Mar 15, 2023

Making aged care feel more like a home than an institution is key to fixing system

15_3_23 more homely aged care HC

The Federal Government and aged care stakeholders have been frantically trying to solve the aged care crisis but the solution could be quite straightforward – a homely and de-institutionalised aged care system for older people.

While a lack of resources is a significant contributor to the broken system, researchers have said that the sector’s problems are related to older people being kept out of the conversation in the creation of a better service model.

Research has shown Australia’s aged care residents often feel isolated and lack autonomy while living in a facility which can often be exacerbated by the clinical feel, and our lack of appreciation and utilisation of older people as a society.

Director of health programs at Monash University’s Sustainable Development Institute’s Behaviour Works, Peter Bragge, described our current aged care system to ABC RN last month as “institutionalised care” that is not centered around residents’ experiences and needs.

He said the routine and lack of constructive stimulus for older people seen in aged care facilities do not emulate a comfy and homely environment, often leaving residents feeling uncomfortable or like they are in prison.

“Why does everyone suddenly have to get up at nine in the morning and be dressed and have breakfast? Just because they’re in an institution?” he said on-air. 

“Why can’t someone who’s in their 80s have an extra bowl of ice cream, even though they’ve got diabetes?”

Stakeholders and providers have discussed the importance of design and that ‘homely’ feel for aged care residents for years, but many facilities lack the resources or funding to revamp their space and take away the ‘clinical’ feel.  

Society’s role in improving the aged care experience

The current approach to aged care suggests older people are no longer able to contribute to society – often influencing  older people to feel useless and like they have nothing more to offer. 

Dr Bragge said this idea can have negative implications for older people — and the rest of us.

“If older people are always represented as frail, unable to move, then they [come] to think of that as their future,” he explained.

Studies have suggested a negative outlook on ageing could influence older peoples’ quality of life. 

In 2016, researchers at the World Health Organisation (WHO) found that negative attitudes about ageing and older people have significant consequences for the physical and mental health of older people. 

Older people who hold negative views of ageing and feel they are a burden on society perceive their lives to be less valuable, do not recover as well from disability and live on average 7.5 years less than people with positive attitudes.

Factors like race and socioeconomic status also can significantly impact the ageing experience. A 2020 paper concluded that higher socioeconomic status was related to greater access to health care and better health outcomes as an older person.

But other areas of the world have healthier and more positive expectancy around ageing which helps fend off deterioration and instils a strong sense of value in these older people. 

Should we follow example?

Older people in places like Okinawa in Japan, Sardinia in Italy and Nicoya in Costa Rica – often called ‘Blue Zones’ –  experience higher than average life expectancies and live healthier lifestyles. Older people living in these areas often live more independently and continue contributing to society well into old age.

Researchers found nine common factors as to why these areas experienced long and healthy lives, including:

  • Moderate, regular physical activity
  • Having a sense of life purpose
  • Stress reduction
  • Moderate calories intake
  • A plant-based diet
  • Moderate alcohol intake
  • Engagement in spirituality or religion, family life, and social life 

Professor Ngaire Kerse, Joyce Cook Chair in Ageing Well at the University of Auckland, says Australian society could learn from these communities on how to give older people more value and opportunities to make a contribution to society to improve aged care overall.

“But our society, the way it’s structured, constrains [older people] from doing that because there’s no expectation from society that they have any value,” she told ABC News this week.

Other factors that influence how well we age also play a part such as how active older people are in the community, mobility and even diet.

Professor Kerse would like to see more older people included in the conversation about improving aged care. 

“We should be having discussions about it in the context of our ageing.”

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  1. It would be awesome if we could have more model villages like the Netherland’s Hogeweyk and Korongee in Tasmania, for people with or without dementia. Residents would certainly be happier and healthier, resulting in less need for medication and better for staff as well.

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