Unpacking the draft Aged Care Design Principles: Questions and Concerns

Professor Richard Fleming

Professor Richard Fleming is a psychologist and environmental design expert with more than 35 years experience in the development of services for people living with dementia.

The Department of Health and Aged Care is making a serious effort to respond to recommendation 45 of the Royal Commission into Aged Care Quality and Safety – Improving the Design of aged care accommodation. The release of the ‘Final report on the development of the draft National Aged Care Design Principles and Guidelines are an important step in this process. As the title indicates, this is a draft document, and the Department is engaged in a consultation process to test and refine the principles and guidelines.

The document deserves to be read carefully – it can be found here. It is the result of a great deal of work. However, it is a document that needs testing and refinement. It tries to do too much, and the result is a document that will raise many questions from key stakeholders. I have attempted to predict some of the more obvious questions here.

Aged care providers are likely to question the substantial emphasis on the ‘small household model’. While this model has great currency in the provision of care to mobile people living with dementia there is no consensus, or conclusive research, on its broader application in residential aged care.

Aged care providers may ask why they are being advised that this is the model of design that will set the standard that they will be judged on in years to come.

The document presents four Design Principles:

– Enable the person
– Cultivate a Home
– Access to Outdoors
– Connect with Community

Architects and designers may ask in what way are these design principles? No definition of a principle is offered in the document. The most usual definition of a principle used in the explanation of how to do something, e.g. design a building, looks something like these:

The Design Principles in this document do not follow these examples, they are more clearly aligned to goals than principles. This may seem academic but the adoption of these as principles puts this document in opposition to the existing Australian literature and resources on environmental design which is largely based on a well-accepted list of ten principles. Architects and designers may ask whether they should abandon the existing principles in favour of these ill-defined ‘principles’.

They may also ask about the nature of the ‘checklist of potential practical changes that may be adopted’. Where did these come from, they are not linked to any research findings and many seem to be quite divorced from design considerations, e.g. chosen almost at random, under Guideline 1.11 Comfortable Temperatures, Checklist item 2 is ‘Ask residents whether they are comfortable in living areas and bedrooms and adjust the system accordingly.’ Is this a design guideline?

Educational and training organisations like Dementia Training Australia, Dementia Australia, Alzheimer’s WA, and Dementia Support Australia have spent hundreds of thousands of dollars on developing an internationally acclaimed collection of textual, audiovisual, app-based and virtual reality resources using the existing principles of design, may ask if they are expected to leave these resources, often taxpayer-funded, behind and develop new resources in keeping with these ‘new principles’.

While the document is described as being informed by consultation with a wide variety of user groups some may ask why the photographs illustrating good design are entirely of the middle class, urban, European heritage facilities and why the ‘small household model’ as described in this document seems to be based on a similarly European idea of home. In this era of co-design some may also ask if there was a representative of aged care residents, perhaps someone with a lived experience of dementia as they make up 57% of the residents of aged care, actively involved in the drafting of the guidelines.

Academics, particularly those who are proud of the contribution that Australian scholarship has made to international research in designing for people living with dementia, may ask about the literature review that supports the claim that the document is evidence-based. They may also ask for evidence that the principles and guidelines offered in this document are an improvement on those currently referred to in the Revised Aged Care Quality Standards.

There are many more questions that can be asked of this document, and it is important that they are asked. I am sure the Department wants a document that it can have confidence in, and I hope that the process of consultation currently underway will lead to that outcome. Feedback can be provided here.

My personal hope is that the outcome will be a simpler, shorter document that states the goals of designing well (Enabling the person, Cultivating a Home, Providing Access to Outdoors, and Connecting with the Community), clearly describes a set of evidence-based principles and their relationships to the goals, illustrates their application to a variety of cultures and stops short of micro-managing the designer and operator with checklists.


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