Residential Care for Younger People by NBRS

ENVISION

RESIDENTIAL CARE FOR

YOUNGER PEOPLE

ENVISION WELLNESS.02

CONTENTS ÂŠ NBRS Architecture 2017

Introduction 3 The BISI Framework

Authors: Alison Huynh, Bernadette Keenan, Brett Sherson

Understanding Disability

First Published: September 2017

Key Concepts & Definitions

NBRSARCHITECTURE.

Case Study 01: Freedom Housing

Level 3, 4 Glen Street

Case Study 02: Summer Housing Abbotsford

nbrsarchitecture.com

Case Study 03: Youngcare Sinnamon Park

+61 2 9922 2344

Summary & Conclusions

References

Milsons Point, NSW 2061 Australia architects@nbrsarchitecture.com

Citation: Huynh, A. Keenan, B. & Sherson, B. (2017). Envision Residential Care for Younger People. Sydney: NBRS Architecture.

Approach 17

INTRODUCTION So many people with disability in Australia have never had access to the support they need to live a fulfilling life. Too often, a person’s disability has prevented them from participating in the community and the workforce because as a society we have not invested in overcoming the barriers society has erected. Luke Bo’sher, Head of Policy and Strategy, Summer Foundation. (Informa Insights, 2017)

NBRS is engaged in the design of public and private health care, aged care and residential environments. In this Praxis paper we explore the intersection of residential habitats and caring environments. Previous papers by NBRS have explored adaptable habits; such as the 2014 Envision report “Affordable Habitats: The BISI Framework”; which explored how architecture can provide affordable habitats that are low cost in construction while maintaining high quality design, amenity and quality of life for inhabitants, across a range of scenarios. ‘BISI Affordable Habitats’ considered a range of demographics in the design for low-income households, including seniors living accommodation. This Praxis Paper reviews the experience of people living with disability and contemporary residential care models that provide age-appropriate environments for a range of demographics. The case study analysis explores the different models currently being offered by service providers. Each project provides insights into different approaches to delivery, care and funding models, and building typology and design. A 2015 Senate Inquiry estimated that more than 7,000 Australians under 65 are living in nursing homes because they have high care needs and are unable to find suitable accommodation to meet their needs (Senate Community Affairs References Committee, 2015). Many young people

are discharged from acute hospitals and rehabilitation services into nursing homes. Once there, it is difficult to move them out, they lose skills and social connections. They need slow stream rehabilitation which allow for extended time frames to achieve small but significant functional gains (Winkler, 2015). The United Nations Convention on the Rights of Persons with Disabilities (UNCRPD) has led changes in the way services for people with disabilities should be provided. Rather than rely on a medical model of care, a ‘social rights’ model is preferred which gives a person greater ability to make individual choices and become an active citizen in their community (EASPD, 2017). Younger people with high care needs deserve: •

Access to suitable housing;

•

Age-appropriate housing and support;

•

Integration into communities; and

•

Freedom of choice in housing and lifestyle.

The National Disability Insurance Scheme (NDIS) offers new opportunities for people living with disabilities to chooses where they live and who they live with. Eligible participants receive payments for Specialist Disability Accommodation (SDA) based on their needs which can be invested into suitable housing. SDA pricing and payments framework is designed

to encourage innovative market-driven responses. Participants are encouraged to consider a range of housing pathways including home ownership, shared equity or renting by registering as their own housing provider. This represents a major shift for people with disabilities and maximises freedom of choice to participate in home and community life (Callaway & Tregloan, 2017). The NDIS was first established in 2013 over a three year period. In July 2016 it was approved for national rollout. In August 2017, the National Disability Insurance Agency (NDIA) reported a landmark 100,000 participants registered to receive individual support through the scheme. The NDIA’s long term target will be to register 460,000 participants by 2020 (“NDIS Achieves ‘Major Milestone’.”, 2017). People living with disabilities who are already receiving disability services and supports will be contacted by the NDIA when they are able to access an NDIS plan. Individual consultations are held to develop a plan to achieve personal goals and identify the supports and services required. Once personal NDIS plans are created, participants are able to choose their own service providers to deliver supports and care services. Specialist Disability Accommodation (SDA) funding forms part of these supports and can be used to pay for home modifications or new builds (“Navigating Disability Support”, 2017).

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THE BISI FRAMEWORK

â&#x20AC;&#x153;Integration of the built environment, infrastructural networks and social capital.â&#x20AC;? 0

The BISI Framework is adaptable across the age & demographic spectrum. Its multiangled, adaptable approach enables bespoke design outcomes for a wide variety of scenarios. The scope of this framework could arguably extend beyond affordable habitats to any facility designed with the purpose of building community. This could span from residential developments to large scale urban design projects. (NBRS Envision Student Program 2014)

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green pedestrian road pedestrian walkway

shaded pavilion

UNDERSTANDING DISABILITY Physical, mental and intellectual disability affects a wide range of the population from all ages and all walks of life. The needs of individuals vary greatly and can change over time. The target group for disability care is children and adults under 65. Services for people over 65 are generally provided by aged care providers in conjunction with acute care providers. Disability in people under 65 may be caused by accident, trauma, genetics or disease. In many cases, individuals who have a long term disability are discharged out of acute health care and find themselves in need of long term accommodation options. Three personal stories have been summarised here to illustrate the range of experiences people living with disabilities have had access housing and support services.

JONATHAN, YOORALLA

BRONWYN, YOUNGCARE

GORDON, SUMMER FOUNDATION

Jonathan is a 26yo living with cerebral palsy, he uses a communication tablet and wheelchair. Despite these challenges, he has been able to move out of his parents’ home into supported accommodation provided by Yooralla. Smart home technology, an integrated walking hoist, and a 24hr shared support hub service allows him to live an independent lifestyle. This has motivated him to be more social with people in his age group, spend more time out and a private and flexible living environment. He values the freedom to control his environment through assistive technologies and home automation. While he has 24hr support, in some cases it may take 30minutes for a nurse to arrive to do a simple task (Bredlin, 2017).

Bronwyn was diagnosed with multiple sclerosis at 36, but at 44, was advised to move into a facility with 24hr monitoring and support. Her condition was too dangerous for her to live at home and the only other option was to move into a dementia unit. However, she was given the opportunity to move into supported accommodation with Youngcare group home. For Bronwyn, living in her own apartment has meant she can keep her cherished possessions and continue her passion for cooking, writing, gardening and painting.

Gordon suffered from alcohol addiction and acquired brain injury and was admitted into a nursing home after being discharged from a rehabilitation program. Despite progress in rehabilitation, his experiences in a nursing home slowed his recovery and resulted in reduced mobility. He continued to struggle with normality and lacked social connections. When he moved into supported accommodation with the support of NDIS funding, he was able to live independently in a ‘normal’ apartment block. The apartment is close to shops and public transport, giving him mobility to achieve his goals and lead an active life (“Gordon’s Story”, 2017).

Yooralla provides more than 70 supported accommodation houses across metropolitan and regional areas of Victoria. These include community units, villas, group homes, transitional accommodation and individual accommodation in selfcontained flats. These are located in suburban areas close to public transport, shops and community facilities (“Accommodation - Yooralla”, 2017).

Youngcare provides supported housing in 4 facilities in Queensland and also supports people living at home with ‘at home’ grants. Youngcare Sinnamon Park has individual self-sufficient apartments with bedroom, bathroom, living and kitchen. All Resident spaces have automated doors, intercoms, 24hr on-call nurse and ceiling mounted track and hoist systems. Communal spaces include guest room and BBQ area (“Sinnamon Park Accommodation”, 2017).

Summer Foundation has completed a demonstration project which consists of six apartments for people with high support needs peppered throughout a larger mixed private and social housing development. The housing is centrally located to maximise independence and inclusion and minimise transport costs and reliance on paid supports. Residents can use an iPad or smart phone to control home automation as well as to contact support staff. This technology means they have greater independence and privacy, while still having access to 24-hour oncall support if they have an urgent need for unplanned support or an emergency (“Housing - Summer Foundation”, 2017).

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KEY CONCEPTS & DEFINITIONS Abbreviations and industry jargon have been avoided in the text where possible. Key concepts and definitions are described to differentiate between many similar industry-specific phrases. Disability care is situated at the intersection between acute health care, residential design and aged care. Some terms relate directly to government policy while others adopted over time by academia, industry and care professionals. Furthermore, terminology continues to change as the way health and care is delivered changes.

Adaptable home

A house that can be converted from a single person dwelling to a family home through minor internal rearrangement. Also refers to a home that can be adapted to allow for aging in place.

Age-appropriate environments

Living and care arrangements environments for children, adolescents, young adults and working age adults who have high care needs but would like to socialise and engage with people in their age-group. This allows individuals to participate in a social, civic and community activities and sustain informal support networks with family friends and carers.

Aging in place

The ability to live in one’s own home for as long possible as aged care needs increase, or to continue living in one’s own room in a group home or residential aged care environment as needs increase. This requires environments to be equipped or retrofitted with support aides such as hoists, water beds, and other mobility devices.

Complex care needs

Substantial and ongoing healthcare needs. These can be the result of chronic illness, disabilities or following hospital treatment. Complex care is sometimes referred to as long-term care or continuing care. May include coexisting conditions and/or co-morbidities. Also described as high and complex care.

Environmental control

Ability to control light, ventilation, air conditioning and other aspects of the built environment

Group home

A home environment where a small group (typically between 4-6) live together with own bedrooms and shared home facilities such as kitchen and living.

High care needs

Physical, mental and intellectual needs which require 24hr monitoring and on-call carer or supervisor. Needs may also be defined as ‘complex care’. Previously, ‘high care’ and ‘low care’ were used to distinguish between care needs in residential aged care facilities.

Independent living

A home which allows aged people with low care needs to continue living in a private apartment but close to assistance and healthcare. This is sometimes described as assisted living where care is available onsite. Supported Independent Living is used to describe similar environments for people living with disability.

Individualised Support Package (ISP)

Funds allocated to a person to meet their disability-related support needs as part of the NDIS.

In-Home Care

Individual care provided in a private residence, either 24hr care, regular daily visit, or on-call support.

Intentional community

A planned residential community designed to promote a high degree of social interaction, whose members typically hold a common social, cultural, political or spiritual vision, and share responsibilities and resources.

National Disability Insurance Agency (NDIA)

An independent statutory agency formed to implement the National Disability Insurance Scheme (NDIS) in accordance with the NDIS Act 2013.

National Disability Insurance Scheme (NDIS)

A national insurance scheme which provides Australians under the age of 65 with a permanent and significant disability with the reasonable and necessary supports they need to live and ordinary life. It provides individualised support and the flexibility to replace a range of existing and inefficient disability systems with a new, national system.

ENVISION WELLNESS Residential Care Design

NDIS participant

Person receiving Individualised Support Package as part of the National Disability Insurance Scheme.

Nursing home

A residential aged care environment for people over 65. Also known as Residential Aged Care.

Personal care

Daily tasks such as eating, dressing or undressing, grooming, toileting, showering, bathing, personal hygiene, shaving, transferring in/out of bed, and administration of medication.

Residential Aged Care (RAC)

A residential aged care environment for people over 65. The NSW Government pays approved providers an amount of residential care subside for each care recipient as well as a number of other subsidies and supplements.

Self-care

Maintenance of personal well-being and health. This includes preventative care, physical and mental maintenance behaviours, as well as hygiene and personal care.

Smart home

Computer and app-based control of home environment including opening doors and windows, security, lighting, and other devices. Includes integrated environmental control. Mobile devices and specialist communication aides may be used to control system.

Specialist Disability Accommodation (SDA)

Accommodation for people who require specialist housing solutions, including to assist with the delivery of supports that cater for their extreme functional impairment or very high support needs. SDA funding is for the dwelling itself, and is not intended to cover support costs (such as Supported Independent Living), which are assessed and funded separately by the NDIS

Supported Home

A residential home environment which is supported by 24hr on-call nurse/carer. This term is also used to describe longer term home environments for people experiencing homelessness. In this case, 24hr support refers to social welfare and counselling and case management. Supported homes are provided by organisations such as Common Ground Australia.

Supports

Any type of aides, support equipment and assistive technologies used by a person with a disability to perform their everyday life activities. This may include Specialist Disability Accommodation. The NDIS can pay for supports that are reasonable and necessary. This means they are related to a personâ&#x20AC;&#x2122;s disability and are required for them to live an ordinary life and achieve their goals.

Telehealth / Telemedicine

Remote healthcare delivery assisted by communication technology. This may be delivered at home or in regional clinical environments with the local support of carers, nursing staff and clinicians.

Telecare

Remote care which supports independence at home utilising mobile technology. This can include health monitors and mobile tracking devices, as well as sensors and cameras linked to monitoring alarms.

Transitional Accommodation

Medium-term accommodation for people requiring a high level of specialised support and slow stream rehabilitation. High level intensive therapy is provided initially, with rehabilitation and reintegration the main goal. Multiple levels of supported accommodation may be provided before transition into a low care or home care environment.

Younger People in Residential Aged Care (YPIRAC)

People who are under 65 who are living in residential aged care facilities. Usually this is because they are unable to access alternative housing and care due to their high care needs. The NSW YPIRAC Program was introduced in 2007 to provide accommodation and support for younger people at risk of entering aged care. The initiative ended in 2011 and current recipients will be transitioned to NDIS.

ENVISION WELLNESS Residential Care Design

CASE STUDY 01: FREEDOM HOUSING Freedom Housing is a privately managed care and accommodation model. It may be privately funded or supported by government. It is comprised of three elements; hardware (the built environment), software (operational intelligence and management) and system (network of homes across Australia). It is a patented design and winner of a Australian Human Rights Commission Business Award in 2013. The National Disability Insurance Scheme (NDIS) has helped make the Freedom Housing model feasible and it is under development in Gippsland, Victoria in conjunction with the George Gray Centre. The model has been developed by Christos Iliopoulos, who cared for his late wife Pamela who suffered from MS for 30 years. Nicholas & Alexander Architects, Melbourne provided architectural design for the Freedom Housing model and drawings shown below.

ENVISION WELLNESS Residential Care Design

Freedom House projects are designed as four individual attached homes on a combined lot to suit the local context and streetscape. Each house faces the street and provides individual amenity, but are attached to a care pod known as a “Freedom Key”. This is a small unit for carers with own front door which features lounge, physical therapy and hydrotherapy space. The small scale allows for each house to be separately funded and integrated within urban and suburban communities. Individual houses may be owner-occupied, or rented out by NGOs, government agencies or private investors. The model may be retrofitted into existing buildings or designed for new development sites. Individual houses can be of varying sizes to suit individual needs.

Freedom Housing aims to accommodate a wide range of disabilities across a wholeof-life care cycle. These include: •

Multiple Sclerosis;

•

Cerebral Palsy;

•

Spina Bifida;

•

Motor Neuron Disease;

•

Autism;

•

Alzheimer’s disease;

•

Down’s Syndrome;

•

Intellectual Disability;

•

Acquired Brain Injury;

•

Stroke;

•

Non-violent mental disability; and

•

Aged care.

By living in a home with access to highquality on-site care, families can remain together. This includes: •

Children living with parents;

•

Young adults and single people living with friends;

•

Couples and families with children; and

•

Retired and older couples close to endof-life.

In order to accommodate whole-oflife care, accommodation needs to be readily available across a large number of locations and in varying house sizes to suit changes in life path. An adaptable home approach is needed for people whose conditions are deteriorating or those who are organically aging in place. In order to receive funding through NDIS, all houses would need to comply with Special Disability Accommodation (SDA) Rules which ensure fully accessible and materially robust and safe environments.

a well-integrated and service providing specialist care accommodation within the community. It can be adapted into a range of residential projects of varying scales. A diverse range of homes will help provide greater options for people living with a disability to integrated into urban life and communities.

SERVICE PROVIDER: Freedom Housing ARCHITECT: Nicholas & Alexander Architects STATUS: Concept Design 2012 LOCATION: Gippsland, VIC PHOTO CREDIT: Drawings - Nicholas & Alexander Architects, Innovation Patent for Freedom Housing and Freedom Key Christos Iliopoulos SOURCE: Freedom Housing. (2017). Freedom Housing. Retrieved 11 September 2017, from http://freedomhousing.com.au

The Freedom Housing model provides

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CASE STUDY 02: SUMMER HOUSING ABBOTSFORD The Abbotsford Housing Demonstration Project was developed by the Summer Foundation and collaborating agencies to take a different approach to supported housing. The aim is to create tailored living arrangements for people with disabilities, particularly those with high and complex care needs. Summer Foundation was established in 2006 and seeks to develop and document housing demonstration projects as part of an evidence base for policy and practice change. Summer Housing was established to manage the accommodation projects. The projectâ&#x20AC;&#x2122;s target group were people between 18-55 years living with a disability and living in or at risk of living in a residential aged care facility. Six fully accessible one-bedroom apartments were integrated into a 59 unit mixed private and social housing development. The multi-storey development was located in

ENVISION WELLNESS Residential Care Design

the inner city, close to transport, shops and community facilities. Location was an important factor in encouraging involvement in the wider community, enabling access to shops and neighbours. Community Equity Housing Limited (CEHL) had commenced the planning of a private and social housing development prior to entering into a partnership to provide accessible housing for people with disabilities. The 2 apartments in the development were purchased by Summer Housing and 4 apartments were purchased by Transport Accident Commission (TAC) and TAC Residential Independence Project (RIPL). Summer Housing capital costs were funded through philanthropic grants and donations. The apartments were purchased during development phase, allowing variations in the design and fine-tuned features for specific individuals. A small staff base was established in the building

with an office, bathroom and bed, located near the apartments. Partner organisation annecto developed and implemented the staff support model of planning, support and facilitation. A dedicated staff member leads the transition and facilitation planning, while support workers and assistive technology provide ongoing care and personalised service. Separation of property ownership and tenant support is part of the model with Summer Housing and TAC each engaging property managers for apartments with individual agreements for each tenant. All apartments were designed in accordance with the Liveable Housing Design Guidelines Platinum level requirements. There were differences in the details between Summer Foundation and TAC apartments. All apartments were designed to be aesthetically pleasing and suitable for future private sale. The design

for the apartments matches the rest of the development, and an emphasis on design integration ensures a high quality of domestic-style finish to the shared environment, with hidden features built into design such as wider corridors and smart home technology. Core technology integrated into each apartment includes; •

enant operated alert systems for emerT gency and unplanned assistance using a range of devices including pendant, wall button or alert buttons on mobile devices. In response, staff can make two-way contact with tenant in their unit through handsfree speakers and microphones throughout apartment;

•

Smart home technology to allow tenants to operate lighting, blinds, heating, cooling and entry door to unit as well as apartment building via mobile devices.

Site and building entry is connected to the home automation system and the building

lift can be controlled via remote control device. Tenants are responsible for their own control systems for personal devices, television and entertainment systems. The Abbotsford Housing Project has been successful in improving the lives of tenants and allowing them to achieve rehabilitation and social integration targets. Learnings from the project demonstrate the need to interface between individual tenants, assistive technology and support staff. Small-scale practical approaches have been effective in supporting tenants to carry out daily routines and avoid accumulated hours of staff support over many years. Supporting personal independence is shown to be effective in improving lifestyle outcomes for the participants.

Community Equity Housing Ltd (developer), & annecto ARCHITECT: Kannfinch STATUS: Completed 2013 LOCATION: Abbotsford, VIC PHOTO CREDIT: Summer Housing Ltd SOURCE: What we do: Housing. (2017). Summer Foundation. Retrieved 11 September 2017, from https://www.summerfoundation.org. au/what-we-do/housing/

SERVICE PROVIDER: Summer Foundation, Transport Accident Commission,

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CASE STUDY 03: YOUNGCARE SINNAMON PARK Sinnamon Park is the first housing project developed by Youngcare Wesley Mission Queensland Apartments. The two-storey apartment building supports 17 units with individualised support services provided by Wesley Mission Brisbane. Each apartment is fully equipped with kitchen, living area, bedroom, bathroom and terrace. Spaces are generously sized for mobility aides and smart home technology allows for integrated control in the home. Apartments have ceiling mounted track and hoist systems and 24hr on-call nurse access. There are also communal spaces, including a BBQ area and a guest room for family and friends to stay the night. The project designed by Cox Rayner Architects was awarded the John Dalton Award for Building of the Year award by the Australian Institute of Architects’ 2009 Brisbane Regional Architecture Awards. The Youngcare building program is aimed

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at providing practical alternatives to aged care for people under 50. They also support disability services group grants for in-home care and partner with Griffith University and Recover Injury Research Centre to research the needs of young people with high care needs. Youngcare have completed four building projects in Queensland of varying sizes, including Wooloowin, an inner city share-house style apartment for four people completed in 2015. At Sinnamon Park, individual apartments are provided for each resident in a purpose built facility which is focused around slow-stream rehabilitation and improving independence in the long term. Youngcare seeks to help people to ‘eventually move home’ where possible. Even for those who have very high care needs, the hope is that the long term costs of care will gradually reduce as people are better able to manage their conditions. Supported home-care can

also help reduce carer burnout, which is often the reason younger people are placed in aged care, especially when there is a lack of respite care and respite facilities. Youngcare provides short-term respite care through ‘At Home Care Grants’ and has found that short-term respite care is successful at keeping people at home over multiple years. Sinnamon Park is designed to look like a small boutique apartment unit, with individual balconies featuring on the façade and the shared areas tucked into the building bulk. Lightwells and small courtyards provide accessible viwews, with full-height glazing used where possible to allow residents using wheelchairs to view the gardens. Youngcare housing focuses on the following design principles; 1. Maximised participation (to allow residents maximum use of all elements

within the internal environment including assistive technology). 2. Aspirational design (provides residents opportunities for self-determination, growth, joy and learning). 3. Personalisation (is able to be tailored to individual need and resident has choice of interior decorating). 4. Viable and replicable design from an investment perspective. 5. The building is located within a residential context near facilities that enable community participation. 6. The building is a good neighbour (is considerate of neighbourhood perception). 7. The design of the building promotes dignity within personal and communal spaces.

exterior expression and internal design (homelike features are desirable – richness of materials (layering, colour palate), ambience).

SERVICE PROVIDER: Youngcare

9. That the building promotes wellbeing (incorporates multi-use space such as a gym, not treatment rooms per se)

LOCATION: Sinnamon Park, QLD

The design is recognised as a ‘new building type’ for supported community housing. Jury Director Justin O’Neill highlighted the importance of ‘highly refined architecture’ which also creates ‘familiar home conditions’ and encouraged care agencies to embrace this model ‘in every state and territory’ (“First-of-its-kind building scoops 2009 Brisbane Regional Architecture Awards”, 2009).

ARCHITECT: Cox Rayner Architects STATUS: Completed 2009

PHOTO CREDIT: Youngcare Australia, Flickr Source: Sinnamon Park Accommodation. (2017). Youngcare. Retrieved 11 September 2017, from https://www.youngcare.com. au/lives-changed/sinnamon-park/

8. The design is non-institutional in its

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SUMMARY & CONCLUSIONS The three case studies explored in this paper offer different viewpoints on the design of residential care environments. The case studies provide insight into a range of housing typologies being offered to suit different age-groups and family structures. Technology and other supports form an important part of the design and planning process to allow for a high level of observation and monitoring while supporting mobility. Funding and care management is implemented differently across the projects, with different organisations involve in capital projects, tenancy management, grant management, and care-giving.

HOUSING TYPOLOGIES The diversity in typologies reflects the fundamental principle of ‘housing choice’. Illness and disability affects people across the full spectrum of age, demographic, cultural and socioeconomic groups. Therefore it stands to reason that housing for disability care should reflect the range of diversity in the market for ordinary dwellings. As a relatively new typology, more research and testing is needed to understand the effects of location, size/scale, design approaches and funding models. The case studies operate at different scales, Freedom house accommodates four families, Summer

Housing accommodates six individuals in a large development, and the Youngcare project accommodates 17 people in a dedicated residential environment. The Freedom House model focuses on a specific scale and physical relationship between residential space and care space. The Freedom Key highlights a direct carer link and keeps the care environment in a compact and centralised. As the Freedom Key is a dedicated environment for rehabilitation and care delivery, it can be optimised as a workplace for carers and health professionals, making their job easier and more streamlined. This helps to make care delivery cost effective. In the pilot model, there are four ‘attached’ family homes, this reflects the large number of people with high care needs who live in family environments. A supportive network of family and friends is recognised as being important for maintaining individual lifestyles as well as promoting personal care and self-care in a normalised residential environment. The Summer Housing projects focus on integration with private and social housing by ‘burying’ the supported homes in an inner-city boutique development. The location and design carefully matches the residential design of other apartments, allowing residents to feel more integrated

with society and less stigmatised. Private and social housing developers can therefore be involved in the delivery of supported housing to meet demand of the community at large. Rental prices in inner city areas usually force lower income earners, pensioners and people with disability out of the area. This model allows the private sector to be involved in delivering critically needed supported housing. Innovations in design for mobility and ease-of-access such as smart home integration throughout the complex can also become selling points for private renters, families with children, older people, and others with mobility issues. The Youngcare projects are generally purpose-built, multi-unit developments with an integrated accommodation and service delivery model in a similar way to residential aged care. Clearly defined ‘design principles are supplied, making it easier to work with architects and developers to deliver a purpose-built facility. For example, the building should be located within a residential context and ‘a good neighbour’. This can help ensure that the development blends in with the existing streetscape and urban fabric, which in turn helps residents integrate with their community.

FREEDOM KEY HOUSE 4

HOUSE 1

PRIVATE FLATS

SUPPORTED FLATS

HOUSE 2

HOUSE 3

FREEDOM HOUSING TYPOLOGY 14

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CARER BASE SUMMER HOUSING TYPOLOGY

SUPPORTED FLATS

ENTRANCE & SUPPORT

YOUNGCARE HOUSING TYPOLOGY

FUNDING AND MANAGEMENT The Freedom House funding model is designed to be small scale to suit privatisation and community scale projects. Small groups can form their own housing and care co-operatives. Care organisations focused on a specific sub-set of disability, for example Acquired Brain Injury, can take the Freedom House model and customise it to suit their particular needs. This would also be suitable for children with autism, as multiple families could live together to get better care. The Summer Housing model provides the most information on funding and management, with a combination of four organisations involved in the project. The Abbotsford project sets an example for collaboration between private and social housing providers and residential care providers. In the design phase, all organisations were involved in refining the design to ensure that the spaces were fit-for-purpose. Once complete, Summer Housing and TAC provided the ‘housing solution’ and tenancy management while Summer Foundation and annecto provide the ‘care solution’. The Youngcare funding model is based on revenue collected through grants and donors. By encouraging sponsors to support housing, they can collect and

Own Capital NDS Funding

Welfare & Welfare & Welfare & Welfare & Other Other Other Other

manage the required capital funds to deliver capital projects and provide ongoing management. All housing providers connect with NDIS participants to help them develop their individualised care plans and access funding. This is combined with welfare sources and supplements including workers compensation, care supplements, and funding for other supports. By working with housing providers, individuals are able to make the most of their payments and can be sure that funding received for Specialist Disability Accommodation is used on a high quality and accessible residential environment.

TECHNOLOGY SUPPORTS All projects emphasise the importance of smart home technology and personal health monitors in supporting independence and day-to-day management. While there are risks associated with relying on technology, there have been effective in reducing the burden on carers and service providers to be present at all times. Mobility devices are also used effectively in residential design, further reducing care dependence. Overall, supports used to promote daily activities seek to provide equality of access for people with disability. Being able to do

ANNECTO CARE

SUMMER HOUSING

NDS NDS NDS Funding Funding Funding Welfare & Other

Welfare & Other

simple tasks that others take for granted seems to be highly valuable. However, while technology and equipment can effectively support daily life, the case study projects emphasise active and ongoing rehabilitation as well as incremental goal-setting to improve daily lifestyle management. Unlike older people with organic age-related illnesses, many younger people with disability seek to continue their education or return to work.

DESIGN QUALITY While each project is formulated differently in typology and funding, all case studies exhibit a high design quality. The architectural style of ‘boutique’ housing is seen as having a positive effect on social integration. Spatial planning for access and planning is important throughout the developments, minimising visual impact where possible. Largely, the homes look like ‘ordinary’ houses wherever possible. All projects highly value natural light and connection with landscape, in particular, full height glazing to ensure equitable access to views. Larger corridors and circulation spaces help create generous spaces and support mobility devices, as well as people such as family groups and visitors. Ultimately, a person-centred approach helps to refine and focus the design around the users.

TAC /RIPL FUND

Capital Funding Ongoing Funding

YOUNGCARE

NDS Funding

Welfare & Welfare & Welfare & Other Other Other

Capital Funding

Ongoing Funding

Self-managed fund / co-operative for housing and care

Built by CEPL, managed by Summer Housing, TAC & Annecto

Owned and operated by Youngcare

FREEDOM HOUSE FUNDING STRATEGY

SUMMER HOUSING FUNDING STRATEGY

YOUNGCARE FUNDING STRATEGY ENVISION WELLNESS Residential Care Design

REFERENCES Accommodation - Yooralla. (2017). Yooralla. Retrieved 11 September 2017, from http://www.yooralla.com.au/services/accommodation Bredlin, J. (2017). About my disability. Calling The Brain’s Bluff. Retrieved 11 September 2017, from http://www.callingthebrainsbluff.com/mydisability-jonathan-bredin Bronwyn’s Story - Youngcare. (2017). Youngcare. Retrieved 11 September 2017, from https://www.youngcare.com.au/lives-changed/bronwynsstory/ Callaway, L., & Tregloan, K. (2017). NDIS housing rules for people with a disability could be life-changing. The Conversation. Retrieved from http://NDIS housing rules for people with a disability could be life-changing EASPD. (2017). Making community-based services a reality: Roadmap on deinstitutionalisation. Brussels: European Association of Service providers for Persons with Disabilities. Retrieved from http://www.aph.gov.au/~/media/Committees/clac_ctte/young_agedcare/report.pdf?la=en First-of-its-kind building scoops 2009 Brisbane Regional Architecture Awards. (2009). Australian Institute of Architects. Retrieved 11 September 2017, from https://dynamic.architecture.com.au/i-cms?page=12795 Freedom Housing. (2017). Freedom Housing. Retrieved 11 September 2017, from http://freedomhousing.com.au Fyffe, C. (2015). Learnings from the Abbotsford Housing Demonstration Project – 2012-2013. Melbourne, VIC: Summer Foundation Ltd. Retrieved from https://www.summerfoundation.org.au/resources/abbotsford-report/ Gordon’s Story. (2017). Summer Foundation. Retrieved 11 September 2017, from https://www.summerfoundation.org.au/documents/digitalstories/gordons-story/ Housing - Summer Foundation. (2017). Summer Foundation. Retrieved 11 September 2017, from https://www.summerfoundation.org.au/what-wedo/housing/ Housing Model – Summer Housing. (2017). Summer Housing. Retrieved 11 September 2017, from http://summerhousing.org.au/about-us/ housing-model/ Inclusive language - Understanding Disability. (2017). Australian Network on Disability. Retrieved 11 September 2017, from https://www.and.org.au/ pages/inclusive-language.html Informa Insights. (2017). Disability housing and support for younger people with very high and complex care needs: Closing the gap through the NDIS. Informa. Retrieved 11 September 2017, from https://www.informa.com.au/insight/disability-housing-and-support-for-younger-people/ Navigating Disability Support. (2017). KinCare. Retrieved 11 September 2017, from https://www.kincare.com.au/disability-support/navigatingdisability-support/ NBRS Architecture. (201). Affordable Habitats: The BISI Framework. Sydney: NBRS Architecture. NDIS Achieves ‘Major Milestone’. (2017). Probono Australia. Retrieved from https://probonoaustralia.com.au/news/2017/08/ndis-achievesmajor-milestone/ Senate Community Affairs References Committee. (2015). Adequacy of existing residential care arrangements available for young people with severe physical, mental or intellectual disabilities in Australia. Canberra, ACT: Senate Printing Unit. Sinnamon Park Accommodation. (2017). Youngcare. Retrieved 11 September 2017, from https://www.youngcare.com.au/lives-changed/ sinnamon-park/ Winkler, D. (2015). Nursing homes are no place for young people with disabilities. The Conversation. Retrieved from https://theconversation. com/nursing-homes-are-no-place-for-young-people-with-disabilities-43847

ENVISION WELLNESS Residential Care Design

APPROACH NBRSARCHITECTURE is a multidisciplinary practice offering services in architecture, landscape architecture, urban design, interior design, heritage and compliance.

vital in ensuring a high quality of design as well as an understanding of the social, cultural and political context within which we operate.

We believe in creating life-changing environments for patients, families, carers, staff and communities. We are particularly interested in helping our clients deliver best-practice, person-centred care. Our experience across a wide range of spaces for living, gathering and working supplements our interest in health care delivery. We develop creative partnerships with our clients to ensure high quality design outcomes, and regularly engage in public discourse on architecture and design.

Envision papers incorporate case study, literature review, desktop analysis and other research. Case studies are useful as they focus on individual projects rather than sweeping statistical or data-analysis based study. By analysing built projects, it is possible to gain an understanding of the effectiveness of design in achieving its desired results. While a case study may not directly answer to a research question, they provide a real-world example with site and context to test theories and ideas. Literature review is conducted across a range of local, interstate and international sources to ensure our designs are responding to international best practice as well as regional issues and trends that directly affect our clients. This provides us with the knowledge to provide strategic

In order to ensure the relevance of the spaces we design, we conduct research into current and projected trends in the way people live and interact with the built environment. Up-to-date knowledge is

advice and guidance to our clients. The Envision Student Partnership Program engages architectural students to work in conjunction with mentors within the practice to do further in-depth research and design around key topics relevant to our work. If you are interesting in knowing more about a topic covered in our research, please feel free to contact us. We are also interested in engaging in new research with current and future clients to support business case development, feasibility and concept design. architects@nbrsarchitecture.com nbrsarchitecture.com +61 2 9922 2344

ENVISION WELLNESS Residential Care Design

Sydney: +61 2 9922 2344 nbrsarchitecture.com