Australia, like the rest of the world, has an ageing population. Over the 20 years between 1999 and 2019, the proportion of the population aged 65 years and over increased from 12.3% to 15.9% and is projected to increase more rapidly over the next decade (Australian Bureau of Statistics, 2019).
On 26 February 2021, the Royal Commission released its final report into Aged Care Quality and Safety. In 2019, there were 4.2 people aged between 15-64 for every person aged 65 years or over. However, this number is expected to decrease to 3.1 people by 2058.
Although many people choose to age in their own homes, for others it is not an option and they must age in residential care. Sadly, more than half of Australia’s aged care residents suffer from dementia. It has long been acknowledged that well designed accommodation can improve people’s lives and well-being, particularly those suffering from dementia. The Royal Commission’s report looked in depth at the issues facing Australia’s aged care system, and acknowledged the impact of the built environment on the lives of the elderly, many of whom suffer dementia and alzheimer’s. Whilst acknowledging that “[w]here older people live affects their sense of security and their quality of life,” the Report stopped short of making the suggested national aged care design principles and guidelines mandatory. Instead, it recommended a needs-based approach and the creation of “familiar households” which facilitate the provision of person-centred care.
This recommendation has both an evidential and philosophical base. From an evidential point of view, Globally, it has been recognised that experiencing lived space which is familiar, safe and secure impacts on the elderly’s social relationships, identity and autonomy, thereby improving quality of life. The Scandinavian concept of “homelikeness” has been developed in the context of both small household models and in public housing.
There has long been philosophical discussion about the significance of the home. There is a relationshio of duality between person and place, emphasising the symbiotic role between individuals and the environments where they reside. For Bachelard, the house is a shelter, without which a person’s identity is diffused. He writes, in Poetics of Space, that “our house is the corner of our world” and that “all really inhabited space bears the essence of the notion of home.”
Bachelard’s observations can be seen to be particularly relevant to the design of aged care, dementia and alzheimer’s accommodation. He writes that “the house of memories becomes psychologically complex … The house we were born in is an inhabited house” and “is physically inscribed in us. It is a group of organic habits.”
The house therefore becomes the repository of an individual’s past, present and future, allowing memories, thoughts and dreams to coalesce and shape his or her identity. As Bachelard writes, “[t]he house we were born in is more than an embodiment of home, it is also an embodiment of dreams. Each one of its nooks and crannies was a resting-place for daydreaming. Therefore, the places in which we have experienced daydreaming reconstitute themselves in a new daydream, and it is because our memories of former dwelling-places are relived as day-dreams that these dwelling-places of the past remain in us for all time.”
A person’s interaction with space creates a place by appropriating that space to personal needs (Lefebvre, 1991) and the home becomes an environment that is created to be a personal refuge adjusted to an individual’s needs (Östberg, 1906). If a person feels ‘inside a place’ then they feel a sense of inclusion, security and safety resulting in a stronger sense of identity. And, conversely, if a person feels separated or alienated from place, they can feel excluded, lonely and isolated which can undermine his or her sense of well-being. (Relph, 1976). Relph’s contrasting notions of insideness and placelessness are particularly relevant to the elderly.
In this context, a person’s home is psychologically resonant – the kitchen, the hearth. If design focuses on these aspects, on the familiar and the reassuring, as Ken Worpole writes (albeit in the context of hospice care) “places of helpless waiting are re-fashioned … as places of contemplation and a gathering-in of memory and self-discovery.”
In other countries, there has been a shift away from institutional types of residential age care towards lower-density, needs based care. In the Netherlands, 152 residents suffering dementia live in Hogeweyk, a nursing home disguised to look like the outside world, where cognitive delay and disfunction is mitigated by providing community-based accommodation in houses designed according to residents’ prior lifestyles. And in the United States, the Green House Project aims to normalise the residential setting for its residents and has seen residents achieve better health and function better on a daily basis than those in institutional aged care.
Typically, Australian aged care facilities, like hospitals, have been based on a medical model, often focussing more on the needs of the staff than the residents. However, recent projects have suggested a shift, following the Scandinavian models of “homelikeness” and focussing more on the resident and lifestyle model complemented by clinical care. In embracing the familiar, Cykel Architecture’s Korongee Dementia Village in Glenorchy, Tasmania, reflects the model adopted by Hogeweyk. The built form is informed by the local vernacular and has been designed to reflect the typical Australian suburban living experienced by residents prior to the onset of dementia. Like Hogeweyk, Australia’s first dementia village is imbued with authenticity and includes a general store, community centre and numerous outdoor areas.
Korongee Arial Photo. (Image: https://www.abc.net.au/news/2020-07-10/inside-hobart-dementia-village/12434416)
Used as a case study of the small house model in the 2020 World Alzheimer Report, Korongee Village signifies a shift in the way in which aged care, and dementia facilities are designed in Australia. A modern, functional interpretation of Bachelard’s concept of home, and the introduction of other factors such as daylight, wayfinding and multi-generational living, will enable our ageing population to receive the care they need in an environment that is familiar.
References:
Bachelard, Gaston. 1969. Poetics of Space. Boston: Beacon Press.
Lefebvre, Henri. 1991. The Production of Space. Oxford, England: Blackwell.
Ostgerg, Ragnar. 1906. Ett Hem (“A Home”). Stockholm, Sweden: Albert Bonniers Förlag.
Relph, Edward. 1976. Place and Placelessness. London: Pion.
Worpole, Ken. 2009. The Poetics of Space by Gaston Bachelard. The Independent (https://search-proquest-com.ezproxy.library.uwa.edu.au/newspapers/poetics-space-gaston-bachelard/docview/309978018/se-2?accountid=14681)