Home' Australian Ageing Agenda : AAA Nov-Dec 2014 Contents Years working in aged care have given me the
opportunity to observe residents living in many
residential aged care settings. In some places, the social
environment ensured the residents were happy, despite
what I thought was poor design with confined spaces
and lack of facilities. In contrast, I have seen purpose-built facilities
with beautiful amenities where the residents seemed less happy.
As part of my PhD, I conducted research that aimed to
identify the design features of aged care centres that supported
residents to meet their needs and to live their lives positively.
This qualitative research investigated how and why residents
used the spaces, and how the buildings worked for the residents.
The study involved two aged care centres in metropolitan
Sydney -- one for profit and one not-for-profit. Staff, residents
and families were informed of the study, reassuring them that the
purpose was to observe the residents in the communal parts of
the buildings and the outdoor areas and not staff practices.
I spent many hours over many months quietly observing the
ways the buildings were used. What were the popular places?
Where were the residents drawn? I looked at the places the
residents chose to be, as opposed to the places the staff put
them. I observed where there were spontaneous conversations,
where there were smiles, and the places where there seemed to
be equal power for residents and staff. I noted the differences
between spaces -- large and small; organised and free flowing;
corridors and lounges. I sat and I watched. I answered residents'
questions and I participated in conversations if invited.
I LIVE HERE, BUT I DON'T LIVE HERE
Early in the study, while sitting in a quiet lounge room, Norma*
came in and sat down. She looked at me and asked, "Do you live
here?" I smiled to myself, wondering if I looked like a resident. "No,
I'm a visitor," I replied. "Do you live here?" I asked. "Well darling,"
she said, "it's like this. I live here, but I don't live here!" In this short
conversation Norma had managed to summarise the purpose of my
research. I wanted to see aged care facilities where the residents
felt they were living their lives well. Later, when speaking with
some staff they suggested I shouldn't bother to speak with Norma,
as she would not be able to offer me anything for the study.
My research also involved interviewing residents to discuss
their favourite places and the areas they used in the facility. The
interviews gave me a picture of life in the facility; they set the
observations in context and helped me understand the residents'
reasons for using the spaces.
Transcribing the interviews was the most difficult task - I cried
every time. The stories, the losses and the overwhelming sense of
resignation moved me.
The dominant theme was a sense of loss. It pervaded every
aspect of the interviews. The residents described a litany of losses
in their lives -- loved ones, friends, home, health, pets, gardens,
treasures, personal and financial independence, mental capacity
and, the greatest loss of all, a sense of personal value. Added to
these were the feelings of resignation and lack of control. This
sobering point should challenge us to consider the impact this can
have upon the quality of life for our residents. Another resident,
Dora, said: "Well my time is not worth anything now."
I saw many examples where a resident would fight to
retain a sense of self and the ability to make choices, however
insignificant they may seem to an outsider. These choices often
related to how they used the building.
On several occasions staff made comments like "no one uses
this space." Later, I discovered that several residents used these
areas at times they would have complete privacy. These residents
often thought no one else used the spaces. Access to some of
these areas was circuitous as confirmed by Hattie's description
of her favourite outdoor area: "You go through the dining room
out to the corridor, along the corridor, around the corner and you
will see a door... it's always locked. You have got to get someone
to open it... I don't tell anybody I am going out there 'cause
everybody will want to come and there's only two chairs (she
laughs). That's my favourite spot...You need to see what goes on
outside and you need to see things passing by and the trees and
the outside. You need to see all these kind of things."
Residents often used spaces because they were the only
spaces that were available -- not because they were adequate.
I observed how the residents would "make do" with a space.
By considering the
experiences and perspectives
of residents we can identify
the design features of aged
care facilities that meet their
needs and facilitate them
to live their lives positively,
writes Dr Lee Chin.
34 | NOVEMBER -- DECEMBER 2014 | AAA
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