Ideal physical environment

Aged care environments can be delightful, homely and a great support, or they can be a huge problem. Modern aged care homes are often built to look and feel like hotels. They do not feel like home. Many aged care homes also create more behavioural problems than they solve. This article will explore three problems with modern aged care homes and what we can do about them.

Hotels are great for short stays. They are special, modern and do extra things for you that you don’t get at home. However, I don’t want to live in one. Not many older people I know want to live in a hotel either. They want to live in their own home. However, this is sometimes not possible when they become frail of mind or body. Then they and their families face the stressful ordeal of deciding where to go next for the care they require.

They want continuity with their old lives and if the new place provides this they often settle better. They also want privacy and protection, to feel safe and secure. They want to be valued and feel like they belong and are important to the people who care for them. This psychological/emotional bonding is crucial for a good transition to a new home. Hotels do not generally provide this. So we come to an important point about the ideal aged care home. It should be homelike in look and feel and it should be staffed by people who have the capacity and motivation to bond with and care about the older people in their care. Sounds simple right. Yep, and so difficult to achieve.

The ideal physical environment for the care of older people is a smallish grouping of up to 10 people, with ample room for outside walking and recreation, simple to negotiate inside, comfortable to sit in for long periods, family style dining and doorways and corridors wide enough for the lifting and wheeling machinery that we will need from time to time. It should look and feel and smell like a home.

Many aged care homes are built for staff convenience and not for resident comfort. The nursing focus in aged care homes is for staff convenience, the placement of beds, the placement of toilet doors, the presence of medication trolleys at mealtime and the large nurses stations that place barriers between residents and staff are more for staff convenience than for resident comfort and wellbeing.

The toilet door should face the resident’s bed so they can see the bed in the middle of the night when they wake and look for the toilet. many episodes of incontinence and falling in the night will be avoided. Medication trolleys do not have to be placed in the eating are during mealtimes. Most medications do not have to be given with food. This is organised for staff convenience mainly. Keep the trolleys out of the dining space. It should be regarded as if it was a restaurant. See how this changes your perception of what you do in it and how you deliver food and act toward the customers you serve!

Dead ends in the corridors should be eliminated so that people with dementia do not become overwhelmed when they are prevented from passing through a locked door. Eliminate locked doors by providing loop paths that lead people back into the safe areas. This can be achieved with paths and covered verandas and thoughtful and obscure security measures that do not interfere with the person’s daily life.

The third problem is that staff often treat the care home as if it is their workplace and the residents have to fit in. This is a chronic hangover from the hospital culture that aged care has inherited from the acute sector. An aged care home is just that – their home. It is also the staff workplace but that is secondary to the primary purpose. The staff purpose in their work is to be their to make a homely experience possible – not to get their work done. If they get their work done that is a side-effect of making life homely.

Person-centred care is often referred to these days as the gold standard of care for older people and especially those with dementia. In this instance I believe person-centred care is what I cam talking about. The person comes first and last. The purpose of staff work is to facilitate resident wellbeing – not to get their jobs done.

These three problems can be remedied by focusing on the strategies I have identified. These among many others can be a beginning in reflecting thoughtfully on the care we provide to our elders.