A New Approach to Aged Care: pseudo-suburbs, robotics and purposeful activity
“I’d rather die.”
For many – particularly in light of the horror stories that have led to a royal commission – that’s the common reaction to any suggestion about going into aged care. But is there a new approach to this stage of life that offers alternatives and possibly even something to look forward to? Maybe. As the baby boomers edge towards their use-by date, they are showing no signs of going quietly or tolerating the conditions their parents put up with.
Dr Mike Rungie is the inaugural director of the Global Centre for Modern Ageing in Adelaide, a thinktank established by the former South Australian government, in the wake of the collapse of the automotive industry, to generate new employment opportunities in the aged care sector.
“Research tells us that older Australians are increasingly rejecting services and types of care that underline their deficiencies and ignores the fact that while you might be 95, you feel like you are still 75,” says Rungie, citing the example a worker in her 90s he met at a factory on a fact-finding tour of the US as part of his research into alternative post-retirement roles.
“The old narrative around the elderly from individuals and service providers has been one of low expectations, boredom and making the best of it. The new narrative is about purposeful activity.”
It’s an idea taking shape in Tasmania at the “revolutionary” Korongee – touted as Australia’s first dementia village – a $25m care facility in Hobart’s Glenorchy, modelled on the example of the De Hogeweyk village in the Netherlands, where small groups of residents with shared interests live in houses with carers. The idea is that they are free to wander the village and go to the supermarket, cinema, cafe, beauty salon or gardens, and live an active life while still being supported by care.
Earlier this year, the entrepreneurial University of Wollongong announced that it is developing a state-of-the-art aged care precinct as part of its innovation campus. The facility, which claims to be a world-first in its integration of academic research with patient care, is modelled on the Mayo Clinic in the US and on the best design elements of aged care in Scandinavia, such as those featured in the Aalborg Care Consortium development. The Danish complex includes 75 apartments with adjustable sinks and ceiling lifts, as well as a medical and dental clinic, a fitness centre, a restaurant that welcomes non-residents and a “living lab” public meeting space for trialling new technology.
Plans for the 700-hectare Wollongong site include an aged care and senior living village with nearly 200 independent living homes, together with a $44m community non-surgical, preventative health clinic.
Promotional material promises “intergenerational connectivity”: 650 students, enrolled in courses on health, ageing and related fields such as exercise medicine, will be available to support older residents in their activities. Childcare will also be part of the mix as it is in an increasing number of overseas aged care facilities.
But that connection will be reciprocal, says UOW deputy VC and executive dean of the faculty of science, medicine and health, Prof Alison Jones: “There will be opportunities for the older cohort to act as mentors and to be volunteers. But also they will have the campus at their disposal so it will be like living at a university of the third age. Technology will enhance the experience with lots of remote sensors, in everything from beds to shoes, so people can wander without anyone worrying they are lost; we are also looking at the sensible use of robotics. With the permission of residents, we will be able to capture big data health analytics to create personal profiles that match their needs and give them more choice.”
A one-stop shop for respite, rehab, disability, mental and aged care services, the development will bring together experts including physiotherapists, dieticians, dentists and pathologists and it will create up to an estimated 1,000 new jobs in an area that has suffered from long-term unemployment. It’s set to open in 2022.
UOW’s project bucks the current trend of older Australians choosing to remain at home in preference to residential care, partly due to the government’s policy direction and funding of “ageing in place”.
South Australia’s Elderly Citizens Homes (ECH), which began life as a not-for-profit providing accommodation for war widows, has a different approach.
Chief executive David Panter says: “Running residential aged care sucks the life blood out of most organisations, requiring a huge expenditure of energy and funds on management and staffing: all that compliance becomes the focus and prevents them from thinking differently. We made a bold decision that freed us up to respond to the wishes of those who want to remain in their homes for as long as possible. We had housing stock that we could sell to invest as part of reorienting ourselves towards the concept of neighbourliness, in response to research that identified fear of social isolation as a key factor in getting older.”
Instead of retirement villages, ECH built clusters of modest home units that are partnered with a community cafe where there had previously been none, to create a hub for book clubs, gardening and art classes and even a “death cafe” where end-of-life issues are discussed informally. “Next up is a project to have a baker in residence in response to the fact that many people enjoy cooking but have no one to do it for. This will mean a senior volunteer can bake and we can sell what they make in the cafe,” says Panter.
“We have also teamed up with a local Montessori school so that pre-schoolers have contact with older residents and their teachers are finding that the Montessori method can help people with dementia. Our vision is all about integrating generations instead of creating ghettos. We are doing a lot of work with the LGBTQI community as they have experienced incredible change in a lifetime and are often on their own when a partner dies, [and] without children or family.”
Evidence from longitudinal, not-yet-published research ECH has undertaken as part of a University of Adelaide study shows that if their clients’ health deteriorates and they need to go into managed care, they do so seven years later than the control group.
Alternative communities, based on a model widespread throughout Scandinavia, are also becoming increasingly popular.
In Queensland, Natasha Chadwick, founder and chief executive of NewDirection Care, has built what she describes as a “micro-town” at Bellmere, on the outskirts of Brisbane. It features 17 houses on six streets, each accommodating up to seven or eight residents, together with a house companion/carer who does the cooking and provides all necessary support. This gives residents, including those with cognitive damage (there is no segregation according to impairment), the opportunity to maintain their own routines, rather than being forced to fit into a regimented schedule of washing, dressing and eating. The dementia-friendly configuration of the homes and the surrounding amenities in the “pseudo-suburb” include a corner shop, cafe, barber shop and cinema.
Unlike New Direction Care, Group Homes Australia caters exclusively for dementia sufferers who live together. Their houses are located in existing suburbs in and around Sydney. Extreme care is taken matching residents so that they are compatible in terms of cultural backgrounds and interests, to create a congenial home atmosphere, staffed by a homemaker, who is not recruited from a traditional nursing background. “Our approach is social – not clinical,” says founder Tamar Krebs, “so we prefer staff who are not trained, so we don’t have to spend time undoing poor behaviour. Given that they are Gen Y, we often have to teach them about the convivial aspects of a home such as eating a meal around a table with others. We teach them how to cook and set a table properly.
“Our activities program includes a silent disco to get residents moving – they love it. We use virtual reality programs, which are very calming, especially the ones that take residents swimming on the Great Barrier Reef. It’s a wonderful, gentle immersive experience.” The company has five new homes in the pipeline in Sydney’s west and Sutherland Shire, due to open next year.
Meanwhile, technology is providing new ways to deliver services at home and in residential care. Lamson trolley robots, which have been operating in many hospitals for several years, now deliver medication and meals and collect laundry. Spatially aware, these automated devices save hours in wages and minimise injuries. They will become increasingly ubiquitous and versatile.
Virtual reality is increasingly being applied as an immersive cognitive distraction to relieve anxiety during wound dressing and to assist with chronic pain. The most popular program simulates swimming with dolphins and whales.
Feros Care uses virtual care for chronic health conditions for around 400 clients nationally, connecting them via mobile networks that feed data about blood pressure and blood sugar back to a virtual nurse in Coolangatta. Chief customer officer Melissa Simpson says: “These systems have seen a significant reduction in the number of bed days in hospital and a reduction in the severity of admission.”
In Adelaide, another not-for-profit, Silver Chain, is experimenting with holographic consultations delivered via a headset to enable remote residents to speak with medical staff.
Client consultation is critical
There’s more tech to come: the latest buzzword in aged care start-ups is non-invasive monitoring. In line with its commitment to home care and the emphasis on independence, ECH is currently trialling Billy in fifty homes. Developed by a Sydney based start-up, the system delivers a live data feed to a family member or care manager.
With no cameras and nothing to wear or press, , Billy relies on discreetly placed sensors that monitor everything from movement to temperature and behaviour patterns to create a tool for prevention and intervention before incidents become emergencies. This is likely to be more effective than safety pendants as data from the 2017 International Carers Conference in Adelaide showed that 70% of those who own pendants do not wear them.
Melbourne-based Umps Health has developed smart plugs to fit any appliance and wall socket. These build up a profile of habitual behaviour patterns as predictors of disease, infection or falls. If the system detects something unusual, it sends the client or their nominated contact a text message.
There are countless stories of elderly people falling in the middle of the night and lying unable to call for help for hours. Now a partnership between Melbourne’s RMIT University, Canadian smart clothing specialist Hexoskin and mattress manufacturer Sleepeezee has developed Sleeptite, a non-invasive monitoring system that will provide reassurance to families and care staff.
All the designers of new tools and service providers interviewed emphasise that client consultation is now a critical part of the process. Feros Care asked its at-home clients to pilot a new portal it is launching next year, similar to a banking app, that will provide up-to-date information about services to users and their adult children. Simpson says: “No one needs to worry if a carer is going to turn up or that they’ve forgotten an appointment. We are already seeing that it is reducing the number of anxious phone calls to our staff.”
“Clients were involved in each iteration so that we end up with something that is user-friendly right from the start and they get a richer experience because they can look up a profile of the person coming to see them.
Feros Care is currently trialling a virtual seniors centre as a tool to help combat loneliness and social isolation, allowing users to dial in, as they would on Skype, to group craft sessions, church services and cooking classes. “Getting this stuff right is about collaborative co-design. And as more and more baby boomers come through the system, they will expect more and more digital ingenuity,” says Simpson.
It may be too premature to call the momentum around these innovations a revolution, but there are significant reasons to feel less dread and apprehension about later life than previous generations. “Current models for life post-retirement shrink your options instead of expanding them,” says Rungie. “But all the research shows there is no diminution of a desire for purpose, even with old age and frailty. It’s about telling ourselves new stories that make this stage of life meaningful.”