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If we really want to know how we should be building aged care facilities, why not just ask the residents, researcher Ralph Hampson tells Darragh O Keeffe.
Ralph Hampson remembers vividly the moment it happened. Seven years ago he was visiting an aged care facility in a country town, as part of his job in the Victorian Department of Human Services. “It was a pretty terrible place,” he says. “To be honest, I wouldn’t have put a dog in there, never mind old, frail people.”
It was at this moment that the former aged care bureaucrat’s interest in the built environment and its impact on the lives of older people who live in residential care was born.
“I’m always surprised when I hear nurses and clinicians saying the built environment doesn’t matter if the provision of care is good. That’s just not correct. The environment is very important to people. I became passionate about this and decided to investigate further.”
Hampson has just submitted his PhD research at the University of Melbourne. It has been seven years in the making and is a cross-disciplinary study between the university’s School of Nursing and Social Work and the Faculty of Architecture, Building and Planning.
The research project involved Hampson interviewing 24 facility residents, over four group sessions, as well as families, facility staff, architects and managers of facilities.
“It’s often wrongly assumed that older people do not need to be consulted in the building process because most have dementia. But about 30 per cent of residents are there because they are frail; they don’t have dementia. They can communicate quite clearly,” he says.
Three different aged care homes in Victoria took part; a recently built facility in a rural town; a multi-storey low care facility in the city; and a suburban low and high care facility.
Numerous themes emerged as the resident spoke about what they wanted in an aged care facility.
Almost everyone talked about the need to feel connected to the local community.
“I found the residents to be fun and intelligent. Inside the 80-year-old is an 18-year-old just dying to get out. They want to feel like they’re still part of something; that they’re still part of the community. It made me wonder why we don’t build more facilities near local shops; closer to communities.”
Facilities should be places that family and friends want to visit, many residents said. It reminded Hampson of a suggestion he made several years ago, during his time with the Victorian government, that facilities should have games rooms to encourage teenagers to visit their grandparents. It’s a pretty isolated life for residents if they don’t have people visiting them, he says.
Many of the other resident recommendations were simple, easy to implement ideas.
“It’s the small things that matter. I had read a lot of literature on building in aged care, during my research stage, and yet the idea of putting a light in the wardrobes came from a resident, not a book. Poor eyesight is a big problem. If you can’t see into your wardrobe, it’s hard to pick out your clothes. That’s a simple change we can make.”
Likewise, having the toilet seat at the right height would fulfil the residents’ wish to remain independent for as long as possible. They expect a built environment that enables them to do that, they said.
Radio and TV reception was another big issue. Residents said those with poor eyesight relied on radio to feel connected to the outside world. Storage space in bedrooms was also on the wish list, and many residents talked about wanting a fridge in their rooms.
“All the residents wanted their own bedrooms with en suite. The days of building shared rooms should be numbered.”
Residents expressed a desire to personalise their rooms. This could be achieved by bringing some of their own furniture with them, or painting their rooms a colour of their choosing.
“We’ll see the emergence of the new consumer in aged care who wants control over their room. One man said to me, I’ve paid $150,000 to be here, I want to make my room my own, why can’t I paint it? The days of the grateful client are coming to an end.”
Elsewhere, the residents said they liked gardens, and outdoor spaces, where they could plant things and watch them grow. They wanted BBQ areas, and rooms with computers that had connections to broadband.
As a result of the series of interviews, Hampson is more convinced than ever that residents – as the end users of residential care services – must be included in the design planning stages.
“The lens we’ve been looking through sees residents as old people, past their use by date. We have to turn that around. We need to listen to all the voices; we need better consultation and planning processes. We don’t have enough conversations.”
It wasn’t just residents that Hampson was keen to speak to during the course of his research. He also convened a forum of facility staff and architects to facilitate discussion about how that collaboration could be improved.
It was the first time these stakeholders, who all have an interest in getting this right, came together for an ideas workshop, rather than to discuss a specific project, said Hampson.
The future for facility buildings must involve a shift in thinking, from following a medical model to a more lifestyle-focussed model, he says. “Facility planning is still largely health dominated, rather than lifestyle focused. People too often compare facilities to hospitals, and that is wrong. How you view that will determine how you build.”
Size, he says, also needs a rethink. He cites the recent shift from big institutions – with large mental health facilities and children’s homes being closed down – to smaller buildings. “However, in aged care, we tend to be making the facilities bigger. And I’m worried about that.”
Hampson refers to providers such as Humanitas, with their apartments for life, and the Eden Alternative, as trailblazers in facility building. “They are led by inspirational characters. We need creative thinking, we need boldness,” he says.
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