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Aged care in the urban context: what’s missing?

Over the last few years, Australia has been witnessing a growing palette of retirement living and aged care options. While many still prefer the classic downsize-to-the-country-side move, theme-based options like golf course and cruise-centred retirement communities are fast becoming popular among today’s retirees. One common assumption these options make, however, is that such centres should be isolated facilities located in the countryside, suburbs and other such areas that are away from the CBD.

This makes one wonder what the future of retirement living/aged care looks like for the current generation of urban dwellers who have lived most of their lives in high-density dwellings in or around cities, and would prefer to continue enjoying the urban life through their sunset years as well. Or what about the elderly couple who yearn for better access to their children and grandchildren living in the city? Is it possible to provide the elderly with the perks of urban life while also addressing their growing medical and emotional needs? What are the social impacts of introducing retirement living in the urban context? With a growing demand for aged care options and a predicted increase in the number of older Australians (65 and over) to 8.7 million by 2056, it’s worth exploring what else is possible for the future of retirement and aged care design.

WHAT IS MISSING IN THE CURRENT MODEL?

While there are many natural fears that are associated with retirement and moving into aged care, perhaps the most daunting one is losing a sense of identity and significance. According to a review by the National Ageing Research Institute, residents living in aged care facilities are five times more likely to experience loneliness and social isolation than those who live independently. It shows that the current models of housing arrangements that are exclusive of building usage and age quite often end up segregating residents from society.

Statistics show that one in eight older people are engaged in employment, education or training. This is a huge chunk of society that not only has the time and life experience but also the will to contribute back to the community. Rather than isolate such a valuable resource to the countryside, it would profit both individual and community if the location and design of aged care facilities provided an avenue for older people to contribute. Achieving holistic wellbeing of aged care residents by including context of community and social interaction is vital to creating a sense of belonging.

Transitioning to an aged care facility is usually a last resort of care and is most often a painful decision, particularly for families. Partners and children of residents deal with the guilt of not being able to provide their well-intentioned time and effort to their loved ones due to demands of their own families and careers. Lack of respite care, fear of medical emergencies and burnout for carers are other reasons why dedicated aged care is considered. Is there a better way for our seniors to receive nursing/medical care and enjoy the presence of family and loved ones?

A PLACE OF BELONGING IN THE URBAN CONTEXT

Intergenerational interaction

Housing arrangements that allow for intergenerational living create an avenue for seniors to impart their time-gathered wisdom and experience to the next generations, giving them a sense of productivity and significance in society. Getting involved in social work, the local kindergarten, library or café not only gives them a sense of purpose and contribution that is vital for maintaining their sense of dignity but also promotes socialising and mental exercise that helps to delay the onset of age-related illnesses such as dementia.

Connection to context

The vertical advantage of high-rise buildings creates more opportunity for visual connection to the urban context and its activities while maintaining privacy rather than disengagement from the surroundings. When aged care design can be focused around places of urban interest, it brings the people from outside within and encourages the residents to venture out. Design that visually includes the context helps residents feel that they are part of their surroundings and feel less isolated.

Inclusivity

Segregating seniors from our communities because ageing and death it is too ‘uncomfortable’ to accept only creates further stigma and division in society. For the sake of mature and healthy societies where old age is accepted as part of life, our urban spaces need to be inclusive of seniors and caring for them. Imagine the Swiss model where high rise aged care facilities have entry spaces that are occupied by cafes, movie theatre foyers, community centres etc. that are used by both residents and the general public, creating a natural integration between both worlds.

Flexibility

Housing unit layouts need to encourage flexible spaces that can adapt as the residents’ degree of care changes. Adaptable construction and installation of duress, accessibility and medical services can easily convert residential spaces to ones better suited for increased nursing requirements. This increases the chances for long-term stay in urban residential areas and consequently establishing long-term relationships with neighbours and the larger community. It is also an advantage for those who prefer to continue to live with their carers while receiving advanced nursing attention rather than move to dedicated aged care facilities.

Proximity

Proximity to urban conveniences like medical facilities, transport and entertainment can encourage seniors to be independent for longer and hence delay their reliance on aged care resources. It also provides easier access to the residents and consequently more frequent interaction with family and friends while also maintaining their independence and privacy.

Susan Mathews is project architect at Collard Maxwell Architects.

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3 comments

  1. I do believe you have just described the need to have universally designed and accessible dwellings across the housing market. This is the topic of the ABCB Accessible Housing Options Paper that will look at the Livable Housing Design Guidelines Silver and Gold levels, which are based on universal design principles. This could be a defining moment in housing history if we should get Gold level – the most suitable for ageing in place and for the staff of care services to work when the time comes. Submissions due Friday 30 Nov. It will benefit everyone and save on the public purse as well.

  2. Hi Jane, thank you for your comment, and good point. Developing ONE universal standard will be challenging though, but we welcome progress. It will be very hard to cover ALL ailments within a single design policy.

    For now, AS1428.1, the reference document on which The Livable Housing Guideline was based does a decent job at covering most accessibility issues, but it is not perfect as some requirements within Dementia Care design, for example, are in contradiction with Primary School education design. So perhaps someday we will see multiple specialized Design Guides as addendum to the universal policy, and those could ultimately make their way into the the National Building Code as reference document.

    • One of the great things about taking a universal design approach is that a range of stakeholders are consulted. In my work where I have been part of groups looking at new developments in building and transportation, having all the voices present actually helps to come up with solutions. People generally are understanding of each others needs and focus on solutions. I’ve seen good ideas come from this process and it’s time saving and cost effective in the end.

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