Hospital design is evolving. We have moved from the Florence Nightingale era focused on regimes and hygiene to one of patient healing. And not just in a medical sense. Knowing that building design impacts our sense of wellbeing, we have entered the era of designing healthy health facilities. This was the topic of Michael Walker’s presentation at UD2021 Conference.
Michael’s presentation took a biophilic approach to designing health facilities. Biophilia is about increasing connection to the natural environment. This is achieved through the choice of building materials and/or direct connection to nature. He gave several examples of the design features that matter:
“Natural shapes and forms – the use of botanical and animal motifs, natural forms such as shells and spirals, egg, oval and tubular forms and shapes that generally resist straight lines and right angles.
Light and space – the use of natural, filtered or diffused light, the incorporation of shadows, warm light, spatial variability, spaciousness and the connection of inside and outside spaces.”
Other factors to consider in hospital design are:
Wayfinding: Most people can be easily overwhelmed when trying to find their way in unfamiliar surroundings.
Entrances: Arriving at a healthcare facility can be challenging for people and their carers. If arriving by car, there will be concerns about safety and wayfinding.
Reception: Areas should be clearly identified and provide people the opportunity to identify that they may need help in navigating the engagement process.
The presentation slides have more information on this aspect of designing healthy health facilities. Michael’s presentation is titled, Design Matters to Make Well Spaces, and linked closely with Stefano Scalzo’s keynote address on universal design.
Virginia Richardson ran a workshop at the UD 2021 on mapping how something gets built. Although local government is not the designer, it has many responsibilities for the project from start to finish. The question for the workshop was, how can we embed universal design in the process?
Virginia began with a graphic showing an example of the number of stakeholders involved in house building.
This concept was developed further in the workshop. It showed how many people get involved in a building project from a local government perspective.
Virginia’s slides include the Draft Universal Design Policy and associated documents for the Mornington Peninsular Shire Council.
The ATSA Independent Living Expo was held alongside the UD2021 Conference in Melbourne. I used this opportunity to discuss the upcoming construction code changes and home modifications.My presentation explained the history behind the changes and what it means for the future.
State and territory Building Ministers agreed in April 2021 to amend the National Construction Codeto include basic access features in new homes. This is meaningful social change for Australia, and time to re-think regular practice.
The supply of home care packages will increase and established homes will need modifications. Currently the government subsidises home modifications for this group, but modifications are not the same as renovations.
Modifications vs Renovations
Occupational therapists assess clients and decide on functional modifications as part of a home care package. They are often done in haste and have little aesthetic value due to funding constraints. Clients often refuse these modifications because of poor aesthetics and concern about devaluing their home. On the other hand, renovations usually have a designer involved. Recent research by Monash University commissioned by the Human Rights Commission, indicates that design-led modifications will gradually increase.
With basic access features already in place, modifications and renovations will become easier. Homeowners will be more willing to have modifications because it will minimise major works, and concern over the value of the home will be reduced. The NCC changes provide an opportunity for smaller builders to capitalise on this market. The Building Designers Association Australia is already on board, and has training courses to bring designers up to speed.
The picture above shows a very poorly sited home where the distance from the front porch to the property boundary was not quite sufficient to put 12 or more steps.
Universal design and existing homes
Modifications are different to renovations and they are not usually chosen willingly. Modifications are often work-arounds – a ramp here, a grabrail there and a rubber wedge for good luck. These tacked-on fittings fail to add value to a home and that’s why they are removed after they are needed. So we need universal design in existing homes when thinking about modifications.
DIY (Do It Yourself) is a popular activity for home-owners especially with places like Bunnings that have everything you could possibly need. But what renovations should people think about for their later years? UNSW has devised a free Appto answer that question.
Builders and building supply businesses should also find this app very useful. The App shows how to select products and how to install them in an easy step-by-step way that allows homeowners to choose the cheapest options that suit them best.
The authors claim that even if the costs are large, they are one time costs. Whereas costs for home services will continue. This article by Slaug, Chiatti, Oswald, Kaspar and Schmidt was originally downloaded from ResearchGate.
The personal value of home modifications is measured in quality of life and health outcomes. Research by Phillippa Carnemolla found that home modifications reduced care hours substantially.
Costs? or Savings?
Lesley Curtis and Jennifer Beecham claim that the expertise of occupational therapists can help save money in health budgets as well as improve the lives of people needing assistance at home. Their article is about home modifications and identifying the hidden savings in providing home adaptations. They argue that significant savings can be made if you tally all aspects into the calculations. The article is available from Sage Publications. You will need institutional access for a free read. The title is, “A survey of local authorities and Home Improvement Agencies: Identifying the hidden costs of providing a home adaptations service”. Or try ResearchGate and ask for a copy.
Powered mobility devices, such as mobility scooters, are forms of transportation, but are they considered in city planning? Little is known about these devices and their users so the likely answer is, no. Climate change is another issue. Transportation systems are turning to renewable power and there is a risk these devices will be left out due to a lack of understanding how they are used. As more electrified devices take their place in our streets, we must be sure we are including mobility scooters in planning as well.
Theresa Harada’s presentation at UD2021 Conference highlighted some of the issues scooter and powered wheelchair users face. Using some of the quotes from participants, the lessons became clear in the slides. On the one hand, mobility scooters allowed a greater freedom to get out and about. But on the other, there were times when it became difficult, such as waiting for a lift along with many others.
The presentationalso showed how others perceive disability. When one participant went from a scooter to a wheelchair, she found attitudes towards her changed dramatically.
Mass transportation is for the masses – that means it’s for everyone. With more understanding of “vulnerable” groups we need an inclusive focus within infrastructure planning. The frameworks that govern mobility have barriers to inclusion which good design will overcome. This research gave voice to those who use mobility scooters. Their voices are loud and clear in Theresa’s published paper.
There’s a lot of potential for accessible tourism in Australia, and everyone stands to win, both operators and travellers. The business case has been well researched over many years and in different countries. However, the data are not convincing many tourism operators to re-think their business model.
Nicole Healy’s presentation at UD2021 Conference covered the facts and figures. Tourism Research Australia commissioned a research project which involved Victorian and Queensland governments. Nicole listed the research objectives which included:
The size of the market and drivers and barriers
Needs of travellers with disability and their companions
The best communication channels
The best ways to support businesses and explore opportunities
The results
The results show the potential of accessible tourism to be in the billions of dollars representing 10% of the total domestic spend. And that’s only for those who are willing to travel. Many others say it is all too hard.
Travellers with and without disability choose trips for the same reasons. Eating out and visiting family or friends are top of the list for both groups. Sightseeing, pubs, clubs, and shopping are all popular. Going to the beach was not high on the list for people with disability.
Lack of awareness of what’s on offer and not knowing what to expect were barriers to travel. Attitudes of tourism operators and staff was not encouraging either. Higher costs for people with disability were an issue as well as not enough accessible rooms.
Travellers with disability want to see better staff training and more practical information. Better access to toilets, public transport and airports were also important. More detail is available in Nicole’s presentation slides and the data report. You can download the executive summary of the Victorian and Queensland report.
Local government rarely gets pro-active about accessible housing or Specialist Disability Accommodation (SDA). But the City of Whittlesea bucked the trend. This local government area is one of the fastest growing communities in Victoria. It also has a significant population of residents with a disability, most of whom are ineligible for SDA housing. Consequently, action was needed for mainstream accessible housing.
The Disability Housing Project was established as part of Council’s commitment to inclusion. The project identified the level of demand for both accessible and SDA housing. This information was then used to inform policy and strategic action.
Rosie Beaumont and Linda Martin-Chew tell their story of venturing into the emerging disability housing market in their presentation at the UD2021 Conference. Council wanted to explore opportunities to progress commitment to accessible and affordable housing. They involved disability advocates, housing developers, strategic and social planners and residents with disability in the project. Developers keen to get into the SDA market were not going to solve the need for accessible housing overall. This was especially the case in the rental sector.
The end result was better industry engagement to promote housing that benefits the whole community. It is an example of joining the dots between the niche of specialist housing and mainstream housing.
There is more detail in the published extended abstract, “From Niche to Mainstream: Local government and the specialist disability housing sector”.
Editor’s Note: Rosie and Linda were clearly passionate about the topic in their presentation. Whittlesea was one of only four councils that joined the campaign for mandated access features in all new housing.
The Inclusive Towns Project was a collaborative affair between Bendigo City and Lodden Shire Councils. It focused on local businesses to show how being inclusive makes economic sense. The aim was to show that improving the accessibility increased their customer base.
Nikki Williams’ presentation at UD2021 Conference had some interesting statistics. One third of complaints to the Victorian Human Rights Commission were about disability. One third of these were about employment, and another third about goods and services. Consequently, the aim of the project was to tackle equal access to goods and services and employment.
A project officer, admin support, and six casual staff with disability were appointed to run the project. It was the role of the casual staff to visit businesses and collect information about their accessibility. They followed up with an action plan and then a review.
One of the key barriers to overcome was previous poor experience with Council. They also had to overcome lack of understanding of disability in terms of employment and customers. Many businesses thought it would be expensive to make changes.
Feedback showed that solutions were easier to to implement than first thought. Businesses saw good outcomes from small changes and enjoyed positive feedback from customers.
The end result of the project is a website with information for businesses and the value of being inclusive. It also has a lot of resources.
The project also saw change both in the community and within Council. The need to build capacity with staff to understand disability better was key.
Stefano Scalzo was speaking fluent universal design at the UD2021 Conference. In his keynote address he showcased what the Victorian Government is doing to progress universal design in state projects. Stefano gave practical examples of how universal design has been applied in real life, to real buildings for real people.
Stefano Scalzo is the Executive General Manager, Planning and Development with the Victorian Government. Their universal design approach is based on their Universal Design Charter, which is:
Equity
Respect
Participation
Sustainability
Responsibility
Awareness
Collaboration
This is not a building code compliance approach: it’s a human rights perspective and putting people first.
It’s part of the tender process
The Government’s commitment is not just a policy – it is action. Their procurement process asks prospective tenderers to tell them how they will achieve universal design. And they are promoting a culture of inclusion where universal design is integrated at the beginning of every project.
Stefano explained more about the tender process and then showed us several examples of buildings that met their charter. He added that we are really just beginning and there is so much more to learn. And he challenged us to keep the conversation going. Specifically he asked delegates to commit to the conversation by:
Taking this back to your Director
Presenting to your team
Forming an advisory group
Redrafting the design
Listening – really listening – to someone with lived experience
Adopting a charter
Adjusting your process
Thinking beyond accessibility – to participation, safety, welcome
Going beyond compliance
Delivering more than a minimum standard.
It was wonderful to hear a government representative speaking fluent universal design. This is the kind of leadership we all need in Australia if we are to become truly inclusive.
Stefano shared his slidesand his speech noteswhich have a lot more detail about the work they are doing in Victoria.
Michael Walker’s presentationexpanded on aspects of this presentation. Victoria is clearly committed to inclusion and universal design.
Easy Read is a good example of how less is more. But conveying messages in fewer words is more difficult than writing more words. Easy Read is for people with low levels of literacy. It’s mostly used for essential information such as health alerts and legal terms and conditions. Writing with minimal words is a skillset of its own. It’s not easy. But it does make you think about what you really need or want to say.
Proficient readers can use Easy Read versions to get the take-home message quickly and easily. That’s also why it’s universal design – it’s for everyone. However, Easy Read is not the same as Easy English – the example in the image. It has even fewer words and focuses on actions not just information. Cathy Basterfield says that Easy Read is not simple enough for some people and explains this in a simple poster analysing the difference
Easy Read not the same as plain English or plain language.Complex documents such as research reports are beginning to include a plain language summary. However, these require an average level of literacy. They are usually presented as a paragraph or a list of sentences in dot points. Easy English drills down further to the key words and concepts. The techniques include:
a lot of white space
directly relevant illustrations (not photos) to convey the meaning of the text
short words and sentences
minimal punctuation
positive phrasing
bullets to separate items in a list.
Editors can learn from Easy English
The Chartered Institute of Editing and Proofreading blog has a more detailed article. It summarises Cathy Basterfield’s presentationat their annual conference. She shows how editorial professionals can learn from Easy English.
Blog writer, Anna Baildon, said she learned a lot from the session and had her assumptions challenged. She said she could see “the links to plain English but it goes further”. The headlines she remembers are:
It’s hard to write in Easy English
Access to written information should not be a reading test. It should be enabling
Unpacking the language so the meaning becomes accessible.
Access to information is a right. ‘Access’ means that a person reads, understands and knows what they can do.
More than 40% of the population has low literacy skills. In some remote parts of Australia and in institutions it is higher than this. There are several reasons why so many Australians need information in easy to understand formats:
– acquired disabilities – lifelong disabilities – poor educational outcomes – psychiatric or mental illness – dyslexia – early school leavers – older people – different cultural backgrounds – hearing impaired and/or people from the Deaf community
Accessibility and universal design needs to be considered at the outset of any project, not as an afterthought. Information formats such as brochures and websites are no exception. Some important government documents include an Easy Read version, but this is still rare.
Cathy Basterfield has pioneered much of the work on Easy English in Australia. People with high level literacy skills can grasp the key points with little effort. And there are times when people with good literacy skills need help. For example, the stress of a court hearing can temporarily affect one’s reading skills and level of understanding.
Interoception is an internal sensory system where you notice physical and emotional cues. Most people develop this system and gain awareness of their internal cues as they grow up. But not everyone does. Dr Emma Goodall’s workshop, Interoception: A universal design approach, enlightened us and linked it to universal design in learning (UDL).
Emma explained how poor awareness or misinterpretation of our internal body state, like feeling thirsty or hot, makes it difficult to regulate our emotions and behaviour. Then she took us through some interoception activities so that we were all able to notice our own bodies.
After understanding the theory and having a practice, we were able to consider interoception in our own lives and apply it in other settings. It is particularly useful for teachers of school children who have difficulty learning. Emma explained how students and teachers are more engaged at school and there are fewer suspensions and exclusions.
Emma made the point that when children and young people have not yet developed interoception skills they will struggle with their emotions and with social interactions. Even just being around others may be difficult for them to manage. This will, of course, affect their ability to learn in and out of school.
Presentation slides and paper
The slides from Emma’s presentation give an overview of interoception and how it applies to children and young people. The title of her presentation is,Interoception as a universal design for learning strategy to support well-being and engagement in learning in education for all children and young people.
There is more in Emma’s published paperwhere she explains how educators, families and other professionals can implement interoception activities. Other contexts where it is useful is the justice system, mental health and aged care.