Aged care – designing for care, dignity and respect

Reading the report of the Royal Commission into Aged Care is confronting. It casts a harsh light on the way financial drivers have overtaken the fundamental responsibility to provide wellbeing and safety for some of the most vulnerable people in our community.

When the report authors conclude that the overwhelming majority of stakeholders want to see an aged care system that provides for care, dignity and respect
it seems such a basic and reasonable request. After all, what is aged care even for if it is not providing those things?

As multidisciplinary engineers and sustainability consultants, we have both a moral and a professional obligation to apply our expertise and creativity to help change aged care for the better. That applies whether we contribute to masterplanning, ESD guidelines and building services design for new build facilities or whether we are advising on and designing for upgrades and retrofits to bring existing facilities up to a suitable standard.

While the overarching goals can be summed up in the words “care, dignity and respect” the delivery of those things in the context of how aged care is designed, built, operated and maintained into the future is a multifaceted undertaking.

To do the topic justice, we will draw on insights and expertise from a range of disciplines and professional specialisms with Cundall for a series of blogs.

We take as our starting place the report’s observation that the design of facilities plays a major role in quality of life for residents.

“Where older people live affects their sense of security and their quality of life. Accommodation that is well designed to meet people’s needs can improve their lives and their wellbeing,” the report stated.

The word “live” is crucial – people in aged care have as much right to a fulfilling, comfortable, engaged existence as any other group of persons. It cannot simply be regarded as an end-of-life waiting room. The average length of stay in residential aged care in 2017-18 was 30 months – two and a half years. Many people live in facilities for far longer – around 40% of people are in residential aged care for 5.9 years or longer.

We recognise the same measures that deliver enhanced occupant experiences in commercial offices such as natural light, natural ventilation, thermal comfort, acoustic quality and non-toxic materials also have a place in aged care design.

Before now, cost-cutting may have been responsible for the poor design of many facilities. The irony is this form of cost cutting, which is focused on the cheapest possible build and minimised consultant input, can result in facilities that have high operational costs for energy and water.

This is contrary to core principle 6 of the Royal Commission’s new agenda for aged care, which states that the aged care system should be “adequately funded, resilient and enduring”.

The word 'live' is crucial – people in aged care have as much right to a fulfilling, comfortable, engaged existence as any other group of persons. It cannot simply be regarded as an end-of-life waiting room. The average length of stay in residential aged care in 2017-18 was 30 months – two and a half years. Many people live in facilities for far longer – around 40% of people are in residential aged care for 5.9 years or longer.

We recognise the same measures that deliver enhanced occupant experiences in commercial offices such as natural light, natural ventilation, thermal comfort, acoustic quality and non-toxic materials also have a place in aged care design.

Before now, cost-cutting may have been responsible for the poor design of many facilities. The irony is this form of cost cutting, which is focused on the cheapest possible build and minimised consultant input, can result in facilities that have high operational costs for energy and water. This is contrary to core principle 6 of the Royal Commission’s new agenda for aged care, which states that the aged care system should be “adequately funded, resilient and enduring”.

Operational costs for energy and water have a direct impact on the adequacy of funding. The quality of passive design measures and the energy system design directly impacts resilience, including resilience to impacts from climate change including more frequent and prolonged heatwaves. Quality of delivery, robustness of materials and the ability to recruit and retain the human capital of committed staff is an aspect of endurance we should not neglect.

We need to acknowledge aged care is in many unavoidable ways a stressful environment both for carers and for the cared for. There are ways the quality of the buildings can help mitigate this. It is now broadly accepted that natural light, high levels of natural ventilation and eliminating volatile organic compounds (VOCs) all help reduce stress, enhance cognitive function and have benefits for emotional and physical wellbeing.

These fundamental sustainability initiatives are recognised and valued in premium commercial offices for their positive impact on workplace health and wellbeing – and this is something that must be considered for the aged care workplace.

Above all, those designing, constructing and operating aged care need to see aged care not as a place other people go, but as a place we ourselves will very possibly need one day. We need to recognise it is our friends and family who will be there. We need to design for others, as we would wish to design for ourselves.

This comment by Commissioner Lynell Briggs in the final report sums it up:

“Life is to be lived. No matter how old we are, how frail or incapacitated we might be, how rich or poor, we all have the fundamental right to wellbeing, enjoyment and fulfilment as we age.”