This article was written and contributed by Dr Ralph Hampson who turned his passion for aged care into a Melbourne PhD which explored the role of the built environment on the quality of life of people who live in residential aged care facilities. Ralph now has his own consultancy.

Have you ever thought about how difficult it is to reduce your life from a 3 bedroom family home to one room? Nearly all older people and their carers have to face this when they have to enter residential aged care. And it doesn’t stop there. The older person will now have to eat in a dining room and share lounges and sitting rooms and activity spaces. Typically, they will no longer have access to a kitchen or laundry. This is not an easy transition for anyone.

It is fundamentally important that we build facilities where every resident has a ‘room of their own’.  Now I can hear you say but there are some people who want to share. Clever design can create rooms that interlock, just like in a modern motel, so you can choose to share. Perhaps if you can remember back to your experiences of shared houses in your youth – this will be a no brainer to most of you.

While research in the field of aged care design is relatively new, there is mounting evidence about the impact of the built environment on people’s health. The majority of older people want a room with a private bathroom … and this is what their partners and children want for them too. If providers want to remain relevant to the surge of baby boomers coming their way, firstly as carers and advocates for their own parents, and then for themselves, they ought to pay much more attention design.

Let me give you one example to illuminate what lies ahead. I have a friend who was a nurse in a residential care facility some 30 years ago and she told me in those days “the residents all got white tea with two sugars”. Let’s go forward a decade or so and imagine residents at morning tea asking for a long black, a cappuccino, herbal tea, a macchiato, a hot chocolate, or a chai tea. Their visitors, carers and staff will also want this too. So installing espresso machines may future proof today’s facilities and indeed make them more marketable.

The same goes for internet access, cable television, easy access to outside areas, a gym, a hairdressing salon and a cafe.To be successful in the medium to long term providers need to change their mindsets from creating a home based on the notion that older people are passive recipients of health care [who should be grateful] to one that recognises that residents are consumers and their needs are multifaceted. This may sound easy but is much harder in practice. Let’s consider a few examples.

Storage! A resident reported that she said to the manager, “I need more space for my clothes,” he replied “you’re in a facility now so you won’t need so many clothes.” The resident was outraged. So she and a friend went out to the local department store and ordered some drawers to be delivered, without seeking permission from the manager, so when the truck arrived it was a shock to the manager. But the residents figured that once they were delivered there was little the manager would be able to do. As this feisty resident put it, “I have paid them a $150K bond for this room and I can do what I like inside these four walls.” And if we are genuine in our commitment to choice and autonomy – she makes an excellent point!

Another resident commented, “We used to have gardens with fresh flowers and a duck pond, but that all went and now we plants that are low maintenance, without colour and the duck pond was removed.” Access to outside areas and views has been shown to be beneficial for everyone, and this is especially for those in long term care facilities.

The built environment is so important to all our lives – it provides a space that can constrain or liberate us. Funding for aged care needs to recognise that all older people who require residential care have a right to live in an environment that is liberating – not just those who can afford it. This must be seen as a ‘human right’ rather than a ‘nice to have’.

It is not all bad news though. Some providers are designing facilities that enable older people to remain engaged and active – two important factors clearly linked to mental well being. The NSW Benevolent Society’s “Apartments for Life” is an example of an organisation prepared to think differently, take risks and understand that the current model has severe limitations. They are a leader in the field, if you would like to learn more click here.

Dr Bill Thomas, an advocate for better aged care, a man with a vision points out eloquently Green Houses, which he developed, de-institutionalize nursing home life and provide an environment where elders engage in meaningful life activities, eliminating the plagues of "loneliness, helplessness and boredom". The idea is to deliver care and services in a facility that is home, not “home-like.” If you would like to hear and see Bill talk about his work follow this link.

The baby boomers are here and they want better for their parents and they will want better for themselves.

It is important that we support people and organisations who are doing new and innovative things because more of the same just wont cut it.