Aged care facilities have been at the centre of the Covid crisis. Here’s how their design can change to lessen risk.

With the elderly community most at risk, seniors’ housing for retirement living and aged care is at the coalface of change to manage COVID-19 and any future infectious diseases.

For the past few months, the focus of seniors’ living providers, especially those offering residential aged care, has been literally on staying alive and protecting their staff and residents with separation measures.

Aged-care facilities have had a no-visiting policy for some time now, and providers like Adventist Care have needed to get inventive, offering video calling between residents and their families, and, for on-site residents, personal contact through an open window where safe distances are controlled.

For those residents who are deemed near the end of their life relatives are permitted to enter the room under very strict conditions and spend time with their loved ones.

In Western Australia retirement living – or independent living units (ILUs – has not been in full lockdown, however, common amenities have been closed, activities temporarily ceased, and all residents have been encouraged to self-isolate.

For example the Australis for Adventist Care has been operating essentially as a block of apartments offering accommodation only, with no socialising. This is in direct contrast to the intent and design of the place.

While sheltering a community’s aged-resident population in their rooms or homes protects them and gives them peace of mind during a pandemic, it also comes with a cost to operators and residents who rely on socialisation to keep their communities vibrant and flourishing.

Future designs will need to seek solutions to safely maximise interaction with the outside world even during a quarantine situation. “The cost needs to be focused on our clients, the resident,” according to Gary Blagden, chief executive of Adventist Care.

“Yes, there is a cost to the provider, however, a service-orientated provider will want to deliver outcomes that are client focused. Therefore, issues of isolation should be seen from the perspective of the resident.

“Mental health is a concern when seniors can’t engage with their peers and families. Loneliness is already a feature of senior living that underlays the reason for senior communities. The loss of socialisation, looking out for each other and peer support is the big cost.”

To avoid community-wide disruptions in the future, more providers may choose to adopt designs that emphasise the use of separated neighbourhoods, where residents can live, socialise and dine together in smaller groups.

For example, communities with compact pocket neighbourhoods could work well, areas that could be easily cordoned off in the event of a future epidemic or pandemic, without bringing the entire community to a halt.

Blagden imagines an ILU apartment facility designed like a donut, where rear balconies allowed residents to interact with each other over a void, such as a pleasant green area. This would limit the feelings of human isolation and provide a positive level of “neighbourhood watch”.

This is an interesting suggestion, and indeed a typology that has been used in other situations, one of the best examples being the Tietgen Dormitory, a residential college in Copenhagen, Denmark. Designed by Lundgaard & Tranberg Architects, it creates a wonderful scale of space and one which encourages you to linger and relax.

This idea can easily be transferred to seniors’ living, showing an interest in creating an environment that is community-focused, rather than isolated and inward-looking. Indeed, the idea and form are part of the future stages at Adventist Care’s Rossmoyne Waters, where buildings are laid out looking down onto a central village green.

In the case of residential aged care, additional measures could include breaking down facilities into 16-bed households or smaller, to enable a manageable environment.

However, the response to the current pandemic should not be to overreact and design for quarantinable buildings – no one wants to live in a hospital for the last years of their lives.

Other changes to the sector following COVID-19 could include:

  1. future residents demanding larger units. As a result of the pandemic, they may be interested in units that are better well-suited for sheltering in place, with ample access to a large, private outdoor area. Suburban-scale villas may become more popular, rather than small apartments.
  2. converting utility rooms in residential aged care to provide sleeping cubicles for staff to stay overnight. “This is something we have recently seen as a need,” says Gary Blagden. “If we get COVID-19 infected residents, we will need to isolate them and have dedicated staff who only work with those residents around the clock.”
  3. architects and designers working with new materials that are either antimicrobial or are easily cleaned. In the future, suppliers will look to make flooring, furniture, accessories, countertops, cabinets, handrails and doors more resistant to pathogens like COVID-19, and cleaning equipment and methodologies may also need to adapt.
  4. better air filtration and purification, possibly driven by future changes in air-quality codes.
  5. more high-tech senior-living communities, with virtual socialisation, technology support and clear communication systems in place so residents can ask questions and feel more comfortable.
  6. technology that allows residents to navigate communities without pressing buttons or grabbing handles. This could be accomplished through motion controls, which are already in use in some senior living environments. “I believe this is a major consideration,” says Gary Blagden. “There is considerable cost and effort to keep decontaminating surfaces.”
  7. facilitation of in-person visits during times of outbreaks, via a dedicated “clean room” – two adjacent rooms separated by a glass partition and equipped with an intercom system or even mobile phones. Staff would then sanitise the room after each use.

The emphasis must be on separation as opposed to isolation. Isolation means no socialisation, which leads to loneliness and depression; separation means distance but “I can still see and hear you!”

Ultimately, it’s the difference between taking sensible precautions against infectious disease and substituting one kind of risk for another one entirely.

Gary Mackintosh is associate director, seniors living leader at Hames Sharley, which designed the Australis for Adventist Care in Western Australia mentioned in the article.

If you would like to contribute to Spinifex please send a note to editorial@thefifthestate.com.au

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