The D word

De-institutionalisation is not an easy word to say. Which is unfortunate, because – when discussing the future of aged care design – it’s the word du jour.

“De-institutionalisation is really important,” Adrian Ciano – head of property development at Uniting NSW.ACT tells Australian Ageing Agenda.

By adopting a small household model of care, Uniting fully embraces de-institutionalisation as a design concept.

And the concept is, in a nutshell, replacing hospital-like vibes with homelike feels. Gone are the long corridors and rows of beds. Instead, more intimate settings with familiar surrounds.

“We have single ensuite rooms for residents in our brand-new services,” says Ciano. And when upgrading older facilities – such as Uniting Taralga in the Goulburn region of New South Wales – de-institutionalisation also sits at the forefront of the re-design.

“We’re transitioning from having multi-bedded rooms into single ensuite rooms,” says Ciano. “We try to use modern interiors. We try to make sure it feels like a home.”

Architect Andrew Walter of Melbourne-based firm Walter&Walter adopts the same concept in his aged care designs. “Using some of those familiar references to people’s usual homes like a numbering or different door colour or material that’s familiar deinstitutionalises the environment for the residents,” he says.

Earlier this year, Walter&Walter were announced as runners-up in the urban-metro category of the aged care design competition.

Launched by the Department of Health and Aged Care, the national competition invited architects and interior designers to come up with innovative ideas while applying the National Aged Care Design Principles and Guidelines. 

“It was a good opportunity to put forward some new ideas,” says Walters. “It was a good opportunity as well to test some of the existing assumptions that are made around aged care and explore the new guidelines which offer a lot of opportunity for new ideas to be explored.”

Walter&Walter’s winning design incorporated architectural references to remind people of the home they might have moved out of. “There was some familiarity from an architectural perspective in the design of the new building,” says Walter.

As he points out, making the transition from living in your own home to an aged care facility can be difficult. Designing a space that looks comfortable and inviting, makes the move less of a dramatic shift. “That transition is not so jarring and intense,” says Walter.

In terms of the functioning of the building, Walter tells AAA the core idea was to invert the traditional floor plan.

“Changing the way people move through the building was a key thing we thought about,” he says.

“So moving the central corridor, or a spine, with rooms off the side to the outside, or the parameter of the building. And having the rooms inwards so you had almost a street that wrapped the building that people could walk out onto and interact with the outside environment rather than being contained within what is normally a long and pretty grim corridor.”

But, as Ciano explains, as a design concept, de-institutionalisation goes way beyond an architect’s drawing board.

“You can build brand new services that look as household as you like but you can still run it like an institution if you want to,” he says.

“It’s a philosophy that needs to be carried from built-form design all the way through to operations and the day-to-day interactions with residents.”

Uniting’s aged care services cater for three types of residents – high-care residents living with co-morbidities, residents living with dementia, and residents receiving palliative and end-of-life care.

Ciano tells AAA, when designing new sites, Uniting adopts in-house design principles developed by its operational teams. “They’re based on best practice and research,” he says.

Uniting’s design principles take into consideration the wants and needs of its residents, says Ciano.

“Why are they coming out of the bedroom and what are they looking for? They may want to be with people or they’re hungry. So we have visual access to the kitchen, living and dining areas. Or if they want to go somewhere quiet, they can follow the sun to find the sunroom at the other end of the corridor.”

Taking into account the needs of its memory support residents, Uniting designs its sites to minimise any signs of a working environment.

“I organise my rooms in a way that reduces unwanted stimuli that might cause behavioural issues in some residents by having services such as laundry in back-of-house-areas rather than in resident-facing areas,” says Ciano.

“When behaviours are reduced, residents have a better day, staff have a better day. Residents’ families are happier because they see their loved ones having had a better day. It’s a one-plus-one equals three-type of outcome that you can get from doing things well from a design perspective.”

Wherever possible, Uniting operates co-located sites that house both residential aged care and retirement living. And rather than hide the residential care component, Uniting ensures the facility is at the heart of the design of the site.

“We don’t put residential aged care in a back corner somewhere. We put it right in the middle with the cafes and multipurpose rooms and other spaces,” says Ciano. “We feel that brings the whole community together as one. It’s the site’s heart.”

The communal design also ensures the facility isn’t isolated from the outside world.

“We don’t tend to put a whopping big fence around the outside,” says Ciano. “Rather, we try to meaningfully invite the wider community into the site to try and liven the site with real life as opposed to a sterile environment.”

Indeed, Uniting sites include spaces where the public is welcome and encouraged to come in and visit.

“You don’t need to be invited.”

By introducing a smaller floorplate, Walter&Walter’s winning design also incorporated a sense of community.

“We had a few key ideas, one of them was to reduce the size of the building therefore reducing the size of the community so you could potentially get to know your neighbours in this setting,” Walter explains.

Such a design also benefits staff, says Walter.

“By de-institutionalising the building, we tried to make it as easy for workers to work and be connected to outside as well.”

Walter says the setting also has the potential to improve interactions between staff and residents.

“They might get to know their residents more closely and be able to tailor their services as well to the residents they work with.”

Walter says he’s hopeful that designs centred around the concept of de-institutionalisation – ones that promote independence, improve quality of life, and foster social inclusion – will become the norm for the sector.

“I think there will be elements that will definitely become the future of aged care – it would be fantastic if they did.”

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