able to solve these
maintain their dignity with staff able to perform
problems and find solutions. This protective design
their duties of care in all settings to provide a
typology is focussed around three key categories:
seamless level of caretaking. Overall, architectures
Spatial, Technology and Regulations which result
role in preventative design will greatly impact
in enhanced wellbeing to provide residents with
the futureproofing
seamless care throughout their lives. Architects
of RACF and
push standards for
should be driving the outcome within the context
body
of the principles. Free plans and with unspecified
must take responsibility in amending the existing
spaces can lead to disorder and confusion for
standards
by
residents suffering from illnesses such as dementia
permanently implementing a legislative package
and dysfunction in an assisted living context.
focussed on futureproofing. This package should
Therefore, a framework is required and under such,
propose a new set of functions offering compulsory
a series of points to be considered.
nationally
to
set
implementation.
of
A
care
a
higher
legislative
to
provide
benchmark Australian
protection
features, without gratuitously overdesigning for
13
spatial + technological + political
wellbeing
Diagram of four aspects in changing aged care facilities in Australia through archtecture.
14
spatial
1.
15
the neighbourhood A new overall building organisation is required to facilitate interconnectedness and protection. The creation of zoning through ‘neighbourhood’ style planning with consideration of corresponding circulation for both indoor and outdoor can provide access and freedom in any situation. This allows for management of smaller groups of residents by physically creating a more controllable environment for staff. Separation can be accomplished without imposing unnecessary restrictions on the entire facility.
‘Neighbourhood’ typology
Traditional ‘inward’ typology
16
healthier staff quarters Staff are also a priority in the buildings function, therefore inclusion of staff spaces beyond a staff room and WC’s is essential. Adaptable areas which can be utilised as staff resting or sleeping areas in the event of an unexpected outbreak is important. Staff are often restricted to work with specific residents to avoid cross contamination.
separation vs isolation A ‘protective’ approach with a focus on engagement and interrelation can be achieved by designing spatial solutions which highlight separation over isolation. This includes zoning different activities such as dining and lounging in a way which is not interlocked. Consideration of smaller, more intimate spaces for social engagement is also a good way for contract tracing but also to allow for various types of social interaction between residents, staff, and guests. This is important for protecting the mental and emotional health of residents in times of crisis.
17
multifunctional impromptu places Practically, a multipurpose provisional back of house space which can be used to host diseased bodies with dignity if no mortuary is able to collect the body should be implemented. Malpractice has been highlighted in the media whereby facilities have resorted to negligent behaviour. By having spaces which enable an array of actions, it will decrease the probability of heartbreaking news headlines such as “Victorian Coronavirus victim was ‘left in aged care home bed for 10 hours after death.”16
Headlines reported on news sites about the Victorian Covid-19 Aged Care crisis. Multifunctional spaces be helpfully used to prevent many outcomes. Click image for animated GIF to play.
18
socially Interactive space For the emotional wellbeing and health of residents and their families, designing adaptable private visitation rooms can be a transformative way to modify the meaning of socialisation in a quarantine situation. Having temporary solutions in place can prevent isolation practices which has negative health eects.
Example of exible spaces/visitors rooms which could be used in creating areas that allow families to visit in the event of a health emergency.
19
technology
2.
20
integrated communication Acclimating for emerging technologies to be implemented into RACF such as intercom systems and accessible video capabilities for residents, sta, and families. This can be achieved by engaging a social worker to assist with providing support for residents unfamiliar with these technologies. In inaccessible situations, maintaining contact will be both supportive and a simple ‘swift’ way to support interaction.
sensor Control Motion control devices should also be considered as a priority when applicable to avert unnecessary germ propagation. This includes sensor technology relating to aspects including but not limited to door/window openings, humidity/temperature, occupancy, air quality, optical (light) and proximity.
21
new materiality New materials which are easy to sterilise and contain properties which are less susceptible to germs is also desirable. This is particularly significant in common areas such as dining, living and staff rooms. Bacteria is prone to grow on surfaces, some living less long on certain surfaces. The Journal of American Architecture has reported on various materials and coatings which can reduce bacteria transmission17, some including copper, antimicrobial coatings such as organsilanes, photocatalytic coatings and superhydrophobic coatings. However, materials are not a substitute to good hygiene practices, but rather an added benefit to safety.
HVAC technologies Appropriate use and application of relevant HVAC technologies such as an Airborne Infection Isolation Room (AAIR) should be considered to reduce risks of unexpected and unprecedented airborne infections. Hospitals use this HVAC system, and in the event of an unexpected occurrence, certain areas of the facility could apply this system for safety.
AAIR HVAC system
Traditional HVAC system
Separate exhausts for contaminated air
Air exhausted through shared ducts
22
legislative
3.
23
To ensure Australian seniors are cared for in the future, a legislative body must take control to provide a standard for RACF. This standard should include spatial requirements as suggested above, technological and material guidance as well as legislative obligations.
legislative package and guidelines Creation of a standardised legislative package for Australian Residential aged Care Facilities is needed to address imperative spatial, technological and health requirements. Execution of respectable medical grade care is essential in some scenarios, therefore a unique speciďŹ cation which unites domestic and clinical practices is necessary. Other medical and health facilities have speciďŹ c and strict guidelines outlined by the SAI Global Australian Standards. Aged care facilities should have a more rigorous outline pertaining to the concurrence of health and home environments.
24
quality control Tailored and speciďŹ c air quality control targets for RACF which should be made mandatory. This is to ensure sustainable measures are implemented to deliver the utmost way of life which starts with Indoor Environmental Quality. Stricter air quality controls for ventilation and indoor air quality is paramount. This means, appropriate HVAC systems tailored to precise ventilation strategies should be applied.
HVAC requirements Air ďŹ ltration with a negative air pressure and speciďŹ c exhausting requirements are needed to protect patients, caregivers, and others in adjacent spaces.18
These rules are
currently only in place for sustainability rating organisations and not an overall National Construction Code (NCC) standard. Furthermore, the criteria outlined in the NCC are not a positive benchmark but rather a minimum standard for achievement. This should be reevaluated to provide improved Indoor Environmental Quality through examples of mixed mode ventilation strategies.
person to space ratio Review of the minimum person to m2 ratio to be increased where applicable to accommodate physical distancing for residents when required.
25
as a result...
wellbeing The points combined form a solution which narrows towards the overall enhancement of human wellbeing in architectural space. Establishing an ‘outward’ focussed architecture for the neighbourhood RAC typology, opposed to a normalised inward experience can enrich living conditions for seniors.
As a final tier, wellbeing is heavily associated with our connection to nature and the external environment. Private outdoor areas are preferable as well as communal spaces directly adjacent to open dining/living rooms for optimal opportunity and use. Forming relationships to nature can dramatically enhance our experiences within the built environment. RACF need to provide these types of opportunities with nature which have had proven benefits in stress, cognitive processes, and mood.19
26
resident
wellbeing
sensory
visual
Positive impacts on heart rate, systolic blood pressure and sympathetic nervous system activity
Lowered blood pressure and heart rate (Brown, Barton & Gladwell, 2013; van den Berg, Hartig, & Staats, 2007; Tsunetsugu & Miyazaki, 2005)
(Li, 2009; Park et al, 2008; Kahn et al., 2008; Beauchamp, et al., 2003; Ulrich et al., 1991)
Improved mental engagement and attentiveness (Biederman & Vessel, 2006)
material
Positive attitude and overall happiness (Barton & Pretty, 2010)
Decreased diastolic blood pressure (Tsunetsugu, Miyazaki & Sato, 2007)
Improved comfort (Tsunetsugu, Miyazaki & Sato 2007)
non-visual water
Reduced systolic blood pressure and stress hormones (Park, Tsunetsugu, Kasetani et al., 2009; Hartig, Evans, Jamner
Stress reduction and increase feeling of tranquility, lower heart rate and blood pressure
et al., 2003; Orsega-Smith, Mowen, Payne et al., 2004; Ulrich,
(Alvarsson, Wiens, & Nilsson, 2010; Pheasant, Fisher, Watts et al.,
Simons, Losito et al., 1991)
2010; Biederman & Vessel, 2006)
Positively impacted on cognitive performance
Improved memory (Alvarsson et al., 2010; Biederman & Vessel, 2006)
(Mehta, Zhu & Cheema, 2012; Ljungberg, Neely, & Lundström, 2004)
Enhanced perception and psychological responsiveness
Improvements in mental health and tranquillity
(Alvarsson et al., 2010; Hunter et al., 2010)
(Li, Kobayashi, Inagaki et al., 2012; Jahncke, et al., 2011; Tsunetsugu, Park, & Miyazaki, 2010; Kim, Ren, & Fielding, 2007;
Positive mood enhancement
Stigsdotter & Grahn, 2003)
(Windhager, 2011; Barton & Pretty, 2010; White, Smith, Humphryes et al., 2010; Karmanov & Hamel, 2008; Biederman & Vessel, 2006; Heerwagen & Orians, 1993; Ruso & Atzwanger, 2003; Ulrich, 1983)
thermal & air
prospect
Improved comfort, wellbeing and productivity
Reduction of stress
(Heerwagen, 2006; Tham & Willem, 2005; Wigö, 2005)
(Grahn & Stigsdotter, 2010)
Improved concentration
Reduction of boredom, irritation and fatigue
(Hartig et al., 2003; Hartig et al., 1991; R. Kaplan & Kaplan, 1989)
(Clearwater & Coss, 1991)
Improved spatial pleasure
Improved comfort and perceived safety
(Parkinson, de Dear & Candido, 2012; Zhang, Arens, Huizenga &
(Herzog & Bryce, 2007; Wang & Taylor, 2006; Petherick, 2000)
Han, 2010; Arens, Zhang & Huizenga, 2006; Zhang, 2003; de Dear & Brager, 2002; Heschong, 1979)
Diagram adopted from the book ‘14 Patterns of Biophilic Design: Improving Health and Well-Being in the Built Environment’ (2014) by William Browning, Catherine Ryan and Joseph Clancy.
27
Overall parti diagram. Examples of 6 building layouts implementing the principles outlined above. Click image for animated GIF to play.
28
With the schisms in ownership, there must be some common denominator in the aged care sector. By providing tailored design standards for RACF which responds to spatial, wellbeing and technological aspects, is way to ensure the uniformity and opportunity for prosperous living nationally. Moreover, architects should be doing their due diligence to design spaces suitably by fulďŹ lling the spatial strategies which respond respectfully to the programmatic systems required for such a building. It is our duty, as spatial leaders to encourage and lay foundations for a new RAC typology. By extrapolating these core principles as a parti, the neighbourhood approach would resolve and improve livelihood. This in succession, will create a less confronting, hasty, and threatening environment for residents amidst unpredictable events in their homes. Designing environments which caters for care and safety, residents will feel safe in their homes, sta will feel protected at work and families will feel assured. The RAC sector must be reimagined as a new neighbourhood. The place residents call home and the spaces in which they reside must provide inherent care to its full potential.
29
endnotes 1. Amy Sherlock “Florence Nightingale’s “Rose” Diagram.” Maharam, published 2020, https://www.maharam.com/stories/sherlock_florence-nightingales-rose-diagram 2. Sherlock, “Florence Nightingale’s “Rose” Diagram. 3. Cameron Logan, “The Modern Hospital as Dream and Machine,” Australia: Fabrications The Journal of the Society of Architectural Historians, no. 1 (June 2009), DOI: 10.1080/10331867.2009.10539646. 4.
Logan, The Modern Hospital as Dream and Machine, 78.
5. 1-8.
Victoria Planning Provisions, “Residential Aged Care Facility – Section 53.17,”
6.
Australian Government, “Quality Standards Guidance and Resources.”
7. Pr. Ralph Hampson, “Dealing with Covid-19 in Aged Care.” Pursuit University of Melbourne, published August 4, 2020. https://pursuit.unimelb.edu.au/articles/ dealing-with-covid-19-in-aged-care. 8. Australian Human Rights Commission. “Face the Facts: Older Australians.”. Human Rights, published February 25, 2015. https://humanrights.gov.au/our-work/ education/face-facts-older-australians#:~:text=By%202050%2C%20around%20one%20 quarter,proportion%20of%20younger%20Australians%20declining.&text=It%20is%20estimated%20that%20the,to%201.8%20million%20by%202050. 9.
Australian Human Rights Commission, “Face the Facts: Older Australians.”
10.
Hampson, “Dealing with Covid-19 in Aged Care.”
11.
Hampson, “Dealing with Covid-19 in Aged Care.”
12. Victorian Government, Department of Health and Human Services. 2019. “Infection Prevention and Control.” Standardized Care Process, published August, 2019. https://www2.health.vic.gov.au/ageing-and-aged-care/residential-agedcare/safety-and-quality/improving-resident-care/standardised-care-processes. 13. Andrea Maier and Rebecca Madill, “Protecting our Ageing Population from Covid-19.” Pursuit University of Melbourne, published March 24, 2020. https://pursuit. unimelb.edu.au/articles/protecting-our-ageing-population-from-covid-19. 14.
Maier and Madill, “Protecting our Ageing Population from Covid-19.”
15.
June Chiong, interview by Kalliopi Patros, Melbourne, September 14, 2020.
16. 7 News, Victorian Coronavirus victim was ‘left in aged care home bed for 10 hours after death’ (Unknown: 7 News, July 29, 2020), https://7news.com.au/lifestyle/ health-wellbeing/victorian-coronavirus-victim-was-left-in-aged-care-home-bed-for-10hours-after-death-c-1203011. 17. Blaine Brownell, “Materials and Coatings That Reduce Surface Transmission of Bacteria and Viruses.” The Journal of the American Institute of Architects, published March 26, 2020, https://www.architectmagazine.com/technology/materials-and-coatings-that-reduce-surface-transmission-of-bacteria-and-viruses_o. 18. William Hercules, Dr Diana Anderson and Mark Sansom, “Architecture Is a Critical Ingredient of Pandemic Medicine.” 19. William Browning, Catherine Ryan, and Joseph Clancy, 14 Patterns of Biophilic Design: Improving Health and Well-Being in the Built Environment (New York: Terrapin Bright Green Ilc, 2014), 12.
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bibliography Australian Institute of Health and Welfare. 2019. “Aged Care Snapshot.”. Australian Government. September 11, 2019. https://www.aihw.gov.au/reports/australias-welfare/aged-care. Australian Human Rights Commission. 2015. “Face the Facts: Older Australians.”. Human Rights. February 25, 2015. https://humanrights.gov.au/our-work/education/face-facts-older-australians#:~:text=By%202050%2C%20around%20 one%20quarter,proportion%20of%20younger%20Australians%20declining.&text=It%20is%20estimated%20that%20 the,to%201.8%20million%20by%202050. Australian Government. 2019. “Quality Standards Guidance and Resources.” Aged Care Quality. September 9, 2020. https://www.agedcarequality.gov.au/resources/guidance-and-resources-aged-care-quality-standards-providers. Barrett, Rosanne. 2020. “Design to Futureproof and protect seniors ‘living.” Inside Ageing. August 24, 2020. https:// insideageing.com.au/design-to-futureproof-and-protect-seniors-living. Beyond Blue. 2020. “Risk Factors for Older People.” Beyond Blue. 2020. https://www.beyondblue.org.au/who-does-itaffect/older-people/risk-factors-for-older-people#:~:text=losses%3A%20relationships%2C%20independence%2C%20 work,admission%20to%20hospital. Brownell, Blaine. 2020. “Materials and Coatings That Reduce Surface Transmission of Bacteria and Viruses.” The Journal of the American Institute of Architects. https://www.architectmagazine.com/technology/materials-and-coatings-thatreduce-surface-transmission-of-bacteria-and-viruses_o. Browning, William, Catherine Ryan, and Joseph Clancy. 14 Patterns of Biophilic Design: Improving Health and Well-Being in the Built Environment. New York: Terrapin Bright Green Ilc, 2014, 12. Chiong, June. 2020. Interview by Kalliopi Patros. Melbourne, September 14, 2020. Department of Health. 2020. “About Residential Aged Care.”Australian Government. January 22, 2020. https://www. health.gov.au/initiatives-and-programs/residential-aged-care/about-residential-aged-care#what-is-residentialaged-care. Ellis Jones. 2020. “Aged Care Architecture Needs More.” October, 2020. https://ellisjones.com.au/aged-care-architecture. Hampson, Pr. Ralph. 2020. “Dealing with Covid-19 in Aged Care.” Pursuit University of Melbourne. https://pursuit. unimelb.edu.au/articles/dealing-with-covid-19-in-aged-care. Hercules, William J, Anderson, Dr. Diana and Sansom, Mark. 2020. “Architecture Is a Critical Ingredient of Pandemic Medicine.” Architect: The Journal of the American Institute of Architects. March 24, 2020. https://www.architectmagazine. com/practice/architecture-is-a-critical-ingredient-of-pandemic-medicine_o. Hanmer, Geoff, Milthorpe, Bruce. 2020. “Poor ventilation may be adding to nursing homes COVID-19 risks.” Architecture AU. August 31, 2020. https://architectureau.com/articles/poor-ventilation-may-be-adding-to-nursing-homes-covid19-risks. Lim,Ching Jou, Stuart, Rhonda L. Kong DC. 2015. “Antibiotic use in residential aged care facilities”, Review of Nursing Home Patients, Australian Family Physician, vol. 44, no. 4, April 2015. https://www.racgp.org.au/afp/2015/april/ antibiotic-use-in-residential-%E2%80%A8aged-care-facilities/ Logan, Cameron. 2009. The Modern Hospital as Dream and Machine. Australia: Fabrications The Journal of the Society of Architectural Historians. DOI: 10.1080/10331867.2009.10539646. Mackintosh, Gary. 2020. “How Covid-19 is Shaping the Future of Seniors Living.” Australian Design Review. May 18, 2020. https://www.hamessharley.com.au/knowledge/how-covid-19-is-shaping-the-future-of-seniors-living. Maier, Andrea and Madill, Rebecca. 2020. “Protecting our Ageing Population from Covid-19.” Pursuit University of Melbourne. https://pursuit.unimelb.edu.au/articles/protecting-our-ageing-population-from-covid-19. Planning Victoria. 2020 “Victoria Planning Provisions Planning Scheme.” Planning Victoria. February 17, 2020. https://www.planning.vic.gov.au/schemes-and-amendments/browse-planning-scheme/planning-scheme?f. Scheme%7CplanningSchemeName=VPPS. Sherlock, Amy. 2020. “Florence Nightingale’s “Rose” Diagram.” Maharam. https://www.maharam.com/stories/sherlock_ florence-nightingales-rose-diagram Victorian Government, Department of Health and Human Services. 2019. “Infection Prevention and Control.” Standardized Care Process. August, 2019. https://www2.health.vic.gov.au/ageing-and-aged-care/residential-agedcare/safety-andquality/improving-resident-care/standardised-care-processes. 7 News. Victorian Coronavirus victim was ‘left in aged care home bed for 10 hours after death’. Unknown: 7 News, July 29, 2020. https://7news.com.au/lifestyle/health-wellbeing/victorian-coronavirus-victim-was-left-in-aged-care-homebed-for-10-hours-after-death-c-1203011.
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imagery Front cover. Pg1 Grampians Community Health. Social Activities. Unknown. Watercolour painting. https://gch.org.au/wp-content/uploads/sites/15/social-activities.jpg Figure 1. Pg4 Nightingale, Florence. Rose Diagram. 1856. Unknown. https://www.dataplusscience.com/images/ChartChat1-3.jpg Figure 2. Pg5 Polak, Martin. Adolf Loos Villa Muller Children’s playroom. 2016. Photograph. Unknown. https://www.iconichouses.org/foto/news/2016/bohemian/9-Villa-Muller.jpg Figure 3. Pg6 Kroll, Andrew. Villa Savoye Entrance. 2010. Photograph. Unknown. https://images.adsttc.com/media/images/5037/e6db/28ba/0d59/9b00/036d/medium_jpg/stringio.jpg?1414231215 Figure 4. Pg7 Alvar Aalto Foundation. Paimio Sanatorium Alvar Aalto Balcony. Unknown. Photograph. https://i1.wp.com/archeyes.com/wp-content/uploads/2020/05/alvar-aalto-paimio-sanatorium-ArchEyes-terrace12.jpg?resize=850%2C567&ssl=1 Figure 5. Pg8 Casabella Costruzioni. Period Photograph’s Antitubercular Dispensary by Ignazio Gardella. 1938. Photograph. Unknown. http://socks-studio.com/img/blog/Gardella-antitubercular-dispensary-02.jpg http://socks-studio.com/img/blog/Gardella-antitubercular-dispensary-07.jpg Figure 6. Pg9 Shulman, Julius. The Lovell Health House in Los Angeles by Richard Neutra. Unknown. Photograph. https://cdn.vox-cdn.com/thumbor/hl7WyFVM-d9ZnFtl_seHqDtqtJg=/69x69:2923x2347/1200x675/filters:focal(1260x963:1740x1443)/cdn.vox-cdn.com/uploads/chorus_image/ image/64150155/HealthHouse_gri_2004_r_10_b0077_f005_7_761_10.0.jpg Figure 7. Pg11 Aged Care Quality and Safety Commission. 8 Standards of Care. 2020. Digital Image. https://www.agedcarequality.gov.au/sites/default/files/styles/square/public/media/high_res_aacqa_quality_standards_diagram.png?h=c24e4232&itok=xyNkb7Q7 Figure 8. Pg15 Resimler, Mimari. Spatial concept collage. Unknown. Collage. https://i.pinimg.com/736x/ea/dd/4d/eadd4db408ea0dbc195c578e3d4515de.jpg Figure 9. Pg20 Tao, Ching Leung Albert. Architectural Collage 2014. Collage. https://i.pinimg.com/236x/11/00/9a/11009a18ed273162b9dd9633f48ee300--landscape-architecture-drawing-architecture-diagrams.jpg Figure 10. Pg21 – Austco Communication Controls Austco. Tacera communication Controls. Unknown. Photograph digital image. https://www.austco.com/wp-content/uploads/2018/10/hp-tacera-collage-2.png Figure 11. Pg23 Soyer, Erwan. The Parallele Exhibition. Unknown. Collage. https://i.pinimg.com/originals/d8/3d/92/d83d92a9dee2cca29603cdf1a68ee02d.jpg Figure 12. Pg24 Master Builders Association. 2019 National Construction Code Volume 2. 2019. Photograph.https://www.mbav.com.au/sites/default/files/styles/uc_product/public/NCC%20Volume%20Two.jpg?itok=XNgDLm_J SAI Global. Guide to Standards – Building and Construction. 2011. Front Cover. https://imgv2-2 f.scribdassets.com/img/document/332065205/original/dfeebfe42e/1596218864?v=1 Figure 13. Pg26 V, Medha. Landscape Render. 2020. Digital collage. https://fiverr-res.cloudinary.com/images/t_main1,q_auto,f_auto,q_auto,f_auto/gigs/156532648/original/4311ba11d5df5b3c86c4dec9408e06f8584dd2b3/make-realistic-landscape-renders.jpg
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