Posted in Caregiving

Dementia design 30 years behind, condition must be recognised as disability

Photo by Lex Photography on Pexels.com

Press release from Alzheimer’s Disease International

21 September 2020

  • Dementia design in built environment is 30 years behind physical disabilities movement
  • ADI calls on governments to embed design in their national dementia responses under the Convention on the Rights for Persons with Disabilities
  • Dementia design follows simple principles, is cost effective and dramatically improves enjoyment and safety of built environment for those living with dementia
  • Dementia design can enable people to live in their own homes and communities for as long as possible
  • ADI launches world’s most comprehensive report on dementia and design for World Alzheimer’s Day, 21st September 2020

21 September 2020 – Drastically improved dementia design in the built environment is needed across the globe according to Alzheimer’s Disease International (ADI), who are calling on governments and multilateral bodies to overtly recognise dementia as a disability following recommendations from the world’s most comprehensive ever report into dementia-related design, World Alzheimer Report 2020: Design, Dignity, Dementia; dementia-related design and the built environment[1].

On World Alzheimer’s Day, ADI is calling for dementia to be more overtly recognised by governments globally as a disability, including as part of national dementia plans, to help to ensure that the therapeutic benefits of good dementia design are felt by people living with dementia at home, in residential and day-care facilities, hospitals and public buildings and spaces.

Approximately 152 million people are forecast to be living with dementia by 2050, and it is already the fifth leading cause for death worldwide, yet most countries are woefully behind in terms of making the built environment accessible for those living with dementia.

Recognising dementia as a disability will help ensure that similar strides are made for dementia design as have been made over the last 30 years by the physical disability movement, such as seeing accessible lifts, ramps, safer pedestrian crossings and the like made commonplace across the globe.

ADI’s Chief Executive, Paola Barbarino, says that dementia design provides an opportunity to adapt built environments in the same way that physical disability design has led to great innovation.

“We need to apply design guidelines and principles for people living with dementia in the same way as design guidelines are provided for people living with a physical disability,” says Barbarino. “When I was in my first job, I remember people saying that accessible lifts and ramps were impossible to install in old buildings but look at it now! If we can cater for those with visible disabilities, how can we refuse to cater for those with invisible disabilities? We need to start working now, with new builds, and consider this new way of thinking at planning stage, and also look at cost effective retro-fit options for older buildings.”

Barbarino says that dementia design does not have to be a costly exercise and can be as simple as considering things like carpets and décor, the removal of hazards, reducing stimulation, clear wayfinding – measures that can reduce anxiety and agitation and improve social interactions.

“It comes down to simple things. I recall during a site inspection of a venue for a conference, the black areas on colourful carpets could look like holes in the floor, people living with dementia might walk around them as they could be worried of falling into them,” says Barbarino. “Things like mirrors on the walls can be an issue, as people with dementia can be disoriented by seeing their own reflection, especially at night. Design is effectively a non-pharmacological intervention, adding to the number of things we can do – in absence of a cure – to make the lives of those living with the condition easier and more fulfilling.”

Co-author of the report, Richard Fleming, says that dementia design is needed urgently, and our knowledge of how to do it has grown over the years.

“Our knowledge of how to design buildings that support people living with dementia has grown over the last forty years and we are now in a position to be more proactive in implementing it in practice,” says Fleming. “The rising number of people living with dementia requires that their needs are considered at the beginning of every building project that is likely to be used by elderly people. Dementia design should never be an afterthought.”

“We need more architects and designers who are switched on to the challenges of designing for people living with dementia. This means that they should be introduced to them in their training when they are looking for areas that inspire them,” continues Fleming. “Designing for people living with dementia should be made an attractive option in the curriculum of every school of architecture and design.”

In the report, Kate Swaffer, Chair, Co-Founder and CEO of ADI’s partner Dementia Alliance International, says that the link between disability and environment is clear.

“The environment’s influence in creating disability or in increasing it has been well established and is seen as integral to the definition of disability,” says Swaffer. “If the environment changes, then the experience of someone living with a disability will also change.

“People with physical disabilities have made major progress as substantial, influential members of society, borne out of society’s response to changes in the built environment becoming the norm in many countries” continues Swaffer. “Yet people with dementia are still being left behind, not only in terms of health and social care but in terms of recognition of dementia as a condition causing disability. It is vital that planners, designers and architects embrace dementia-related design at the outset and include people living with dementia in the whole design process”

Covid-19 has disproportionately impacted people with dementia, with around a quarter of virus deaths in certain countries being those of people with dementia. Care facilities, where many people with dementia live, have been hard hit when exposed to the virus.

“Covid-19 restrictions implemented to protect residents in long term care may have resulted in interventions that could have accelerated physical and cognitive decline or indirectly contributed to the deaths of some residents,” says Barbarino. “Better design could have absolutely helped to minimise the spread of the virus in care facilities. Dementia design needs to be a crucial part of how countries rebuild following Covid-19.”

Recognising dementia as a disability is one of several recommendations from the World Alzheimer Report 2020, alongside the recommendation to incorporate dementia-related design into national dementia plans in response to the WHO Global action plan on the public health response to dementia 2017-2025[2].

“The first target in the WHO plan is for 75 percent of the Member States to have developed or updated national policies, strategies, plans or frameworks for dementia by 2025,” says Barbarino. “Presently, only 30 Member State countries out of 146 have met this goal. The analysis of these plans available through the ADI website shows that only about 25 percent of these currently include designing for people with dementia.”

Australia, England and Scotland are global leaders in dementia-related design leading the way in translating existing research into practice. Barbarino says that these are among many great examples of existing efforts to develop dementia-friendly design, pointing to the likes of Swedish furniture giant IKEA.

“In 2019, IKEA partnered with a construction company to launch flat pack housing for people living with dementia. The homes feature key elements of dementia design, including mirrorless bathrooms, old-fashioned appliances, traditional cupboard handles in kitchens, simply adapted bathrooms and importantly dementia-friendly outdoor spaces and gardens,” says Barbarino. “Their focus has been to encourage accessibility and engagement with activities that promoted socialisation and wellbeing. With over 100 simple adaptations – many dementia specific – this is an innovative new model for living independently at home for longer.”

Barbarino says that it just one such example of how dementia design can be adopted, but that ultimately it comes back to having strong national planning for the disease.

“We cannot stress enough how important it is for countries to develop and implement national dementia plans, and to include dementia-friendly design into these plans,” says Barbarino. “Design considerations can make a world of difference for people living with dementia, helping them to live with dignity and respect.”

The principles of dementia design include:

  • Unobtrusively reducing risks: Minimise risk factors such as steps and ensure safety features are as unobtrusive as possible.
  • Providing a human scale: The scale of buildings can impact the behaviour of people with dementia, so provide a human scale to minimise intimidating features.
  • Allowing people to see and be seen: The provision of an easily understood environment will help to minimise confusion. A literal line of sight should be clear for both residents, and staff.
  • Reducing unhelpful stimulation: Environments should be designed to minimise exposure to stimuli that are unhelpful, such as unnecessary or competing noises and the sight of unnecessary signs, posters, spaces and clutter.
  • Optimise helpful stimulation: Enabling the person living with dementia to see, hear and smell things that give them cues about where they are and what they can do, can help minimise their confusion and uncertainty.
  • Support movement and engagement: Providing a well-defined pathway of movement, free of obstacles, can support engagement with people and opportunities.
  • Create a familiar place: The use of familiar building design, furniture, fittings and colours affords people with dementia an opportunity to maintain their competence.
  • Provide opportunities to be alone or with others: A variety of spaces, some for quiet conversation and some for larger groups, as well as spaces where people can be by themselves, gives people with dementia a choice to how they spend their time.
  • Link to the community: The more an environment enables visitors to drop in easily and enjoy being in places that encourage interaction, the more the sense of identity that comes from spending time with loved ones and others is reinforced.
  • Design in response to vision for way of life: The way of life offered needs to be clearly stated and the building designed both to support it and to make it evident to the residents and staff.

“As the number of people living with dementia rise, and young onset dementia is increasingly an issue, we need to build a world for people living with dementia, one that they and their families can all be proud of.”

Download a full copy of ADI’s World Alzheimer Report 2020: Design, Dignity, Dementia.

ENDS

For story ideas, interview requests and more information, please contact:

Alzheimer’s Disease International

Tori Levy
Mana Communications
T: +64 (0)27 858 1884

E: tl@manacommunications.com

Caleb Hulme-Moir

Mana Communications
T: +64 (0)22 069 8065

E: chm@manacommunications.com

About World Alzheimer’s Month

World Alzheimer’s Month is the international campaign every September to raise awareness and challenge the stigma that surrounds dementia. September 2020 will mark the 9th World Alzheimer’s Month. The campaign was launched in 2012: World Alzheimer’s Day is on 21 September each year. For more information, please visit: https://www.alz.co.uk/world-alzheimers-month

About Alzheimer’s Disease International (ADI)

ADI is the international federation of 102 Alzheimer associations and federations around the world, in official relations with the World Health Organization. ADI’s vision is prevention, care and inclusion today, and cure tomorrow. ADI believes that the key to winning the fight against dementia lies in a unique combination of global solutions and local knowledge. ADI works locally, by empowering Alzheimer associations to promote and offer care and support for persons with dementia and their care partners, while working globally to focus attention on dementia and campaign for policy change. For more information, please visit www.alz.co.uk

Appendix:

Design, Dignity, Dementia: World Alzheimer Report 2020 will be launched by webinar on Monday 21 September 13:00 BST (London). The webinar will be hosted by ADI’s Chief Executive Paola Barbarino and will feature key expert speakers. Sign up here.

Report recommendations:

  1. ADI will facilitate discussions on the development and adoption of a common set of design principles that will be used to structure the exploration of designing well for people living with dementia and the formulation of future recommendations.
  2. A call for more overt and considered inclusion of dementia related design as a non-pharmacological intervention, to be included in national dementia plans, in response to the WHO Global action plan on the public health response to dementia 2017–2025
  3. ADI, alongside partner Dementia Alliance International, and other advocacy groups, will work to give prominence to the arguments contained in the Convention on the Rights of Persons with Disabilities (CRPD) for the recognition of dementia as a disability and the consequent need to apply design guidelines for people living with dementia in the same way as design guidelines are provided for people living with a physical disability.
  4. A call to all educators about the need to include designing for people living with dementia in the curricula of schools of architecture and design.
  5. Encourage health economists to engage with the field of designing for people living with dementia to clearly establish the cost benefit of investment in dementia related design translating to savings in health and care costs by facilitating people to live in their own homes and their communities for as long as possible
  6. ADI will encourage governments and academic institutions to engage researchers to translate knowledge on designing for people living with dementia. This knowledge, often gained in high income countries, can support and service development in low- and middle- income countries.
  7. ADI will encourage National Dementia Associations to better inform themselves about the available knowledge on designing for people living with dementia, consider its relevance to their contexts and priorities, and advocate for relevant knowledge to be implemented by planners, designers, architects, care operators and developers.
  8. ADI will encourage governments and the international community to proactively engage designers, architects, developers, operators and innovators, in the construction and IT sectors, in designing for people living with dementia.

[1] FLEMING, R., ZEISEL, J. & BENNETT, K. 2020. World Alzheimer’s Report 2020: Design Dignity Dementia, Case Studies. London, England: Alzheimer’s Disease International.

[2] Global action plan on the public health response to dementia 2017–2025. Geneva: World Health Organization; 2017. Licence: CC BY-NC-SA 3.0 IGO.

Posted in Caregiving

Poor ventilation may be adding to nursing homes’ COVID-19 risks

Geoff Hanmer and Bruce Milthorpe, University of Technology Sydney

Over 2,000 active cases of COVID-19 and 245 resident deaths as of August 19 have been linked to aged care homes in Victoria, spread across over 120 facilities. The St Basil’s cluster alone now involves 191 cases. In New South Wales, 37 residents were infected at Newmarch House, leading to 17 deaths.

Why are so many aged care residents and staff becoming infected with COVID-19? New research suggests poor ventilation may be one of the factors. RMIT researchers are finding levels of carbon dioxide in some nursing homes that are more than three times the recommended level, which points to poor ventilation.

An examination of the design of Newmarch in Sydney and St Basil’s in Melbourne shows residents’ rooms are arranged on both sides of a wide central corridor.

The corridors need to be wide enough for beds to be wheeled in and out of rooms, but this means they enclose a large volume of air. Windows in the residents’ rooms only indirectly ventilate this large interior space. In addition, the wide corridors encourage socialising.

If the windows to residents’ rooms are shut or nearly shut in winter, these buildings are likely to have very low levels of ventilation, which may contribute to the spread of COVID-19. If anyone in the building is infected, the risk of cross-infection may be significant even if personal protective equipment protocols are followed and surfaces are cleaned regularly.

Why does ventilation matter?

Scientists now suspect the virus that causes COVID-19 can be transmitted as an aerosol as well as by droplets. Airborne transmission means poor ventilation is likely to contribute to infections.

A recent article in the journal Nature outlines the state of research:

Converging lines of evidence indicate that SARS-CoV-2, the coronavirus responsible for the COVID-19 pandemic, can pass from person to person in tiny droplets called aerosols that waft through the air and accumulate over time. After months of debate about whether people can transmit the virus through exhaled air, there is growing concern among scientists about this transmission route.


Read more: Is the airborne route a major source of coronavirus transmission?


Under the National Construction Code (NCC), a building can be either “naturally ventilated” or “mechanically ventilated”.

Natural ventilation requires only that ventilation openings, usually the openable portion of windows, must achieve a set percentage of the floor area. It does not require windows to be open, or even mandate the minimum openable area, or any other measures that would ensure effective ventilation. Air quality tests are not required before or after occupation for a naturally ventilated building.

Nearly all aged care homes are designed to be naturally ventilated with openable windows to each room. In winter most windows are shut to keep residents warm and reduce drafts. This reduces heating costs, so operators have a possible incentive to keep ventilation rates down.

From inspection, many areas of typical nursing homes, including corridors and large common spaces, are not directly ventilated or are very poorly ventilated. The odour sometimes associated with nursing homes, which is a concern for residents and their visitors, is probably linked to poor ventilation.

Carbon dioxide levels sound a warning

Carbon dioxide levels in a building are a close proxy for the effectiveness of ventilation because people breathe out CO₂. The National Construction Code mandates CO₂ levels of less than 850 parts per million (ppm) in the air inside a building averaged over eight hours. A well-ventilated room will be 800ppm or less – 600ppm is regarded as a best practice target. Outside air is just over 400ppm

An RMIT team led by Professor Priya Rajagopalan is researching air quality in Victorian aged care homes. He has provided preliminary data showing peaks of up to 2,000ppm in common areas of some aged care homes.

This figure indicates very poor ventilation. It’s more than twice the maximum permitted by the building code and more than three times the level of best practice.

Research from Europe also indicates ventilation in aged care homes is poor.

Good ventilation has been associated with reduced transmission of pathogens. In 2019, researchers in Taiwan linked a tuberculosis outbreak at a Taipei University with internal CO₂ levels of 3,000ppm. Improving ventilation to reduce CO₂ to 600ppm stopped the outbreak.


Read more: How to use ventilation and air filtration to prevent the spread of coronavirus indoors


What can homes do to improve ventilation?

Nursing home operators can take simple steps to achieve adequate ventilation. An air quality detector that can reliably measure CO₂ levels costs about A$200.

If levels in an area are significantly above 600ppm over five to ten minutes, there would be a strong case to improve ventilation. At levels over 1,000ppm the need to improve ventilation would be urgent.

Most nursing homes are heated by reverse-cycle split-system air conditioners or warm air heating systems. The vast majority of these units do not introduce fresh air into the spaces they serve.

The first step should be to open windows as much as possible – even though this may make maintaining a comfortable temperature more difficult.


Read more: Open windows to help stop the spread of coronavirus, advises architectural engineer


Creating a flow of warmed and filtered fresh air from central corridor spaces into rooms and out through windows would be ideal, but would probably require investment in mechanical ventilation.

Temporary solutions could include:

  1. industrial heating fans and flexible ventilation duct from an open window discharging into the central corridor spaces
  2. radiant heaters in rooms, instead of recirculating heat pump air conditioners, and windows opened far enough to lower CO₂ levels consistently below 850ppm in rooms and corridors.

The same type of advice applies to any naturally ventilated buildings, including schools, restaurants, pubs, clubs and small shops. The operators of these venues should ensure ventilation is good and be aware that many air-conditioning and heating units do not introduce fresh air.

People walking into venues might want to turn around and walk out if their nose tells them ventilation is inadequate. We have a highly developed sense of smell for many reasons, and avoiding badly ventilated spaces is one of them.

Geoff Hanmer, Adjunct Professor of Architecture and Bruce Milthorpe, Emeritus Professor, Faculty of Science, University of Technology Sydney

This article is republished from The Conversation under a Creative Commons license. Read the original article.

Posted in Caregiving

4 steps to avert a full-blown coronavirus disaster in Victoria’s aged care homes

Shutterstock

Joseph Ibrahim, Monash University

As of July 22, the total number of COVID-19 infections nationally was 12,896, with 128 deaths. This figure includes 43 aged-care residents.

In Victoria, at least 45 aged-care facilities have now reported outbreaks, with about 383 positive cases in the sector overall (including among staff).

St Basil’s Home for the Aged in Fawkner and Estia Health in Ardeer have the largest number of cases: 73 and 67 respectively.

Although these outbreaks don’t compare to what we’ve seen internationally, the rising case numbers within Victorian aged-care homes are of grave national concern.

We’ll need a concerted community effort to arrest this looming disaster.


Read more: Why are older people more at risk of coronavirus?


Aged care was in crisis even before COVID-19

The interim report of the Royal Commission into Aged Care Quality and Safety laid bare the system failures in the provision of aged care in Australia.

These deficits include workforce and skill shortages. A report on the sector’s performance between October and December 2019 found around 20% of facilities audited did not meet standards in “safe and effective personal and clinical care”, while 13% fell short on the measure of a “safe, clean and well-maintained service environment”.

This makes aged-care homes highly vulnerable to any external disaster.

Several other factors set the scene for infection transmission in aged care, including its design. Residential aged care is intended to provide a home-like physical environment. While this serves an important purpose, it means aged-care homes may be missing some clinical features needed for optimal infection control, such as prominent placement of multiple hand basins.

Aged-care homes are designed differently to clinical settings like hospitals. Shutterstock

Communal spaces and a high volume of foot traffic (residents, staff, external contractors and visitors) also increase the risk of infection, while some residents have shared rooms and bathrooms.

And residents have a range of cognitive and physical disabilities that can make it difficult to adhere to the fundamental infection control measures of social distancing and handwashing.

COVID-19 and the elderly

We had early warning of the catastrophic effects of COVID-19 in aged-care homes in March and April from countries like Spain and Italy, which saw widespread outbreaks and deaths in nursing homes.

While roughly one-third of COVID-19 deaths in Australia so far have been aged-care residents, a review taking in 26 countries found this group has accounted for almost half of coronavirus deaths.


Read more: Banning visitors to aged care during coronavirus raises several ethical questions – with no simple answers


Severe illness and death from COVID-19 is more likely in older people because they tend to have lower immunity, less biological reserve and higher rates of chronic conditions such as type-2 diabetes, high blood pressure, heart failure and renal disease.

One study found the case-fatality rate — the proportion of people who get COVID-19 who will die — is 33.7% for aged-care residents.

Avoiding disaster

We need a coordinated, standardised, compassionate, supportive response to prevent premature deaths, and to minimise psychological harm to residents, families and staff.

Different aged-care homes will need different strategies to suit their varying circumstances. For example, facilities located in areas without community transmission, such as South Australia, will be different to those where there’s community spread, like in NSW and Victoria. And the needs of those homes with an active outbreak, such as St Basil’s or Estia Health, will be different again.

But broadly speaking, I believe these four key pillars are applicable to all aged-care homes.

1. Stop COVID-19 entering

In areas where there’s community transmission, all aged-care homes should be put into lockdown, with tight controls at entry and exit points. This should be done as humanely as possible, for example by creating teams to keep residents connected to family and community, and with exceptions for essential visitors.

Staff should be tested routinely and counselled about limiting contact with other people outside the workplace. Staff should also only work in one facility, and be allocated the same group of residents (to minimise the number of contacts in the event of a confirmed or suspected infection).

Finally, the development and provision of specific guidance, training and support around the use of personal protective equipment (PPE) is essential. Individual homes should be supported to engage experienced infection control nurses to train staff if possible on site.

We’ve known since early in the pandemic that older people are more susceptible to COVID-19. Shutterstock

2. Be prepared in case it does

Every aged-care home in Australia should have a “risk and readiness” rating to determine the likelihood of a COVID-19 outbreak and the facility’s ability to prevent and manage an initial infection.

This would include factors such as the experience and size of the aged-care provider, location of the facility, the size and structure of the building, ventilation, access to open spaces, the residents’ profile, staff numbers and skills, and past performance in accreditation audits.

And each home should have designated vacant rooms to be ready for isolation of any suspected cases.

Finally, the government should establish a national rapid response and advisory team dedicated to the management of aged-care homes during COVID-19. This would strengthen existing public health response units and should include clinicians with expertise in aged care.


Read more: Our ailing aged care system shows you can’t skimp on nursing care


3. Respond quickly and decisively when an outbreak occurs

Aged-care homes along with public health units should have protocols for coordination of their on-site response, with clear lines of accountability for action and escalation.

They should rapidly separate residents when an outbreak occurs, rather than relying on a continued usual model of care with the addition of PPE.

Aged-care homes require productive partnerships with hospitals to ensure residents can get the specialised care they need. Wherever possible, all confirmed cases should be sent to a clinical setting such as an acute or sub-acute hospital.

And importantly, all homes should have dedicated communication channels to keep family members informed.

4. Learn from past experience

The two major aged-care outbreaks in NSW, particularly the one in Newmarch House, attracted national attention. But we’re still awaiting a public statement from government about the lessons learned.

There are also ongoing inquiries into COVID-19 in aged care by a senate committee and the Royal Commission. But neither are due to report for some time.

The government should release interim reports into the investigations of recent outbreaks which might give us valuable information about reducing transmission.

Eliminating COVID-19 outbreaks from aged-care homes reduces community transmission, the need for hospital care and reduces premature death. This benefits the whole nation.


Read more: Why prisons in Victoria are locked up and locked down


Joseph Ibrahim, Professor, Health Law and Ageing Research Unit, Department of Forensic Medicine, Monash University

This article is republished from The Conversation under a Creative Commons license. Read the original article.

Posted in Caregiving

‘Ageing in neighbourhood’: what seniors want instead of retirement villages and how to achieve it

Photo by Şahin Sezer Dinçer on Pexels.com

Caroline Osborne, University of the Sunshine Coast and Claudia Baldwin, University of the Sunshine Coast

The COVID-19 pandemic has brought into sharp focus the need for connection to our local community and the health challenges of the retirement village model.

We know that, as we age, most people prefer to stay in their own homes and communities instead of moving to retirement villages. Some have gone so far as to say retirement villages have had their day. However, the reality is not quite that simple.


Read more: Retire the retirement village – the wall and what’s behind it is so 2020


The challenge is that seniors are not well informed on what they could demand of the market. Planning schemes could also do more to create incentives for the changes we need now.

The challenges are complex and urgent as the global population grows and ages. Yet our housing supply reveals a bad case of the tail wagging the dog. Finely tuned financial models and development processes are driving the housing products available in the market.

What’s needed instead is adaptable housing and neighbourhoods to help people as they move through life’s stages.

Are the days of the retirement village numbered?

Many individuals and families struggle to find the right “fit” between the supported living options of retirement villages, independent living lifestyle villages and staying in the (often unsuitable) family home as their needs change.

Such villages offer viable products in the market as an important part of the housing mix. The models have some advantages in that they:

  • are thoroughly costed and provide a good return for developers
  • offer a range of living options to suit most budgets and level of care needs
  • promise security, activities and a sense of community.

Seniors are best placed to say what they need

However, our research with seniors in south-east Queensland revealed a desire to “age in neighbourhood” and to have neighbourhoods with a mix of ages and building forms.

Planning schemes could drive this now by giving priority to, and providing incentives for, sustainable and accessible housing close to transport and other services.

We worked with more than 42 seniors in south-east Queensland to design a series of housing types. These were based on what they told us were important to them in a home and a neighbourhood.

The table below summarises the key features that they told us make a neighbourhood and a home a good place to live as they age.

The resulting principles and housing types paint a vivid picture of what older people in a subtropical environment find appealing and supportive as they age.

Many participants preferred an accessible home on one level. Ideally, it should have two bedrooms and a study. This means it can easily be adapted to changing needs.

An essential component for our participants was to take advantage of the mild climate by having both private and shared outdoor spaces. Here they could socialise, relax and enjoy pleasant outlooks from the home. Cutting planning requirements for car parks by 50% could add more shared outdoor space and cut housing and living costs for residents.

Homes should be sustainably designed. This means they capture natural light and prevailing breezes for through ventilation, take into account privacy and noise considerations in higher-density areas, and have solar and rainwater harvesting systems to save resources and money.

Also important was a neighbourhood with a variety of green, clean and safe public open spaces. This includes flat, well-maintained and shaded walkways for exercise and easy access to shops, facilities and public transport.

We then showed how all these housing types could be incorporated into one Brisbane suburb, as the image below illustrates. This would mean seniors could remain in their neighbourhood in more suitable housing, reducing the stress of moving to unfamiliar surroundings.

How to make it happen

As with all complex challenges, everyone has a role to play in achieving these goals. However, local government planning reforms can act as a catalyst for the market to change and innovate.

Planning schemes could, for example, reduce application fees for developments that include accessible or universal design within 400-800 metres of key services, facilities and transport.

Carpark allocation could also be uncoupled from housing in locations close to transport and services. This would reduce the cost of housing and encourage greater used of active (cycling, walking, etc) and public transport.

This research clearly signals to local and state government, developers and small-scale property investors how houses, duplexes and mid-rise apartments could be put together in an age-friendly suburb. This transition to mixed-density infill development would support what we call “ageing in neighbourhood”.

Further, this research suggests planning “priority zones” could give the market the incentive to invest in the future-focused neighbourhood development it should be providing to keep people connected to their community.


This article was co-authored by Phil Smith, Associate Director of Deicke Richards at the time of publication of the research report. Phil Smith is Director of Gomango Architects.

Caroline Osborne, Postdoctoral Research Fellow, Office of Community Engagement, University of the Sunshine Coast and Claudia Baldwin, Professor, Urban Design and Town Planning, Co-director, Sustainability Research Centre, University of the Sunshine Coast

This article is republished from The Conversation under a Creative Commons license. Read the original article.

Posted in International Policies, Research & Best Practice, The Built Environment

Why some nursing homes are better than others at protecting residents and staff from COVID-19

Life Care Center in Washington state was at the center of the U.S. outbreak back in early March.Photo/Ted S. Warren, CC BY

Anna Amirkhanyan, American University School of Public Affairs; Austin McCrea, American University, and Kenneth J Meier, American University

The coronavirus pandemic has posed a serious threat to the U.S. long-term care industry. A third of all deaths have been nursing home residents or workers – in some states it’s more than half.

Yet some long-term care facilities have managed to keep the virus at bay. For example, veterans’ homes in California have seen only a handful of cases among roughly 2,100 residents. And preliminary results of our research on COVID-19 cases and deaths in nursing homes also support the idea that some homes are doing better than others at protecting clients and staff from COVID-19.

Why might this be?

As scholars of public management, we have found that three factors likely play the biggest role in determining how well a nursing home responds to a disease outbreak: whether it operates for profit, the degree of government regulation and the quality of management.

Profit versus quality care

More than 15,000 nursing homes currently operate in the U.S. Most of them are for-profit facilities backed by private investors, but a small share are operated by nonprofits or government.

For-profit companies selling the same product or service typically perform optimally in what’s known as a perfect market in which there’s plenty of competition and consumers have comprehensive information. More importantly, consumers are able to act on the information.

The nursing home industry, however, is far from a perfect market. Residents – who require constant assistance due to serious physical and cognitive limitations – are often unable to differentiate between good and bad care, advocate for themselves or choose a better facility. Their care is often arranged and paid by others.

As a result, for-profit homes, which are motivated to keep costs low and profits high, tend to be understaffed and, on average, provide lower-quality care compared with public and nonprofit homes.

In contrast, nonprofit and public homes tend to put higher emphasis on patient-centered care and reinvest their profits into better physical spaces, equipment and responsiveness to clients’ needs.

The numbers back this up. Our ongoing research shows that government inspection of for-profit homes found nine violations in an average regulatory inspection cycle, compared with 6.4 at nonprofit homes and 6.8 at government homes. These trends have largely remained constant during the past two decades.

As we examine the data on COVID-19 cases in nursing homes reported by states in real time and link them to the federal data on regulatory violations, we are observing more COVID-19 cases per capita in for-profit than nonprofit or public homes. So far, we’ve looked at homes in Illinois, Nevada, Colorado, South Carolina, Oklahoma and Oregon.

While it is too early to draw firm conclusions, it appears likely that fewer regulatory violations will correlate with success in managing the outbreak.

Government regulation is critical

Federal and state government regulation aimed at protecting residents is another critical factor that influences nursing homes’ ability to combat infection.

All nursing homes that accept Medicare or Medicaid must comply with federal regulations, while states are able to set their own rules for all facilities in addition to the federal minimums. A closer look at the variation among states offers strong evidence that more stringent regulation leads to better care quality.

That is a key finding of our recent study on a voluntary federal program that provides biometric criminal background checks of front-line care workers such as nurses and health care aides. About half of U.S. states have signed on to the National Background Check Program. Nursing homes in those states have fewer deficiencies and higher 5-star ratings.

Staffing requirements in nursing homes are regulated too. We looked at the impact of having more high-skilled nurses on the quality of care in counties hit hard by Hurricane Katrina in 2005. Facilities with a higher share of registered nurses on staff experienced little to no impact on residents’ health outcomes, such as mobility or personal hygiene, as well as on the number of regulatory violations, while most that witnessed significant evacuations saw a large increase in violations and deteriorating health.

The federal government sets a minimum requirement of one registered nurse on staff at least eight hours a day. States are allowed to set their own higher standards – yet even these are considered insufficient by experts.

One key problem is that many state regulations emphasize staffing levels, rather than staffing mix, which means there is little incentive for homes to hire more skilled and expensive personnel. While federal rules issued in 2016 would have strengthened staffing requirements, including one that required homes to have an infection specialist on staff, they have yet to take effect, and the Trump administration has taken steps to weaken them.

Better management

Our research also suggests that management plays a critical role in determining the level of care quality – and ultimately a facility’s ability to withstand COVID-19. Specifically, we have identified several key factors that make a meaningful difference and are certainly worth considering by those looking for a home for their loved one.

For example, nursing home administrators who are more innovative and constantly looking for new ideas tend to run better homes, keep costs lower and address organizational flaws. In addition, homes with managers who have been around for longer periods of time usually deliver better quality of care because this makes it easier to buffer external threats – such as a disease outbreak.

We’ve also found that homes that engage residents and their families and apply their feedback in decision-making boast higher ratings and fewer health violations.

Understanding the pitfalls

Billionaire investor and philanthropist Warren Buffet is credited with saying that it is only when the tide goes out that you discover who has been swimming naked.

COVID-19 seems to be having this kind of effect on nursing homes, exposing which ones were in a better position to handle a pandemic. And that’s why it’s essential for more states that are not publicly sharing their COVID-19 cases or deaths in nursing homes – such as Alaska, Hawaii and Idaho – to begin doing so.

This will allow more research to be done and ensure that the U.S. nursing home industry is adequately prepared for the next pandemic when it inevitably comes.

[Get facts about coronavirus and the latest research. Sign up for The Conversation’s newsletter.]

Anna Amirkhanyan, Associate Professor of Public Administration and Policy, American University School of Public Affairs; Austin McCrea, Ph.D. Student, American University, and Kenneth J Meier, Distinguished Scholar in Residence Department of Public Administration and Policy, American University

This article is republished from The Conversation under a Creative Commons license. Read the original article.

Posted in Ageing & Culture, Caregiving

How coronavirus exposes the way we regard ageing and old people

Shutterstock

Shir Shimoni, King’s College London

The elderly have come to occupy a central place in our news bulletins these days. Headlines were quick to inform the public that the highest mortality rate from COVID-19 is in people aged 70 and over. Experts have repeatedly announced that the pandemic is severe and the virus is especially dangerous for the elderly. This has frequently been delivered as a kind of reassuring message to the public – as long as they are under 70.

This news coverage not only emphasises that the elderly are at much higher risk but also describes them as a passive and vulnerable minority. This kind of portrayal ultimately strengthens the idea that old people impose an undue burden on society and more specifically on the health system, and that addressing their needs might endanger younger people.

In times of public emergency, social truths are revealed. The coronavirus crisis is one such emergency, and it reveals that the lives of the elderly appear to matter less and, in some cases, are even deemed disposable. Some went so far as to commend the virus, calling it a “boomer remover”.

Against this backdrop we must also understand a number of other recent cultural trends that have helped to engender a heightened ambivalence towards old people. My research into cultural representations of the elderly has demonstrated a striking increase in this group’s representation in popular and mainstream media.

The crisis, however, has drawn attention to the dramatic global increase in the number of ageing people relative to the general population, the economic resources necessary to ensure their well-being, and the fact that many occupy positions of power in the political, economic, social and cultural landscape.

Visibility of the elderly

As a researcher studying the representation of the ageing in popular culture, I have found the depiction of older people has shifted over the last decade, reflected not only in the way their lives are more visible in everything from film and television to social media, but also in terms of a more positive representation.

Hollywood’s interest in the lives of older people is reflected with ever greater frequency, with a whole host of films from 2003’s Something’s Gotta Give to 2011’s The Best Exotic Marigold Hotel, to Scorsese’s 2019 epic The Irishman, and in the proliferation of TV series such as Netflix’s Grace and Frankie and The Kominsky Method.

This trend is also noticeable in a wide range of newspapers and magazines, while books designed to inspire people to view their “third act” as an opportunity to finally realise themselves have become instant bestsellers. Social media sites such as Twitter and Instagram have participated in this celebration of older people too, where many have transformed into social media stars, attracting thousands of followers to their dynamic and upbeat profiles. Across these media, ageing people are presented as happy, resilient self-starters.

The reality for many

This is clearly informed by the widespread understanding that they constitute potential consumers, often with considerable buying power. However, this positive representation cannot be understood simply as a reflection of commercial interests.

It is also aims to conceal the impact of neoliberal policies – which have eviscerated the social safety net through deregulation, privatisation and regressive taxes – on the vast majority of older people. As the ageing population has grown in size, the responsibility for health and wellbeing has been deflected from the state on to individuals through austerity measures and the erosion of social welfare.

Ageing people’s “third age” is presented in popular culture as a time to reinvent themselves, and as a phase of new opportunities. By depicting older people as self-reliant, popular culture encourages them to focus on their self-care and to constantly enhance their individual qualities, whether these qualities are aesthetic, emotional or professional.

In short, as market logic has led to reduced state investment in welfare infrastructure and the care economy, we have witnessed a cultural response that encourages ageing people to assume responsibility for their own health and happiness. This is a position that might be tenable for the more affluent, but it is unfeasible for the vast majority of elderly people.

It is precisely in this context that we need to understand the representation of older people in a time of COVID-19. The warnings delivered to the elderly since the coronavirus outbreak expose our culture’s ambivalence and profound denial of ageing. It also highlights the government’s refusal to acknowledge frailty since such an acknowledgement would mean admitting that years of slashing programmes designed to safeguard the elderly have amounted to an abdication of its responsibility.

Austerity policies in the UK have meant that the safety net for old people has been eroded. Shutterstock

As people are living longer, there has been an explosion of positive portrayals of older individuals which focus on good health, affluence and independence. Meanwhile, the entrenchment of neoliberalism and austerity policies have meant that states like the UK are much less able to cope with the pandemic, while forcing those on the frontlines to make impossible choices.

While COVID-19 clearly reveals to all of us how much we need and depend on each other, the social imperative aimed at the ageing population remains the same: defy ageing for as long as possible and avoid becoming socially superfluous.

Shir Shimoni, PhD candidate, Culture, Media and Creative Industries, King’s College London

This article is republished from The Conversation under a Creative Commons license. Read the original article.