Guide aims to improve quality of life through design

The aged care accommodation design guidelines have been released and are available for stakeholder consultation.

Built on evidence-based research undertaken over several decades – and in response to a recommendation by the royal commission – the National Aged Care Design Principles and Guidelines aim to create safe and comfortable living environments that promote independence, function and enjoyment for aged care residents – particularly those living with dementia.

The principles and guidelines – which Australian Ageing Agenda first saw at an industry conference in March – also aim to support the development of safe workplaces for staff to provide high-quality personal and clinical care.

As well as informing the design of new builds, the principles and guidelines include improvements that can be made to existing aged care homes.

Minister for Aged Care Anika Wells promoted the document on social media Thursday, saying: “The Albanese Government is putting the ‘home’ back into aged care homes.”

Nick Seemann – managing director at Constructive Dialogue Architects – helped develop the design principles and guidelines as part of a University of Wollongong-led consortium of academia, government and industry experts.

He told AAA: “The physical environment really does matter in aged care. Good buildings do support people and they make the care easier to deliver for the staff.”

People with abilities can compensate for bad environments, said Mr Seemann. However, “if somebody has challenges or impairments that are related to dementia or other age-related impairments, it’s much harder to compensate for things like noisy environments and clutter,” he said.

The draft document contains four principles that seek to address design issues for all people living and working in residential aged care.

Incorporating learnings from the Covid-19 pandemic, the principles, say the authors, aim to “facilitate stronger alignment between models of care and design. Each principle is built around promoting the rights of residents, valuing care staff and encouraging positive relationships.”

The four principles are:

• Enable the person

““That’s all about those basic issues that relate to compensating for disabilities through design,” said Mr Seemann. “That’s about reducing noise, reducing clutter; making it easier to see and find your way around a building.”

• Cultivate a home

“Most aged care is some form of congregate living and often the size of the building – when there are 40 people having a meal together – that’s a problem,” said Mr Seemann. “The core of the second principle is how you can set up a household for 15 or less people.”

• Access the outdoors

“People in aged care don’t often get outdoors much,” said Mr Seemann. “I read once that the median time people in residential aged care spend outdoors is about two minutes a day – as in people don’t go out.”

• Connect with community

“Often aged care facilities are cut off from the world, so this is all about how we keep buildings connected to the wider community,” said Mr Seemann.

Each principle comprises a set of guidelines that focus on a particular design challenge.

For example, minimising clutter is among the guidelines that support Principle 1. “People living with dementia can be particularly susceptible to experiencing disorientation, agitation and confusion” in chaotic environments, say the authors.

Among the guidelines supporting Principle 2 is adopting small models of care. This, say the authors, follows international consensus “that the best health and wellbeing outcomes are achieved in living arrangements that bring together 15 or fewer people and promote familiar, domestic activities.”

The 63-page document also includes examples of spaces designed to cultivate a homelike environment and avoid a clinical appearance. These include:

• private, personalised bedrooms
• kitchen, dining and living areas of a domestic scale
• domestic laundries
• easy access to outside.

As the authors note, “people living in care homes typically spend very little time outdoors, despite the evidence linking access to outdoors to a range of health, psychological and social outcomes.”

Among the examples of outdoor spaces:

• a garden set up for meaningful activity, including animal contact
• shared communal gardens with potting areas
• covered areas providing shade, clear paths and comfortable seating
• balcony space outside a bedroom.

Dementia Training Australia – which also helped develop the principles and guidelines – heralded the release of the document.

“The National Aged Care Design Principles and Guidelines represent a crucial step towards improving the quality of life for older Australians in care facilities,” said DTA chief executive officer Isabelle Meyer. “Our hope is that these guidelines will not only raise the bar for aged care services but also inspire a broader conversation about the importance of compassionate and person-centred care.”

Dementia care specialists HammondCare – which launched its “cottage-style” accommodation in 1995 – said the release of the design principles and guidelines was welcome news for the sector, “especially around recommending a move to small household models of care,” said Angela Raguz – general manager residential care and The Dementia Centre.

Speaking to AAA, Ms Raguz said: “The cottage model is supported by a relationship-based model of care that empowers residents and care workers to flexibly live life in a normal way. The model is about enablement and quality of life, especially for residents living with dementia.”

She added: “The cottage model also has considerable workforce benefits, including lower-then-average staff attrition and high levels of employee engagement.”

The Older Persons Advocacy Network also welcomed the release of the design principles. “Older people and their families have been calling for the deinstitutionalisation of aged care for some time,” said OPAN CEO Craig Gear. “The traditional model of large, multi-bed institutions is socially isolating, and it deprives older people of their autonomy.”

Calling the guidelines “an important first step” in supporting older people to live in homelike environments, Mr Gear said: “Now we need to find a way to fund and implement them.”

Regarding funding, Mr Seemann told AAA that the key thing about the document is: “Whatever investment is made – whether it’s coming from the consumer, the provider or the government – this shows how it can be spent well.”

Feedback requested

The National Aged Care Accommodation Design Principles and Guidelines will be the centrepiece of the government’s new Residential Aged Care Accommodation Framework due to commence from 1 July 2024.

The government is inviting input on the draft principles and guidelines from older people, aged care providers, design experts, and those involved in the construction and refurbishment of aged care homes.

“Your feedback will ensure the principles and guidelines provide a comprehensive, evidence-based resource to guide accommodation design and put quality and dignity back into aged care,” said Ms Wells.

“The principle and guidelines will explain how to make simple changes that can have enormously positive impacts on residents and staff,” she added.

Feedback on the principles and guidelines can be presented here.

A design ideas competition will also be launched later this year to put the principles and guidelines to the test.

Main image: An example of a kitchen design – source: National Aged Care Design Principles and Guidelines 

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