Alzheimer village
This Alzheimer village to be designed and built by Nord Architects is set to replicate vibrant cities rather than "depressing care institutions"

OXYGEN FILES: The design, supply and affordability of housing for older Australians isn’t keeping up with our rapidly aging population, say experts. But the solutions aren’t straightforward.

Amidst the horror stories emerging from the Royal Commission into Aged Care is an issue the property sector and design community needs to address: how the built environment affects the quality of life and care.

The Commission’s interim report recounts “strong evidence” heard at its Sydney hearings in May, this year, that “poor design of physical and social care environments — for example, large, noisy facilities with poor visual layouts and an inappropriate mix of residents — contribute to behavioural and psychological symptoms of dementia and poor care management”.

This “poor care management” includes rampant over-use of physical and chemical restraints to limit patient mobility and control behaviour.

Research and experiential evidence heard by the Royal Commission shows there are design elements that can help people with dementia and improve quality and safety in care.

“Many of these design elements have been reflected in voluntary guidelines and audit tools for the design and construction of new and renovation of existing residential aged care facilities, such as those available in Victoria,” the report found.

The Royal Commission will further consider this topic and examine how dementia-friendly design principles can be implemented. This could include mandatory requirements for new residential aged care facilities or the refurbishment of existing facilities.

The key themes emerging from the more than 7000 submissions the inquiry has received so far are neglect, dignity and governance. Submissions remain open until the end of April, next year.

Many of the issues raised in the report and in published submissions echo the problems we already know exist in the sector, such as making it easy for older people to access appropriate care so they can remain at home longer, and how to prevent people who don’t have stable accommodation falling through the cracks of the Home Care system.

Finding a place within a residential care facility is equally challenging, particularly for people without significant financial means.

Even the government’s digital portal for aged care services and support is a problem, with many older people who aren’t comfortable using mobile phones and computers, having to rely on younger relatives and friends to navigate the site.

Who gets to enjoy “retirement living”?

On a philosophical basis, the inquiry found that there had been a shift towards thinking about the aged care sector as an “industry” with “customers”, rather than a social service for older citizens.  It found also that ageism pervades the way many services and facilities are governed, operated and funded.

Looking at how the retirement living sector is marketing itself also shows there could be a fundamental ableist bias at work, discriminating against people with disabilities or who are perceived to have disabilities.

For the well off, there are lots of options for retirement living. And, although retirement facilities are usually designed for people who have limited mobility, the marketing pitch often targets people who are able to enjoy an “active lifestyle”, rather than people with early dementia or major mobility limitations.

Research shows that even high-end retirement developments don’t attract everyone who can afford them.

Research released last month by the Australian Housing and Urban Research Institute (AHURI) shows that the majority of older homeowners are reluctant to downsize and use any profit they make on a sale to set up in a smaller home because they don’t want to lose access to familiar places, social networks and service providers.

And the renters and home-owners who do move are initially unhappy, according to the research.

Most people only move out of the family home when prompted by a major event, such as the death of a partner or a serious illness.

Older renters tend to be more mobile than home owners but that’s usually because they can no longer afford the rent or are forced to move because of the sale of the property they live in.

Policy settings around the pension and assets tests (the family home is exempt) also play a role, says University of Sydney associate professor Stephen Whelan.

Whelan says there isn’t enough stock available for down-sizers to move into. And, many affordable homes are in “less desirable” locations, or have a different level of amenities, he says.

The market mostly delivers a mix of large, detached or semi-detached homes, or apartments in large multi-residential buildings, but seems to be failing to deliver low-rise density within easy reach of amenities and services, he says.

Another problem, says Whelan, is a growing cohort of older home-owners who still have a mortgage on their home. People who own their homes outright manage better on an aged pension, but it can be difficult to survive on the pension if you have a mortgage or are a renter.

This complicated picture also includes a growing number of older people who are the most vulnerable – those who are homeless.

AHURI research released last week shows the number of people aged 65 and over who are homeless grew by 30 per cent between 2011 and 2016.

The researchers found three broad groups of older Australians who become homeless: those who experience a “shock” late in life, such as eviction from rental housing, relationship breakdown or death of a partner; people with transient work and housing histories; and, those who have experienced long-term social exclusion and had previously been homeless.

Poverty the root problem

Having an income lower than the level needed to sustain a decent, healthy and secure life increases the chance that a older person will become homeless, says University of South Australia professor Andrew Beer, one of the authors of the AHURI report.

“With an ageing population and a decline in home ownership, we can expect further growth in rates of homelessness amongst older Australians,” he says.

Of the roughly 1500 services that address homelessness in Australia, only three assist older people.

Some of the report’s recommendations include providing funding to build specialist facilities for older homeless people, and reviewing, increasing and indexing the federal government’s Homelessness Supplement for aged care providers.

The researchers also say the provision of affordable, secure and appropriate housing “must be central to any solution to homelessness amongst older Australians”.

Centrelink’s push to move older people onto Newstart is also a problem, according to Kate Colvin, spokesperson for Everybody’s Home, a NGO-backed campaign to fix Australia’s housing system.

The qualifying age for the aged pension will rise to 67 from 65 by 2023. At the same time, people aged over 50, in particular, women, are increasingly struggling to find and keep jobs, which is pushing older people onto Newstart.

But Newstart is simply “not enough” to cover rent or mortgage payments in any Australian capital city for a single person, says Colvin.

Even couples struggle to find affordable housing. And, if a partner dies, leaves or becomes ill and needs to enter care, the remaining partner may no longer be able to afford to stay in the home.

Many people who are retrenched from the workforce do not receive a substantial payout, and under Newstart rules, people must use all of their assets and savings before they can access government benefits, another factor that can lead to homelessness.

People on social security payments have to compete in the rental market against employed people, and there aren’t enough properties to go around, she says.

“The people who are most vulnerable get pushed to the bottom.”

Raising the rate of Commonwealth Rent Assistance would help, she says. Currently, a single person with no dependents receives a maximum of $135 per fortnight rent assistance, no matter how high the rent is.

Many people are paying more than 50 per cent of their benefit on rent, she says.

We also need more housing for low income households, and housing for low-paid workers, such as aged care staff. 

Colvin points out that when a community has many older people who need care, it can be a struggle to find workers to provide it because there is no nearby housing the workers can afford to live in. 

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  1. Excellent article and thanks for raising the issues. With the impending RIS process to look at the way we design housing (unfortunately named Accessible Housing RIS) we need to keep this issue alive. I say unfortunately named because the word accessible has a specific meaning in the construction sector as something only for people with disability instead of its universal appeal to everyone. And no, I am not talking grab rails and funny looking bathrooms. The RIS should be aiming to update the old style cookie cutter and make it fit for purpose (occupants purpose, not building purpose). Therefore it should just be named a housing RIS. But the industry sees this as competition for those RVs