An overseas visit has reminded me that Australian aged care has models of care and innovations that hold up internationally, writes Dr Eleanor Horton.
Last year I visited some aged care facilities in the Netherlands, accompanied by a friend who could help me with the language.
Many of the facilities are similar to those in Australia: they have a retirement village, a care facility and a community hall and offer typical amenities and services.
One of the facilities I visited was the dementia village Hogewey, information about which I have used to supplement my teaching on international dementia models of care for many years.
On arrival we were given the public relations material for the village and instructed that we were free to walk around but to respect the privacy of residents and not look directly into rooms.
We spent the next few hours walking around the different housing clusters and amenities and visiting the coffee shop and restaurant.
Each cluster at Hogewey is home to six residents and there are 23 separate clusters each catering to different preferences. Some clusters had small gardens and vegetable gardens although there was not any large therapy garden as I had expected. A few cluster houses had an outdoor furniture setting, but not all and this fits with the placement based on preference.
Australia has an ageing in place policy ensuring people can stay living in their facility as conditions change, but they may need to move within that facility to meet their needs. In Hogewey, as a residents’ conditions change and more care is needed they do not have to move from their room.
As we wandered around the village I reflected on what I was expecting to see. The resident’s rooms looked exactly the same as ours, although rooms in some Australian facilities would be more spacious.
One of the main differences in Hogwey is that every service provided – such as the physiotherapist, podiatrist and hairdresser – has a shop-front window facing onto a village street and is therefore more visible.
It was was evident that the architectural design of the Hogewey village was being actively sold throughout the world as a model. There are villages in Canada, Switzerland, Italy, Ireland and – soon – Australia. The visitor’s book read like who’s who in aged care throughout the world.
Providing high quality care to one of the more vulnerable populations in our community is a privilege that is yet to be recognised and valued by many governments throughout the world.
The government in the Netherlands subsidises the aged care industry and therefore the facilities can afford to have 24/7 medical staff, psychologists and physiotherapists on staff. This is a dream for most if not all facilities in Australia.
In our context, having a nurse practitioner 24 hours a day would be more beneficial and cost effective than having medical staff present.
Knowledge related to the staffing models in these facilities is not highly publicised, but when I did a comparison with Australian staffing levels I found we have a better resident-to-staff ratio overall. Resident monitoring using technology, especially at night, is used in both countries but in Australia it is used in conjunction with a more acceptable staffing level.
The hours I spent in the village on a beautiful clear fine sunny day did not provide me with any evidence that this model of care engages people more in life than any other model of care. There was not an abundance of residents wandering around the streets in the sunshine. They may have been wandering in their clusters but they are no larger in area than current secure areas in Australian facilities.
I left the village feeling somewhat disillusioned, but at the same time with a sense of pride about what we offer in many Australian facilities which, with a few minor building modifications, could equal this village design.
More recently I have been in contact with a company in the US that has designed a facility of streets of houses with shops and amenities but has added a false sky that is changeable so that residents can enjoy the sunshine and see stars. This addition would also be helpful in managing some challenging behaviours.
A village being developed in Caboolture in south east Queensland also has a street scape and is based on Hogewey principles.
Ultimately, the ageing population globally presents us with an ever-increasing number of people diagnosed with dementia and is opening up new opportunities for different models of care.
We need to be mindful that in the Australian aged and community care sector we have models of care and innovations that do hold up internationally and we can be proud of what we have and what we do.
Dr Eleanor Horton is a senior lecturer in nursing at Sunshine Coast University.
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