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Opinion: Build community around where seniors live

Written By Dan Levitt

The rising tide of seniors coupled with increasing cases of dementia has led aged care industry leaders to drive the typical standalone old age institutions out of existence. The nursing home, as it is presently known, is becoming a dinosaur as the industry experience of old bed stock being replaced with new care facilities often generates living conditions for seniors similar to those in traditional nursing homes with the overuse of medications, psychotropic medications prescribed without a clinical diagnosis, and food services that are comparable to hospitals rather than restaurants. The nursing home has got it wrong. In the age of status quo disruptors, the medical approach to caring for seniors has primarily relied on clinical solutions to combat the plagues of social isolation, loneliness, boredom and helplessness.

In New South Wales, Australia, Catholic Healthcare operates over 50 seniors care communities in and around Sydney. One of the facilities offers seniors independent living and residential aged care — what is unique about the multi-purpose community is how the neighbours use the property. The city operates the onsite library and an independently run café serves breakfast and lunch and delicious espressos. The library attracts families who live in the area, bringing a whole other aspect to the community. Adjacent to the library and café is a children’s playground attracting young parents with their preschool children, some in strollers.

Seniors who live onsite frequent the café, which is easily accessible from a pedestrian walkway. The café scene is hip in Australia and this facility is a hub of that culture. Both the café and library bring the community into the aged care residence and give the seniors options in how to spend their day beyond the confines of a locked dementia ward. A good measure of quality of life is how frequently seniors leave a nursing home for a reason other than going to a medical appointment. These Australian seniors have the daily option to go to a library or café on the same city block. This gives new meaning to a retirement village, or perhaps the end of the traditional standalone old age institution, certainly not built on the same property as a hospital.

Ordinarily, nursing homes are isolated from the rest of society, no longer integrated into the community. Seniors disappear from their homes when they no longer are capable of living independently and are moved into a nursing home.

The current old bed stock in western countries is in need of replacement. The biggest challenge in replacing old nursing homes is finding the capital funding to pay for the building costs.In Australia, a bond program was introduced to create the economic conditions to encourage age care innovation. Seniors contribute a refundable bond. The financial contribution covers their portion of the building costs of a new nursing home. When the senior passes away, 100 per cent of the principal is returned to the estate, and in some cases a portion of the interest. This financial formula has brought a cash infusion into the aged care marketplace to replace antiquated bed stock that creates undesirable institutional outcomes dehumanizing the last few years of a seniors life coupled with the health outcomes of living with Alzheimer Disease and related dementias. There is an equitable subsidy program for seniors and their families who cannot afford a bond or the monthly property fees.

The bond program has led to a flourishing of new seniors living development projects. At another such facility, choice, dignity and wellbeing have formed the foundational elements for a senior’s residence that has pulled the best practices into a leading provider of programs and services that dignify old age. The cash infusion has allowed this faith-based non-profit organization to create never-before-seen amenities. A resort-style hydro therapy pools complex complete with a hot tub provides rehabilitative services led by physiotherapists who focus on re-enablement of seniors, emphasizing that the top predictor of longevity is mobility.

Exercise equipment that is specially designed for elderly fitness helps to ensure seniors’ muscle tone is increased at a time in their lives when most people do not think they can reap the muscular benefits of fitness. Contrary to some cases where there is a disincentive built into the funding and regulatory environment that discourages lifestyle programs like therapeutic programs led by allied professional staff. The aged care residence uses plush carpeting to create a home that feels warm and welcoming. Each senior has a memory curio for the staff to remind themselves of the life lived by seniors before moving into the residence. Outdoor areas are accessible with smooth transitions where tropical plants, park benches and tiled cement flooring allow for rain water to run off decreasing the likelihood of falls from wet surfaces.  

Sensor technology has been installed throughout the campus, remotely monitoring seniors’ movements during nighttime and allowing for a full night sleep instead of staff conducting regular rounds.

In the dining room, white table cloths drape the tables and no design features resemble anything suggesting this is a nursing home but a five-star restaurant. A pastry chef takes the time to make puréed food for people who have dysphagia, a disordered swallowing condition, creating a fine dining experience.The occupational therapy workshop has shoe fitting services that matches seniors with the correct shoes to enable better gait and enhance lifetime mobility. A studio displays the artwork of a senior whose masterpieces are displayed in the afternoon in the common gathering area.

Australian aged care industry private operators like Summit Care, a multi-site purpose-driven organization, has responded to the changing demand of baby boomers who desire improved living environments, increased privacy, increased focus on lifestyle, integration of family and community. At Curtain Care, in Perth, seniors are no longer accepting the traditional nursing home grandma resides in where she receives visitors in her bedroom, which is awkward at best and considered an invasion of privacy in most other living situations. Curtain Care has a new operational design strategy. The new standard is for all one bedrooms doubling the living space for each senior with additional space for sitting and dining with family and friends and a balcony or direct access to the gardens. In some lighter-care living environments, personal laundry is available, as is a basic kitchen.

Rethinking the role of seniors in city planning will view this segment of the population as market drivers who desire better living conditions and lifestyle options that have not been commonplace in previous generations. After all, wasn’t it the aging baby boomers who have changed every aspect of society as they moved through the decades? Just imagine what the next community development might include as the multigenerational living movement takes hold and aged care buildings become destinations with services that all ages enjoy injecting life back not just to senior’s homes, but to all citizens.

Reprinted with permission.


Dan Levitt is the executive director of Tabor Village, a faith-based aged care community in Abbotsford, an adjunct professor in gerontology at Simon Fraser University, and an adjunct professor in the School of Nursing at the University of B.C.