Small-scale living offers many benefits
Dr Nathan D’Cunha and colleagues from the University of Canberra share innovative projects that highlight the importance of architectural design, community engagement, and inclusive care strategies for improved resident wellbeing.
The recently drafted National Aged Care Design Principles and Guidelines aim to be a resource for providers and architects building or renovating an aged care home.
These guidelines support a move towards small-scale care and creating an enabling environment where residents can access the outdoors and connect with the local community. Small-scale care is described as having between six and 15 people living in a person-centred and homelike environment.
Evidence suggests this model enables greater support for residents to live a meaningful life and maximise their abilities. Financially, it has been found to be comparable to traditional residential care, though further research is needed.
Small-scale care may improve social connections, independence, eating, safety, infection control, and family and staff satisfaction.
For people with dementia, living in small-scale care can improve mood and reduce unmet needs, which can reduce the use of medications or physical restraints.
Preliminary evidence suggests people with younger-onset dementia may also benefit from small-scale care as autonomy and independence could be maximised by remaining engaged in activities enjoyed before requiring care.
Research at the University of Canberra supports several of these findings. In a study of Kambera House, operated by Community Home Australia, we explored the experiences of residents, family members, and staff in a small-scale home for people with younger onset dementia. The home fostered a sense of community and care and staff felt empowered to genuinely get to know the residents.
Research is also underway into innovative aged care projects in the Canberra region, including The Neighbourhood, Canberra. TNC is an association of volunteers working with an aged care provider, people with dementia, carers and stakeholders to develop a cluster of small-scale homes in the Australia Capital Territory region for people with dementia.
Their vision includes onsite services, including a communal supermarket, childcare centre, cafe, hairdresser, arts centre, and community and intergenerational gardens – inspired by Korongee Village in Hobart.
Workshops at UC with people impacted by dementia, care providers and experts were favourable towards a village concept that seeks to involve the broader community with a range of opportunities for intergenerational connections and community engagement. The ACT Government has also announced plans for a new village incorporating small-scale homes.
While clusters of small-scale homes or villages are becoming more popular in Australia – such as the new HammondCare site at Daw Park in South Australia – suitable architectural design following best-practice remains important for new builds and it will take time for more sites like these to be established.
Staff said they had more opportunities to get to know the residents and build relationships with residents and their families, compared with previous roles
In our workshops, several strategies were identified for future sites that could also be implemented into existing residential care. These related to a clear philosophy of care focused on:
- respect for the individual
- promoting independence
- enablement
- dignity of risk
- meaningful activities
- connection to the local community
- connection to the outdoor environment
- more staff trained to work with people with dementia.
Other strategies were suggested by those already implementing small-scale care, including creating a culture of inclusiveness and respect within and beyond the care setting.
Examples include inviting residents or families to board meetings; including residents in interviews for staff recruitment; and providing dementia-specific training opportunities for staff, stakeholders, and the broader community so they can be involved in dementia care as volunteers.
In our study of Kambera House, staff said they had more opportunities to get to know the residents and build relationships with residents and their families, compared with previous roles. Flexibility to attend to the needs of people experiencing a broad range of dementia symptoms on a moment-to-moment basis was seen as a benefit.
Staff also felt that removing nursing stations and signs of medication altogether was a sign of a care environment that feels like a home. Finally, small-scale care was seen to provide greater opportunity to engage with the broader community, maximising a resident’s ability to remain active and contributing members of society.
Dr Nathan D’Cunha – an assistant professor at the University of Canberra in the Centre for Ageing Research and Translation – is editing a research topic titled Environment and Design for People with Dementia, which is open for submissions
Robyn Lewis is a PhD candidate at the University of Canberra in the Centre for Ageing Research and Translation
Helen Holloway is a senior research advisor at the University of Canberra in the Centre for Ageing Research and Translation
Dr Jane Thompson is a public advisor
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