Conversations in Aged Care: The Enlightened Layman

There is, perhaps, no greater time of insecurity in a person’s life than when they – or their family – have to make the choice to move to an assisted living facility. We seem to have a cultural horror for these places – I’m always reminded of the film Gran Torino when Clint Eastwood sends his family packing after they suggest he is too old to live at home and should move to one of the new ‘communities’ – paired with innocuous pamphlets. We celebrate his tenacity and victory over this insidious threat. There seems to be an unwritten rule that a facility such as this is nothing but a death sentence. But whether it is due to cognitive or physical degeneration, the home that once sheltered a person can become the greatest danger in their lives, and assisted living facilities are often the best choice in this time of changing needs.

Although clean well kept, this Victorian aged care facility still speaks of the dreaded ‘institution’

I spoke with 3 people (Suzi, Leeanne, and Christina) who have each recently undertaken the arduous process of touring, selecting and applying for the many aged care facilities that are available throughout Perth. Between them, the search stretched from Yanchep to Busselton and included more than 15 facilities. I asked them about their overall impressions. Suzi, who was looking at facilities for an aunt, told me “Most new ones look the same, feel too big, have little garden space because they try to fit too much on the site and if they are more than 1 storey high, there is little or no outdoor areas accessible by residents. The older style places are pretty depressing but their saving grace is they are single storey and tend to be smaller and more homelike (if any aged care can be categorised as homelike).” Her final parenthesis was the most telling of all. All the research suggests that the familiarity – the homeliness – of an environment is crucial to the health of its residents (here I would recommend Alzheimer WA’s Dementia Enabling Environment Project for further reading). But Perth doesn’t have to look far for good examples. The Tasmanian development of Korongee (modelled on the De Hogeweyk village in the Netherlands) is a “care village” that has been constructed to simulate real life and stimulate its residents into engaging with their surrounds.

Each outdoor space at De Hogeweyk has its own purpose, such as theatre or shopping

The other priority that came to the fore in my conversations was the importance of socialisation. We are increasingly aware of the harmful effects that can result from isolation from immediate family and the larger community. Leeanne – who was looking for a place for her mother – emphasised that the facility that stood out to her was “set up to get you out of your bedroom and mixing with other residents,” and “right in the middle of suburbia.” Christina echoed these sentiments for her mother as well. Maintaining socialisation, connectedness and a greater purpose has been shown to increase the life-span of the elderly. In the aged care space, this has resulted in a push to more intergenerational facilities. The most iconic example is the Residential and Care Center Humanitas in the Netherlands (established in 2008). They offer cheap accommodation to university-age students (alongside the older residents) in exchange for their time – they volunteer, share experiences and swap stories. Now that Perth residents and their families have greater expectations, we can expect to see these models appear.

A resident and their student neighbour in the Humanitas community

So Perth has any number of trail-blazing models to follow. Instead of simply applying superficial changes to an existing structure, we must innovate our designs to affect genuine change. And Perth, it seems, is ready to embrace this change.