A new program is helping providers address the barriers of improving existing aged care facilities, writes Nick Seemann.
Updating corridors can address disorientation and make buildings feel more residential
A major challenge currently facing aged care providers is improving existing building stock. Most have inherited facilities built over the past four decades that do not reflect their values or models of care.
Based on current research, we know that many of these facilities further disable residents who are already burdened by dementia, frailty, macular degeneration, and other issues that have led them to move into the facility.
Constructive Dialogue Architects is working with providers to improve existing buildings to better support residents. Renovations and additions are programmed in a manner that is both economically and operationally sustainable.
The strategic improvements program involves a three-step process that begins with auditing existing environments against objectives established with staff and management. The next step is to establish a series of targeted, site specific building works.
The works progress in a sequence at a rate set by the provider. Work is packaged to achieve a specific social outcome in one area of a home by holistically addressing changes to room layouts, finishes, lighting, access to gardens and a host of other issues. As each renovation or addition is completed, there is an evaluation process prior to progressing to further work.
For example, to address disorientation and make buildings feel more residential, we are working with providers to address a range of issues within corridors. As shown in the before and after graphics (top), these include providing a consistent floor tone throughout, good contrast between walls and floors, increased lighting level, providing places to sit, installing orienting objects, removing clutter, and improving the visibility of external areas.
The aim is to address all issues in one corridor at a time. After completion of each corridor, staff involved assess the work as a package prior to commencing work on the next corridor.
We are also working with providers to shift from institutional environments to smaller scale living. Even a challenging layout can be fundamentally improved. One building had a very internal focus with large dining areas and very poor connections to gardens.
On that project the objectives included providing smaller household groups, smaller scale living experiences, residential scale kitchens for preparation of meals, and better access to usable gardens. The relocation of two bedrooms, work to the gardens, and the creation of covered deck areas are the primary changes through which this site is being transformed.
The strategic improvements program has a strong empirical base as it draws upon the writings of researchers and practitioners in aged care such as Kirsty Bennett, Richard Fleming, Stephen Judd, Margret Calkins and Mary Marshall. The success is further ensured by staging, sequencing and evaluating the work with the staff running a site. This also addresses a key barrier that we believe has limited the application of the evidence base: the separation between theory and practice.
The sequencing of work also addresses a perception that upgrading a facility is too big and too expensive. By reducing a master planning process to individual items, the work at each stage can be kept within the capacity – financial and operational – of a provider.
We know that the physical environment in aged care matters. The methodical approach described here allows organisations to improve their buildings at a rate they can afford, manage and justify. Through these projects we have often made space for additional bedrooms and reduced the quantity of multi-bed rooms. This has helped fund projects, together with significant refurbishment funding and increasing occupancy levels through the work.
Beyond the social and human rights imperative to improve existing facilities, the more competitive aged care market will likely leave facilities that are not upgraded unable to attract residents in the future.
Nick Seemann is a registered architect and a director of Constructive Dialogue Architects. This article draws on his presentations at the Australian Aged Care Quality Agency’s Better Practice Conferences throughout 2017.
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