Background: The Neighbourhood Canberra (TNC)

TNC is an Association incorporated in the ACT in 2019. It was formed by a group of volunteers with a personal interest in, and desire to improve, the quality of residential care for people living with dementia in the Canberra Region.

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Our purpose was and remains:

To establish, for people living with dementia needing residential care, home-like clustered care homes in a village setting connected with the surrounding community and where intergenerational connections are fostered.

Our vision is:

‘To create thriving communities for people living with dementia’.

And, our mission:

‘To establish in the Canberra Region an innovative model of residential care for people living with dementia based on best practice environmental and architectural design principles and where exemplary evidence-based care is practised.’

 

We have been working towards achieving these ends since 2019. This has involved creating connections with relevant stakeholders including:

•  The University of Canberra - culminating in signing a Memorandum of Understanding and our contributing financial support for research relating to the development of the dementia village concept. We contributed to three workshops run by UC researchers with people impacted by dementia, people working in aged care, and academics with expertise in gerontology and clinical experience The research findings were published here https://content.iospress.com/articles/journal-of-alzheimers-disease/jad230368 and include principles necessary for a village for people with dementia to be successfully integrated into the local community and to facilitate an inclusive culture that promotes dignity of risk and meaningful activities.

•  Federal and ACT government and MLAs – including, as an outcome, a commitment in TheGreen’s Parliamentary and Governing Agreement for the 10th Legislative Assembly ACT to: ‘Support The Neighbourhood, Canberra to secure land for Canberra’s first Dementia Care Village’.

•  Aged care providers and peak bodies interested in supporting innovative dementia care practices, noting the active support from Dementia Australia.

•  A Reference Group, jointly with Dementia Australia, including people impacted by dementia.  Architects, town planners, and land/housing developers in the Canberra Region.

 

Dementia prevalence

The proposal is timely. In the ACT, dementia is now the leading cause of death overall with the death rate for women being almost twice that of men, mirroring the broader trend across Australia.

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Dementia is a major cause of disease burden in Australia Dementia in Australia, Summary - Australian Institute of Health and Welfare (aihw.gov.au). It is a significant and growing health and aged care issue that has a substantial impact on the health and quality of life of people with the condition, as well as for their carers and family. People living with dementia may have cause to draw on residential care services as the symptoms of their neurodegenerative conditions inevitably progress. More than 50% of residents in Australian residential aged care facilities have dementia.

They need to be enabled to live their best lives possible at this stage of their lives.

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Traditional aged care in Canberra

Existing aged care facilities in Canberra for people living with dementia adhere to traditional architectural styles and care approaches. There is a need for alternative models offering personalised, person-centered, or more radically, person-directed, care within smaller households. Inspiration can be drawn from international examples known for excellence in both practice.  

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TNC recommendations

The Royal Commission into Aged Care Quality and Safety Final Report released in March 2021 made 148 recommendations for the improvement of aged care services for the future. Recommendations 45 and 46 specifically addressed aged care accommodation. In response to recommendation 45, a set of National Aged Care Design Principles and Guidelines have been drafted as a resource for providers and architects who are building or renovating an aged care home. These guidelines support a move towards small-scale homes for up to 15 people and provide principles to cultivate an enabling environment where residents have access to the outdoors and connections with the local community.

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Best practice dementia design principles

•  Single-storey small-scale houses (5-6 residents each) with live-in staff. Small scale housing models can improve social connections, independence, eating, safety, and infection control, and improve family and staff satisfaction and for residents, improve mood and reduce unmet needs, which can reduce the use of medications or physical restraints.

•   Desirable village size: 90 residential places in 15 homes

•  Avoid obtuse signage to achieve a visual integration with the surrounding community

•  On-site parking for staff and visitors

•  Clear wayfinding (external and internal) is a crucial design element for a successful outcome for residents

•  Follow the principles outlined in World Alzheimer Report 2020 | Alzheimer's Disease International (ADI) (alzint.org) and the National Aged Care Design Principles and Guidelines.

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Environmental Considerations:

•  Design/build according to green built environment principles

•  Landscape is integral to site design for resident amenity. High quality private and communal landscaped areas are essential. 

•  Sensitive architecture, colour schemes, and materials should be used.

True connection to the local community

•  The design should incorporate communal facilities for residents and be accessible to the local community. Creating a village that enables and supports people living with dementia with true integration with the local community, allows a range of opportunities for intergenerational connections and community engagement.

•   For this site, we note there is no need for on-site provision of certain community facilities (e.g., childcare) as these are already provided for in the immediate area, which is an advantage.

Cultural and staffing considerations for the operator:

•   The culture of the eventual operator should align with current best practices.

•  The successful tenderer should demonstrate a cultural shift that starts with the vision, mission, and philosophy of the organisation, and focuses on respect for the individual living with dementia. Avoid selecting traditional residential aged care providers to run the village who may be restrained by traditional thinking.

•  Demonstrated organisational investment in programs and models that truly embrace the principles of person-centred care or person directed care, such as The Pioneer Network, The Green House Project, Eden Alternative; The Butterfly Model, Community Home Australia, Group Homes Australia, Namaste Care or the Montessori Method will be critical to success.

•  Creating a culture of inclusiveness is vital. This can be done, for example, by including families or residents in the operator’s Board or management meetings; including residents on interview panels for staff; dementia-specific training for all staff and stakeholders; and, providing opportunity for the broader community to learn more about dementia thereby reducing stigma associated with dementia.

•  For residents, promotion of independence, enablement, dignity of risk, implementation of meaningful activities, connection to the community, with staff who are skilled to work in these ways with people with dementia is essential.

•  Staff must be valued by the organisation and enabled to get to know the residents, to build relationships with residents and their families, with scope for flexibility to attend to the needs of people experiencing a broad range of dementia symptoms on a moment-to-moment basis.

•  Generally, in traditional care, staff must provide routine-based care and be reactionary to behaviours. Staffing at weekends must be improved to support residents to live a meaningful life seven days a week. Improved staffing ratios and dementia-specific training can reduce falls, wound management, and hospitalisations.

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Collaboration with Research Institutions:

•  Establish collaborations with reputable research institutions or universities to conduct the evaluation.

•   Foster partnerships that bring in expertise and credibility to the research process.

•  Use research findings to inform continued adaptations or improvements to the residential care model.

•  Ensure that the research contributes to the ongoing refinement and optimisation of the care model based on evidence-based practices.

Tender Assessment Criteria

 Canberra has an opportunity to showcase a new model of residential dementia care. Therefore, TNC recommends the SLA assessment criteria for this dementia village tender should include at minimum:

•  a demonstrated track record in innovative and evidence-based dementia care.

•  a demonstrated track record in innovative and evidence-based dementia related design and/or a willingness to work with a design team with experience in innovation in design for people with dementia.

•  a demonstrated willingness to consult with the local and wider community on the proposed design.

•  A willingness to support research to evaluate the effects of the new model of residential care and impact on the local community.

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We cannot emphasise enough the importance of the eventual operator either being the purchaser/builder or at least integrally involved in the design – otherwise, it risks not being fit for purpose.

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Ongoing Consultation & Engagement

•  It will be important to involve people living with dementia in the consultation and development process. Taking into account the perspectives of people living with dementia regarding the built environment they live, or may at some time, live in, can enrich the planning and design process because it directly relates to their life-world, everyday life and environment they live in. 

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