The old model for residential aged and dementia care comprised of a sombre, hospital-style facility, a sterile environment scented with disinfectant, and lacking in vibrancy and inspiration.
The future, however, is looking different. Instead of taking cues from hospitals, architects and aged care providers are drawing inspiration from villages, farms and exclusive hotels.
Gary Mackintosh, Associate Director at Hames Sharley, said that the core of this new approach is a shift in expectations.
“Expectations have changed drastically in the last decade,” he said.
“People are living longer with dementia, their families are seeking a better quality of life for them, and with more people needing these services, aged care providers are needing to raise their standards and differentiate their products.”
There are currently more than 350,000 Australians living with dementia, with that number expected to exceed 400,000 in less than five years.
Although many people with dementia are able to remain at home with support, many will eventually require residential care.
Farms, villages and hotels
One of the pioneers of dementia care can be found in Hogewey, Holland, and is commonly referred to as ‘Dementiaville’ because the community has been created as a village, allowing the residents to live without locks, with minimal medication, in their own homes, and doing daily things they love – including shopping, cooking, going to movies and visiting the barber or hairdresser.
Now 20 years old, Hogewey started out as a standard care home, with wards of 20 people sitting around watching TV and doing very little. According to founder Yvonne van Amerongen: “It wasn’t living. It was a kind of dying.”
Hogewey (Dementiaville) takes residents back to their heyday before dementia eroded any sense of identity. And the most impressive part? The treatment has been widely recognised as effective, despite the controversy surrounding the creation of the village two decades prior. The villages cater to the times of the residents’ best years; so 50s through 80s decorations and way of life are the norm.
“When we make up a home, there are different mood boards for decorating according to the lifestyle of the people concerned,” says Yvonne. “The mood boards create a feeling of the familiar, the safe. The family helps us choose.”
In Singapore, Spark Architects have been working on a unique design for elderly residents, bringing together a high-density apartment block with a vertical farm.
Addressing both the ageing population and food scarcity, SPARK, unveiled its ‘Home Farm’ project which integrates vertical aquaponic farming and rooftop soil planting with high-density housing designed for seniors that provides residents with a desirable garden environment and opportunities for post-retirement employment.
Home Farm is imagined as a private rather than public entity, but one that is within the reach of seniors who encounter financial stress. The architecture has been conceived for economic construction using simple materials and modular parts. The concept offers multi-dimensional benefits related to economics, food security and quality, social engagement, health, sustainability, placemaking, and healthcare provision.
In the United States, one trend is for aged care facilities to be smaller and similar in design to a modern boutique hotel. The Green House Project in New Jersey has taken four elegant homes in a tree-lined suburban street and created space for ten residents, in a vibe that is more a hotel than a hospital.
Each Green House home is designed to look like other homes in the community and it is not obvious that it is a fenced-off property and that the residents are locked in their homes. At night, deer walk through the area. The home setup is a bit like a communal house that university students would live in – there is plenty of seating, reading material and art on the walls. The living rooms have enough space for exercise and plenty of couches that can pull out as beds for family members who may want to stay the night or aides who can’t get home because of bad weather.
The right models for Australia
Having recently visited a number of aged care facilities in Perth for a close family member, Gary says it was a reminder of just how important design is for residents and their families.
“It was an opportunity to really put myself in the shoes of the resident and a realisation that people spend 24 hours a day in these facilities, sometimes for many years,” he said.
“The international trends are inspiring, but we need designs that resonate with an Australian way of life, and which meet the specific needs of elderly residents with dementia.”
What types of spaces do dementia care patients need?
According to Jeevan Krishnan, an architect specialising in aged care design at Hames Sharley, designing residential care for dementia patients requires a level of sophistication beyond taking the best elements of apartment and hotel design.
“There are three principles which are particularly important,” he said. “The first is creating calm and familiar spaces. It means designing spaces that are more like a home and paying careful attention to how the residents’ rooms are clustered together to create smaller more intimate communities.
“Secondly, we are trying to create a calm environment, taking account of everything from reducing traffic noise to getting the size of the rooms right and creating small and comfortable communal spaces for exercise and socialising.
“Finally, it is really important to have a connection between indoors and outdoors. It’s how Australians like to live and we all feel better when we can see greenery and connect with the outdoors. Whether we design facilities that are like hotels, or farms, or villages, it’s always about making sure the needs of residents and their families are front and centre.”