Consumer

Home, sweet home

^{Dr Ralph Hampson | APRIL/MAY 2009}

What makes a ‘good’ aged care facility and how we build better homes? Dr Ralph Hampson is an aged care consultant who studies the impact the built environment on has on people. He explains what makes a nursing home pleasant or otherwise.

I visited a nursing home in a small, rural town: the facility was dismal, it looked like an ageing hospital, with metal framed hospital beds, crowded corridors, a barren outdoor area, old and tired furniture and a lounge room that was so small it could not hold a family, let alone a group of residents. I was shocked, and at the time commented to a colleague: I wouldn’t put a dog in there!

This really disturbed me and I began to wonder about what the residents who actually lived in hostels and nursing homes really thought about the built environment. So began my journey about eight years ago to find out what residents thought.

How many people live in residential care facilities? What does it cost?

On any given day, about 160,000 Australians live in nursing homes and hostels. Michael Fine from Macquarie University wrote in 2007 that the cost of providing residential aged care in Australia will rise from the present cost of around $6.6 billion to an estimated $52 billion a year in 2032-33 because of the ageing of the baby boomers. Funding for residential aged care services, despite the increased focus on community care, continues to dwarf all other allocations to aged care services.

And while many of us think we will not end our lives in a nursing home it is clear from work undertaken by the Australian Institute of Health and Welfare that that the longer we live, the more likely we are to see out our days in an aged care facility.

Let’s build the best facilities we can

Everyone gets older. This means it is in everyone’s business to plan for a better future with the best facilities possible. But who decides this? In my research I discovered that very rarely have the actual residents who live in nursing homes and hostels been asked about their experiences and what they would like to have in their last ‘home’. So I decided to explore what residents who lived in these facilities thought. Seventeen women and six men participated in the study from three different facilities, two in metropolitan Melbourne and one in a rural town.

The residents participated enthusiastically and had strong views about what they liked and what they wanted to improve about the design of the facilities they lived in. The key thing they valued was having their own room with a private ensuite – this provided them with privacy and respected their dignity (as some of the participants had or were currently having to share bathroom facilities).

One of the interesting things that emerged from our discussions was how the little things matter. As one group began a resident handed me the note below:
Laura [not her real name] had clearly thought about the issues before the group began and had some clear views which wanted to be heard. What her note illustrates that your quality of life can be impacted on by the smallest things in the design of a building.

For example, if the toilets are too low, then it is difficult to use them, which may mean you have to be assisted by a personal carer – reducing your independence and privacy. If the lighting is poor then it is hard to read or use a computer. If the TV or radio reception is bad this can impact on your quality of life. In your own home, if the TV was blurry or the radio crackling, you wouldn’t put up with it. These little things are important to all of us in our everyday lives.

Storage is another major concern. Often, residents report that their rooms are often not big enough to hold enough of their special things. In some facilities, there are rules about what furniture residents may have in their rooms. One example that sticks in my mind is of a man who really missed his favourite chair which he had been told was ‘not suitable’. Something as basic as a chair meant a lot to him, and would certainly have made the place feel more like home. A good question to ask is what rights do residents have to paint their rooms, put up different curtains – make it their own space. One resident said: I’m paying rent for these four walls and I should be able to put things on the wall that I want!

Here are some real examples of things residents wished their nursing home had:

A wardrobe big enough yo hold my clothes with a light	A photo board at the entrance
A say in the furniture I can have in my room	Be able to watch my clothes dry in the wind
My own private bathroom	Fresh flowers
Good television and radio reception	A glass of wine with dinner
Some garden seats and planter boxes	Clean windows
Net curtains	Better food
Care and cleanliness	A little dog
A game of Scrabble	Space for my computer

Buildings can helpful or unhelpful in helping us to stay independent and active

The residents fundamentally wanted the facility to help them remain as independent and active as possible by making it easy for them to get around, providing easy access to gardens and outside areas, and a facility that was inviting to their family and friends. Interestingly they also voiced a concern that management needed to listen to, understand and respect their ideas, requests and concerns.

The residents talked about how great the front line staff were in providing daily care – but they did think things could be better for them and the staff who cared for them if improvements were made to the built environment. Without exception the residents I spoke with had ideas and views that could be used as a resource to help us design better facilities in the future. Residents wanted to have a say and engage in shaping their lives, rather than being viewed as grateful recipients of care, who were ‘past it’.

To illustrate this practically none of the literature and research I reviewed mentioned putting a light in the wardrobe so the resident could see their clothes, especially as most residents will have poor vision. This simple design feature can have a profound impact on the resident’s quality of life – and it was a resident who pointed this out – this confirmed to me that the residents’ experiences and voices are an untapped resource.

Brian Kidd, an Australian architect and pioneer is this area got it right when he said in 1993 the nursing home has to be designed and built in a way that can support and challenge the resident who is frail and ambulant, while at the same time delighting the senses of the person who is bedridden, and also providing security and reducing risk for the person with dementia. This is the task we face in building nursing homes for the future.

This is no easy task but I think we could do it better – by consulting the people who currently live in these facilities as consultants alongside architects, nurses, accountants, families and investors. Building nursing homes costs a lot of money and once they are built it is difficult and expensive to renovate or rebuild – good planning and robust discussion by all stakeholders needs to be encouraged and facilitated before we commit our ideas into concrete (a very inflexible material). This may also encourage new ideas and approaches. Daring and imagination are needed if we are to build the facilities we will want to live in.