Ageing in Place vs Aged Care: The Costs

Three stacks of coins sit alongside a wooden cut-out of a house shape.Most people want to stay in their own homes rather than go to an aged care institution. The Royal Commission into Aged Care report confirmed this. And the obvious follows – it’s also beneficial for governments because the costs of home care are less than institutional care. But are our homes designed to support care at home?

According to an AHURI Brief, on average, someone on a home support program costs the Government around $3,900 per year. The cost of a person living in residential care costs around $69,000 a year. These figures are the annual ongoing cost per person. The cost of a home care package ranges from $9,000 a year to $52,000 per year depending on the level of support. 

The AHURI Brief includes a chart comparing the various costs of of the different packages and support against the cost of residential care. Another cost that could be reduced is the need for home modifications. Not only can people stay home more safely, care hours are also reduced. In rental accommodation such modifications can be denied by the landlord. That will lead to early entry into an institution. 

The AHURI Brief concludes, “We note that there is currently no discernible connection between the Australian Government aged care program and any Australian or State or Territory Government housing program. This must change.”

The title of the AHURI Brief is, Better supporting older Australians to age in place

AHURI (Australian Housing and Urban Research Institute) is a national independent research network. AHURI’s work informs policy about housing and urban development. They have not engaged with the proposed reforms to the National Construction Code for improved accessibility in all new housing.  

 

Aged Care: Are institutions still the way to go?

An older woman using a walking cane walks over a paved section towards the roadway.Why is it still OK for older people to be “put” in aged care institutions? We closed such places for people with disability and mental health conditions last century. There will still be a need for some people to receive care in a place that is not their home. But the vast majority could be better served with homes and neighbourhoods designed to support them. And that doesn’t mean these places won’t suit everyone else – they will. 

The Conversation has an article that discusses this issue arguing it’s time to support healthy ageing in place. “Age-friendly places aren’t just good for older people. They also support the needs of children, people with a disability and everyone else in a community.” The article includes the well-established global age-friendly framework devised by the WHO many years ago. It is still relevant today. As the authors say, the WHO framework covers the essential ingredients of liveable communities. And it supports well-being for all. 

The title of the article is, Aged care isn’t working, but we can create neighbourhoods to support healthy ageing in place.  

A previous post, Ageing in the right place, has links to more on this topic.

Community engagement and civic innovation

An international group of adults stand with a big board in front of them. It says, Make Things Happen. There are lots of coloured post it notes on the board.Community engagement sounds like there’s more interaction than community consultation. But is ‘engagement’ enough, or is there a way for the community to also innovate? That is, to be part of the Civic Innovation process.

Civic Innovation is a global movement embracing smart city technology and social innovation. Citizens can play an active role in democracy if they have good information to inform their views and ideas. 

The Future of Place website has an article that outlines this new social and technological movement. It explains social innovation, the role of civic-tech, citizen activation, and collective impact. 

“Citizens often identify social and infrastructure problems before planners and developers. But are city leaders thinking community engagement strategies are enough? Or are they tapping into these valuable networks?” The question posed is whether current community engagement processes are recruiting the next generation of active citizens. Doing more with less is also an outcome of collective impact.

The title of the short and straightforward article is, When community engagement might not be enough – Let’s talk ‘why?’ civic innovation.

The Future of Place website has other useful resources.

 

Disability and Planning Research

A book and notepad lay open on a desk in a library.Planning research has not yet evolved to include disability perspectives. Is it because the medical model of disability still prevails? Or is it mistakenly believed that disability is not a design issue? Some might say it’s because the needs of people with disability are fragmented across government departments. Practitioners in the planning field are required to engage with communities, but it seems the researchers are not keeping up. 

Two Canadian researchers took a look at the situation. A search of five prominent planning journals showed that people with disability largely remain invisible. The researchers found just 36 articles – most of which come from the US and the UK. Only 20 had people with disability as the central topic. 

The authors describe the content of the papers that go back as far as 1916. Attitudes towards people with disability clearly changed over the years but including them in research did not. Papers that did mention people with disability generally added them to a list of other groups considered vulnerable or marginalised. 

The paper concludes:

“Planning researchers and practitioners, therefore, must continue to question what knowledge, assumptions, and biases we may have toward PWD and experiences of disability that manifest through our environment. More broadly, planning scholarship can be strengthened by continuous questioning of self—on the processes through which certain knowledge is produced or a pursuit of certain knowledge is prioritised within the discipline. The development of critical discourse focusing on PWD can be a vehicle for such self-reflection.

The title of the article is, The Precarious Absence of Disability Perspectives in Planning Research. It is open access on cogitation press website, or you can download directly

Public toilets by universal design

A row of handbasins in a public toilet.We all have to go sometime. Accessible public toilets have their own Australian Standard. It spells out how to design it and what fittings go where. But an accessible toilet doesn’t solve all our toileting issues. It’s time take a universal design approach and re-think the business of public toilets. That’s what Katherine Webber will be discussing at the upcoming Universal Design Conference.

Thinking more broadly than people with limited mobility is important if we are to be inclusive. Katherine Webber’s Conference paper explains where the design of public toilets are letting some people down. She discusses the taboos, policy and legal barriers in several countries. Katherine lists the many issues people found with public toilets and they go beyond those of wheelchair accessible toilets. She proposes that a universal design approach be taken to the design and placement of public toilets. 

Katherine recently visited Canberra to talk to policy makers how our public toilets should better. ABC News has written a short piece on her visit and some of the findings from her Churchill Fellowship research. 

The title of Katherine’s paper is, Everyone, everywhere, everyday: A case for expanding universal design to public toilets. She will also lead a discussion group at the lunchtime Table Topics session at the conference.

You can find more peer reviewed papers from the upcoming conference in Melbourne  17-18 May 2021 on the Griffith University website 

Planning Inclusively: Make Communities Just for All

View from high building in Brisbane overlooking building roofs and the Brisbane river and bridges. Jacaranda trees can be seen in the street.Urban planning is a highly contested and politicised area to work in. The talk is that planning is about people, not roads and buildings. But when do users – people – get a say in planning? Only at the end when plans are put on exhibition. Then you need to be an expert to understand them. Planning inclusively is to make communities just for all. 

Lisa Stafford, in a briefing paper, asks how well do we consider human diversity in planning cities and regions?  Planners and bureaucrats would rarely even consider the concept of “Ableism” in their designs. That’s why we still have marginalisation by design. The lens of the average or the “normal” person is rarely put aside for a lens of diversity. 

Graphic with four circles: one each for exclusion, separation, integration and inclusion.Social planning can drive inclusive communities because it operates from a justice framework. Participatory planning is one way to work towards inclusion. 

The tile of Lisa Stafford’s paper is, Planning Inclusively: Disrupting ‘Ableism’ to Make Communities Just for All.  She has four recommendations at the end of her easy to read paper. Briefly they are:

      1. Adopt an approach of planning for all
      2. Apply spatial justice thinking to planning
      3. Embed universal design as a core planning principle
      4. Re-emphasise the social in planning

Editorial Introduction 

“Disabled people continue to experience exclusion by design in our everyday spaces, infrastructure and services, which has been magnified through the COVID-19 pandemic. Now, more than ever, there is an opportunity for urban and regional planning practitioners, researchers and disabled people to come together to advocate for and create inclusive, sustainable communities for all. However, to make this transformative, we must first critically question how well do we really consider human diversity in planning cities, towns and regions? This question is examined in this briefing paper by contesting entrenched challenges like ‘ableism’ before providing fundamental starting points for planners in planning more inclusive and just communities for all.”

Age Friendly Communities Handbook

Front cover of the handbook.From Norway comes an Age Friendly Handbook that presents information in easy to consume formats. Norway has been driving a universal design agenda through national and local government since 1999. Norway’s key document for this is Norway Universally Designed 2025. This Handbook fits nicely within that framework but with an emphasis on an ageing population. The WHO Age-Friendly Cities guide is useful and detailed, but it’s showing its age. So this handbook comes at a good time.

Infographic from the handbook showing the essential element of age friendly.The Handbook for Age-Friendly Communities is 70 pages with many photos and graphics. It covers the key steps in the planning cycle, aspects to consider in built design, transport, housing and social participation. Pre-requisites for age-friendly development are co-creation and communication.

Elements not considered in the WHO guide are plain language, internet use and how to co-create and gather information from older people.  Checklists and examples are included. Fortunately the Handbook is in English so many more people can benefit from Norway’s 20 year’s experience. A great resource, particularly for local government.

Norway has reviewed its policies over time and began to include more than the built environment. They also developed a method for mapping their level of accessibility in 2017.

 

Disasters and emergencies: Leave no-one behind

Road Closed signs and a barrier of a road that reaches down to swollen river.‘Leave no-one behind’ is the tag line for the Sustainable Development Goals. In disaster management this idea takes on a very practical meaning. People with disability are two to four times more likely to die or be injured in a disaster than the general population. So why is our planning and risk reduction failing people with disability?

Being able to attend community meetings to find out what to do in an emergency is one factor. Having more than one person in the household with disability is another. Community education and plans assume everyone can get out of the house with a few belongings, get in the car and drive to safety. But some of the problem is that people with disability don’t make a plan or don’t tell anyone their plan. 

There is no nationally consistent standard for including people with disability in disaster risk reduction. An article in The Conversation explains some of the research into this. It includes the comments made by people with disability when asked about disaster planning. One such comment is very telling,

“But I spoke to three different people who had three different disabilities, and you realise that the communication has to be targeted. Because those three people required completely different things. And the information they got was not in a mode which they could use.”

Four men with orange lifejackets are standing in a yellow State Emergency Service boat on a swollen river.The title of the article in The Conversation is, ‘Nobody checked on us’: what people with disability told us about their experiences of disasters and emergencies

The academic version was published in the International Journal of Disaster Risk Reduction. The title of the paper is, Applying a person-centred capability framework to inform targeted action on Disability Inclusive Disaster Risk Reduction, and is available from ScienceDirect.  

Key points from the study are:

• Disability Inclusive Disaster Risk Reduction requires collaboration with people with disability to remove barriers that increase risk in emergencies.

• The Person-Centred Emergency Preparedness framework directs attention to the choices that people with disability have in emergency situations and factors that enable or limit them.

• Findings can be used to support implementation of Australia’s National Strategy for Disaster Resilience by defining person-centred responsibilities of people with disability and service providers in emergencies.

“Findings from this study enabled deep insight into the diversity and interrelatedness of factors that increase the vulnerability of people with disability and their support networks to disaster; offering new perspectives on why Australian’s with disability are disproportionately affected by disaster. The Capability Approach is used to consider what is required for stakeholders to work together across sectors to increase the safety and resilience of people with disability to disaster.”

COVID-19 Screens and hearing augmentation

A man wearing a striped apron passes is behind an acrylic screen. A woman on the other side of the screen is paying for her goods.Acrylic screens have appeared at almost every reception desk in response to covid-safe requirements. But without related hearing augmentation installed, it makes it harder to hear each other.  If people are wearing masks as well, this makes it worse. 

We are familiar with screens at ticket offices, such as train stations, where hearing augmentation systems are mandatory. An article by Bruce Bromley explains how these new reception desk screens contravene the building code if they don’t have hearing augmentation. When businesses installed new screen, few, if any, thought about the communication problems they would cause. And if they did, they perhaps thought we could all live with it.  We need respond to this issue because being covid-safe looks like being a new normal. 

Any service or business that recently installed an acrylic screen at reception should look at finding a hearing augmentation system. It will benefit the receptionist and the customer. Plug and play solutions are available where there is a microphone and speaker on both sides of the screen. I suspect that these screens will not disappear even if and when covid does. It’s all part of adjusting to the “new normal”.

Editor’s comment: Sometimes I find myself or the receptionist ducking around the screen to hear and to be heard. So the screens only work some of the time.

Walking Space Guide: Ease and Comfort

A large arched walkway at night with purple bougainvillea flowers overhead. The pathway is well lit but has the line shadows of the arches across it.Getting out and about is good for our health. We know that. But the environment has to be conducive to encourage walking and wheeling. That means streets and paths have to be designed for ease of access and walking comfort. The Walking Space Guide sets out standards to ensure sufficient walking space is provided for everyone. That includes people with disability, people with mobility limitations, families with young children and prams, and people walking dogs. 

A graphic from the guide showing the distance needed for footpaths.The Guide sets standards for designing, planning and implementing footpaths. It sets targets for five levels of footpaths: local with low and medium activity, and main streets with low, medium and high activity. There is no standard less than 2 metres wide. 

There is a quick overview in a summary of the Guide. Transport interchanges or where walking is highly managed is not covered. Work on a space guide for crossings is underway.

Included in the guide is a method for carrying out a Walking Space assessment and guidance on how to understand the results. There is an accompanying Excel spreadsheet for recording data and calculating results. The Guide was developed by the NSW Roads and Maritime Authority