by Ken Blair on Ageing Agenda March / April 2015 issue
Looking for lessons in acute care
Despite a major rejection of the hospital model by the aged care sector over the last 30 years, it may now be time to re-examine recent developments in that sector to ensure our aged care designs are achieving optimal results, writes Ken Blair.
Hospital developments with often very large budgets and government sponsorship have been the crucible for innovative responses to space planning, energy use, and general therapeutic healing environments. For the last 20 years we have been advocating a rejection of the hospital model for the design of residential aged care buildings. Perhaps it is time to review that approach, to see what trends are occurring in the hospital sector that could be usefully adopted in aged care.
Residential aged care design developed out of the hospital sector, and was characterised by multi-bed wards and group shower and toilet facilities. The interior décor was clinical, with predominantly white walls and ceilings, shiny vinyl flooring and long unbroken corridors.
Just as hospitals were not seen as pleasant places to stay, neither were the aged care buildings that evolved out of that model, especially given the longer stays typical for most aged care residents.
It was perceived that aged care residents would, in fact, be better served by a more homelike living environment. One of the first targets was a reduction in the number of residents accommodated in a bedroom, and while there have been regulatory incentives to reduce average occupancy rates for new buildings down to average of 1.5 residents per room, the market has also played a part, with the public strongly favouring single bedrooms with ensuites.
However, in parallel with this move in aged care, average rates of occupancy in hospitals have also come down, again following public demand.
Many other aspects of hospitals design have also changed since 1950s and 1960s. The hospital model that was rejected by the aged care sector in the 1980s is not the same as the hospital model of today.
A useful case study
A well-recognised example of the current innovative hospital design has been the recently opened Royal Children’s Hospital in Melbourne.
This building sought to break from the traditional hospital stereotype and create an inviting, non-threatening and healing environment, being especially relevant given the age of the patients – children.
Key design innovations include:
It achieved the highest standards in sustainability in the design of a hospital facility. Features include rainwater collection from 75 per cent of roof areas, a black water treatment plan, a 10 per cent reduction in energy use compared to a normal hospital, a 2.4 megawatt gas fired trigeneration plant, chilled beam air conditioning, a biomass boiler, solar panels and parking for 500 bikes.
The design maximised the engagement of the building with adjacent park land environments, providing a healing environment for patients. (The equality of outlook from patient bedrooms in hospital environments has been well-recognised as providing a positive contribution to the healing of the patient.)
A central linking “street” that deinstitutionalised the hospital and provided a hub of activity for the hospital community, and made it easier for patients, visitors and staff to navigate their way around the building.
Flexible design and infrastructure has been adopted, capable of adapting to new technologies and emerging trends in healthcare, and changes in clinical practice and models of care.
Many of the features, albeit on a smaller scale, could be incorporated into aged care, with some already being introduced.
Another visible feature in the design, both internally and externally, has been the bold use of colour, and the incorporation of large-scale works of art, which provide playfulness to the public area. While particularly suited to children’s environments, we would explore use of these features more in aged care.
Loose fit, long life
Hospital designs are looking to accommodate future technological needs by providing wide pathways with accessible, flexible interstitial service space.
Establishing accessible upgradeable pathways for technology is certainly a strategy being adopted in major healthcare developments and should similarly be implemented in aged care projects via accessible service ducts and channels, adoption of improved wireless technologies (requiring minimal infrastructure), and avoiding major expenditure on technology that has either a short life compared to its cost, or is unproved.
General spatial planning
It is generally recognised that a hierarchy of resident social spaces should be provided for aged care facilities, to allow for a range of living options, from small-scale intimate and private to large-scale social activities.
Hospital design seeks to maximise use of all areas, via adaptable layouts, and again, this philosophy can be adopted for aged care by combining spaces, using movable walls, and locating appropriate spaces adjacent to each other to allow for greater flexibility use.
Energy use has been a major concern for hospital building managers and significant attention has been given to lower energy usage to reduce carbon footprints as well as operating costs.
In the past, many of these technologies were not viable for aged care projects, but technological advances have now brought many of them within reach.
Micro gas turbine electrical cogeneration is now being installed on one of our current aged care projects to provide for all the electricity needs of the 100-bed facility and supplement the hot water system. This also provides a reliable source of electricity independent of the grid.
Recent developments in both the price and technology around solar panels will see their adoption on a far greater scale than we have previously seen. While early installations have sometimes had problems, most of these issues have now been resolved.
Buildings need to adopt well established methods of passive design, and allow for technology to be bolted on as it develops and proves to be cost effective.
Recent changes to the aged care funding regime, with a focus on the consumer, will lead to additional demands on providers, with a requirement for buildings to be more efficient, both spatially and energy use wise.
Hospital developments with often very large budgets and government sponsorship have been the crucible for innovative responses to space planning, energy use, and general therapeutic healing environments.
It may now be time to re-examine recent developments in that sector to ensure aged care designs are achieving optimal results for the funds being expended.