The Royal Commission Proposed Recommendations 57 (above) and 58 (below), refer to the ‘small home’ model and ‘small scale congregate living’.
This poses many questions that challenge current ‘big box’ buildings, and future developments.
Is it right and are there models to follow?
If we push the concept of small-scale congregate living to its natural conclusion, we could see a move to smaller facilities, integrated into their urban or suburban location. This has many benefits, such as keeping residents in their local community and opening up locations for development.
We could see something akin to the care homes developed in the Netherlands such as this expel of the Werkt voor Ouderen Foundation developments that have a smaller footprint and encourage domestic living within a supported environment.
This approach, while fundamentally challenging to current funding and cost positions, would see more intimate, domestic scale care settings, with the ability to provide greater choice and control.
We can see an evolution of the concept of continuum of care in the UK with Guild Living, with their Epson and Walton sites. This sees a model that is integrated into urban areas.
Only 10% of the accommodation in these developments is a higher care and memory care oriented offering. The rest of the accommodation covers independent living, assisted living including co-living and affordable options.
When combined, this creates a pallet of living options for prospective residents that can be tailored to their current and evolving needs within the same site.
The Greenhouse model from the USA uses 10 residents as a fixed size for its’ small home model.
Their key focus is explained with their core philosophy of “creating a real home not just a homelike environment”. Dr. Bill Thomas, who developed the Greenhouse concept, states the model is based on “a really radical idea: Let’s abolish the nursing home.”
Thomas, a geriatrician, had patients who lived in nursing homes, and he realized “that the medicines I was prescribing were not treating the true source of suffering, which was loneliness”.
Examples in Australia
It is based around groups of 16 residents. This project demonstrates that you can deliver a small home model within the current funding structures.
The outcomes for individual residents have been significant and research continues to be done to map out these benefits.
If we consider one of the residents there called “Margaret”. She is not only enjoying a more comfortable living environment, but she has also seen an overall improvement to her quality of life; her family are staying longer when they visit.
Margaret attributes this to the non-clinical feel of Gaynes Park Manor. The grandkids have told their parents they don’t mind visiting now, because Granny isn’t living in a hospital anymore.
Business options to downsize and ‘big box’
If large facilities need to downsize their accommodation we may be left with excess space in current big facilities.
One solution is to provide a more diverse accommodation product mix, with a bigger focus on true ageing in place and a continuum of care, plus the creation of health and wellness hubs to support a range of community needs. The Royal Commission recognises this. See Recommendation 47.
It suggests opportunities for the co-location of health facilities. This is certainly an avenue for some more creative developments and partnerships, broadening the business base for aged care and better meeting the needs of residents.
The recent impacts of the COVID pandemic have also directed attention to smaller household models. When the facility is operating in an infection control mode, the smaller household units can be more easily be isolated and separated.
Marchese Partners has been helping a number of organisations revisit their design briefs in a holistic way to map out how COVID may change requirements through the building.
Can 200 bed facilities achieve ‘small house’ outcomes within the design standards of the future?
It is possible to structure the current developments in a way that can move towards this goal.
Our focus should turn to allowing residents to control their own environment to the best of their ability. Rather than design an operation around “needs”, we can turn this focus onto designing around “abilities”.
The environment and the carers can become facilitators of care within a domestic setting, rather than providers.
Here are some key elements we can consider:
- emphasise the home like environment through scale and detail
- create social and personal destination places beyond the “residential home unit”
- enable a resident’s personal choice in controlling their physical environment
- provide clear transitions between public and private zones
- access outdoor spaces from all levels of a building.
- make all care functionality recessive and discreet
- make staff bases/nooks on the floor discreet
- consider resident wayfinding
- remove passage handrails
In summary, we can all start now by engaging with best practice models that already exist.
The Royal Commission Interim Report states in its conclusion:
“Most of all, however, we will continue to benefit from the insights of older people and their friends and family. Their voices are fundamental to our ability to design a system that puts older people at the centre of aged care services.”
Our challenge now is to facilitate the creation of living environments to adequately support these goals.