Aged care design principles

While the principles of universal design aim to enable people to stay in their own home for as long as they wish, the principles are also applicable to aged care settings. Four principles underpin the Australian Government’s National Aged Care Design Principles and Guidelines. These principles are:

  • Enable the person
  • Cultivate a home
  • Access the outdoors
  • Connect with community

The four principles are, of course, applicable to any dwelling or place of accommodation. This is an example of universal design where specific features are essential for some and good for everyone. Consequently, the document is useful for anyone designing any type of home.

Front cover in bright yellow of the National Aged Care Design Principles and Guidelines.

The guideline provides detail on each principle. For example, the first principle covers acoustics, air quality, lighting, tonal contrast, supportive seating and comfortable temperatures. Before and after illustrations as shown below provide additional information. At the end of each sub-section is a checklist.

The authors have chosen to use six personas to bridge the gap between abstract concepts and lived experience of residents and staff. Three personas for each group is possibly too few and runs the risk of limiting a designer’s vision of the breadth of diversity. For example, cultural diversity is considered, but other characteristics such as marital status and sexual orientation are not.

The outcomes for the resident personas are explained alongside each checklist. They provide some of the “why” certain features are required by individuals.

Overall, this is a useful guide for aged care in any context – indeed for all people. After all, home is the centre point of our lives. Below is a page from the guidelines showing before and after illustrations.

A page from the Aged Care Design Principles showing before and after designs.

Social Value Toolkit for architecture

Design impacts both social and economic value to a community, but how do you measure and track it? The RIBA Social Value Toolkit has the answer. The Toolkit makes it easy to evaluate and demonstrate the impact of design on people and communities. A research project by the University of Reading provided the evidence for the Toolkit.

“If we cannot define what we mean by value, we cannot be sure to produce it, nor to share it fairly, nor to sustain economic growth.” (Mazzucato, 2018)

“Social value is created when buildings, places, and infrastructure support environmental, economic and social wellbeing to improve people’s quality of life.” (UK Green Building Council)

Front cover of the Social Value Toolkit. Deep blue with light blue text.

The underpinning concepts for the Toolkit are based in the wellbeing literature. Social value of architecture is in fostering positive emotions, connecting people, and in supporting participation. The Toolkit has two parts. A library of post occupancy evaluation questions, and a monetisation tool that links to other post occupancy evaluation processes.

Eilish Barry says that if we don’t define and measure the social impact of design, it will be pushed further down the priority list as costs rise. Generating social value is useful for potential future residents as well as designers and developers. Barry poses five recommendations for industry in her Fifth Estate article:

  • Knowledege sharing is vital
  • We need a common language
  • Social value should be part of the design process
  • Methodologies need to be flexible
  • Opportunity for collaboration (Eilish Barry pictured)
Eilish Barry is smiling at the camera. She has dark brown hair and is wearing a black top.

The Social Value Toolkit

The library of questions means you don’t have to reinvent the wheel. They cover positive emotions, connecting, freedom and flexibility, and participation. Each of these has a monetary value attached.

The dimensions of social value in the built environment context.

A diagram showing the dimensions of social value in the context of the built environment. Jobs, wellbeing, designing with community, learning, using local materials.

The approach to monetising social outcomes is based on Social Return on Investment. There are several different ways to measure this.

  1. Value for money: Willingness to pay extra for something you value.
  2. Time is money: The value of savingtime.
  3. Subjective Wellbeing valuation: Putting a value on wellbeing – most appropriate to understanding the impact of design on end users.

The Toolkit references the UK Social Value Bank, an open access source that contains a series of values based on subjective wellbeing valuation. There is also an Australian Social Value Bank with resources.

The Toolkit is briefly explained on the Royal Institute of British Architects website where you can download the 2MB document. Or you can access the document here.

Architecture & Design online magazine also featured this topic with more from Eilish Barry.

Dementia friendly outdoors

We know that people want to stay home as they age. This does not change for people with dementia. Staying safe at home also means staying safe in the neighbourhood, not just at home. That means we need a dementia-friendly outdoors.

Ash Osborne writes in the Access Insight magazine about dementia and outdoor environments. Although dementia is NOT a normal part of ageing, one in ten people over the age of 65 experience dementia. It is the single greatest cause of disability for this group. 

A black and white paved area. The black pavers are laid in an "S" shape and look like a long black snake against the white pavers. Not very dementia friendly outoors.

Osborne takes us through the key design elements that support people with dementia as well as other groups. Depth perception often changes and that means strong changes in contrast can be perceived as steps or a hole. This can lead to falls.

Sun cast shadows through a pergola with large beams create shadows on the footpath that look like steps.

Wiggly lines in paving and sun-cast shadows from a pergola are similar situations. A black mat at a doorway looks like a hole in the ground and pooled lighting can be confusing. So the images show what NOT to do.

Distortions of perception are not just experienced by some people with dementia. So, once again, think universal design.

hallway with lighting across the floor making it look like steps.

Osborne’s article, Age and Dementia Friendly Outdoor Spaces is an informative introduction to the topic. 

Dementia and urban design

In Improving the lives of people with dementia through urban design, Barbara Pani presents four brief case studies: a gated community, a dementia-friendly city, intergenerational housing, and health services at a neighbourhood level in a social housing estate.

The article provides technical information and in the conclusion raises several points. Retrofitting existing buildings could be better than a massive redevelopment.

Consideration of people with dementia could also be good for the wellbeing of people with mental health issues, and the importance of developing social spaces at the neighbourhood level. 

Many people with dementia are able to live independently for several years before they need constant care and support. Studies are showing that the design of the built environment is influential in supporting people with dementia to maintain their sense of well-being and independence.

Out and about with dementia

Getting out and about is good for everyone’s physical and mental health. However, the fear of getting lost or confused when outside the home prevents many people with dementia from leaving home. Consequently, they tend to limit their time away from the house. But with good planning and community help, people with dementia can maintain the benefits of walking and taking a holiday.

“I am a person.

Sometimes people like to go for walks, even people with dementia. Sometimes people get lost, even people without dementia”

Taken from Kate Swaffer’s poem, ‘Wandering along the beach’. (2014)

Front cover of Walking with Dementia.

Dementia Australia has two booklets, Walking safely with dementia, and Travelling and holidays with dementia. These booklets are designed for people with dementia and their families. However, the information is good for communities who want to make their places and spaces dementia friendly.

Walking

The walking guide features strategies people can take to make sure they stay safe and know what to do if they become lost. They can be as simple as carrying identification and establishing familiar routines and places. The section on safety involves avoiding crowds and disorienting entry and exits. Double entry and exits in shopping centres can cause confusion for people without dementia. Directional signage on the way out of the toilet is useful for everyone.

Dementia Australia has a Dementia-Friendly Communities program where people can learn more about dementia and how they can help. There’s a list of things you can do if you meet someone who may be lost.

“My mother has dementia, but her life continues to be enriched with fulfilment. We went on a cruise last year that provided us with uninterrupted time, gave me some time to relax and just be there for my mum while our needs were taken care of. It was difficult at times, but so rewarding to have shared this time together”

Front cover of Travelling and holidays with dementia.

Travelling and holidays

Similarly to the walking guide, careful planning is key to success. The holiday booklet covers travel by sea, air, car and public transport. There’s a checklist of things to consider and how you can plan to optimise your level of capability. When it comes to accommodation, it’s useful to notify hotel staff. Some hotel accessible rooms might be more comfortable.

There is nothing in this booklet for transportation agencies for people with dementia. However, it gives travel and accommodation providers insights into the lives of people with dementia and their families.

Inclusive building design: a guide

Talking about inclusive built environments is easy, but how do you do it well? With different stakeholders involved in the design and delivery of a project, how do you get them to join up their thinking to approach projects with the same inclusive mindset? An inclusive building design guide focused on the processes is the way to do it.

The Royal Institute of British Architects (RIBA) created an Inclusion Charter in 2020. One of their commitments was to embed inclusive design in all projects. But architects cannot work in isolation – all stakeholders need to take on an inclusive mindset. As an extension to their Charter, they created the Inclusive Design Overlay to the RIBA Plan of Work. It seeks to bring all stakeholders on board for every part of the project.

“The role our built environment has on each and every person’s life cannot be overestimated. This Inclusive Design Overlay provides a consensus across built environment professions for how we accelerate inclusion and value diversity.” Robbie Turner, Director of Inclusion and Diversity, RIBA.

Front cover of the RIBA Inclusive Design Overlay showing a montage of nine different groups of people.

Twenty-five different built environment professions provided insights and best practice content for the overlay. The inclusive design tasks apply to the client, project management team, design team, construction team and asset management team.

There are three core parts: the Client Team, the Design Team and the Construction Team. In addition, they recommend having an inclusive design consultant, or champion, with specialist inclusive design expertise. As Australian access consultants know, the earlier they are consulted the better. So it is good to see RIBA encouraging involvement from the outset of the project. The overlay also encourages the project team to look beyond building regulations.

Good design must be fundamentally inclusive just as it should be sustainable and resilient. Inclusive design should be elevated to the same level as sustainability.

A man in a white hard hat and hi-vis vest is on a large monitor in an office. Four people are watching him. RIBA inclusive design overlay.

The overlay details the roles of each team and stages of work. It begins with setting the project brief and budget through concept design, construction and handover to asset managers. There are separate sections for each of the key teams and what they should do and understand at each stage.

Enablers

The document includes a section on inclusive design enablers. These are actions that support the development of an inclusive design strategy, and implementation of inclusive design across the delivery of a project. Each sub-section has clear information on the diversity of the population and different levels of capability, and how to approach them in design and construction processes.

Access the document by visiting the landing page on the RIBA website, which will give you an overview as well.

Editor’s note: In the UK they use the term “inclusive design” where other countries use “universal design”. The goals and actions are the same.

Design guide for active travel

This design guide aims to improve infrastructure for people wanting to walk, cycle, scoot, and ride mobility devices. That means anyone and everyone who is not a driver of a motor vehicle. This is part of the ACT Government’s policy is to support active travel.

In the Canberra context, unless designated, all paths are shared by people walking, wheeling, cycling and using mobility aids.

Few people fully understand road rules, which is why design treatments must indicate that pedestrians have priority.

A diagram of an intersection taking from the Design Guide .

People using mobility devices and older people are given the label of “vulnerable” pedestrians. This is default language in transport jargon, but serves, unfortunately, to reinforce stereotypes. In reality, all pedestrians are vulnerable compared to motor vehicles.

When all pedestrians are incorporated into designs, we should just talk about “pedestrians walking and wheeling”. And with a Safe Systems Approach there should be no delineation between who is safer than whom.

Movement and Place framework

The Movement and Place framework together with a Safe Systems approach puts people into the centre of the frame. The lens has always been on vehicle traffic flows and the convenience and economics of reducing traffic delays. If we are to have active travel really happening, we have to re-think this priority.

The Design Guide is comprehensive and serves as a “how-to” tool for transport planners. It covers:

  • principles of safe design
  • street types
  • walking
  • cycling and micromobility
  • intersection principles and elements
  • signalisation
  • pedestrian and cycling provision at intersections
  • public transport
  • intersection guidance
Photo of a cycle path from the ACT Design Guide.

The title of the 63 page guide is, Design Guide: Best practices for urban intersections and other active travel infrastructure in the ACT.

Images are from the Design Guide.

Access Audit Handbook

The Royal Institute of British Architects has updated their Access Audit Handbook in conjunction with the Centre for Accessible Environments. Access auditing is an evolving concept and means different things to different people. Some take it as being compliant with a standard while others consider aspects beyond compliance.

The Access Audit Handbook is priced at £40.00 from either the Centre for Accessible Environments or the Royal Institute of British Architects.

Fortunately, the Ergonomics in Design for All Newsletter explains the content of the document. In doing so, the newsletter provides an synopsis of some of the key concepts in the handbook.

Front cover of the access audit handbook.

Similarly to Australian Standards, British Standards only apply to people with disability and do not cover any other groups in terms of access and inclusion. This is despite other groups who fall under anti-discrimination law. The handbook addresses some of these gaps. For example:

Faith spaces, prayer facilities, features relating to women’s safety and their well-being, including pregnancy and menopause, baby feeding and changing, and non-gendered sanitary and changing facilities.

A woman cradles a new baby in her arms. They are both white skinned.

There is guidance on neurodiversity and reducing sensory overload, anxiety and stress, such as quiet rooms. Designers are asked to plan logical wayfinding with straight lines, and create curves rather than corners.

Technology is evolving on building accessibility, space and wayfinding, and auditors need to keep up with these developments. Lift destination control systems are a case in point where people no longer press a button for their floor. The central control system can be very confusing where there is a bank of lifts.

Case studies

The handbook recommends engaging with building users for insights into the level of accessibility and to keep them engaged throughout the project. There are six case studies: a theatre, a zoo, a parish church, a university science lab, and an outdoor space. The case study of an inaccessible heritage town hall shows how to create an accessible community building.

The handbook has 32 checklists for the external environment, internal building space, management and communication.

Thanks to Isabella T. Steffan and Ergonomics in Design for All for the content of this post.

Accessible fitout case study

The Centre for Accessible Environments in London has been providing access advice for many years, many of them heritage buildings. As a not-for-profit, their aim is for more mainstream buildings to be accessible and inclusive. They got the chance with the office space for the Royal College of Occupational Therapists (RCOT). The Centre for Accessible Environments (CAE) website has an overview of the work they did on this building.

The image shows the accessible shower room prior to the refit. The design is based on a public standard and looks very clinical.

Image from the CAE website.

A shower room designed in a clinical style. There are lots of grab rails and other equipment. It is all dark grey and white.

The building accommodates around 90 staff across four floors with meeting rooms on the ground floor. This floor had level access, powered doors, and an accessible shower room that looked like a hospital room. Not what CAE would consider gold standard.

The image shows the same wheelchair accessible shower room but with improved colour aesthetics. While this might meet British Standards, Australian access consultants might take issue with some aspects. The placement of the mirror, for example.

Image from the CAE website.

An accessible shower room with a fitout to standards but some aesthetics in terms of colour.

The outcome of CAE’s involvement is that the fit-out of the shower room looked less clinical despite the considerable amount of specialised equipment and features. The overall success was the focus on detail such as the amount of pile in a rug.

Quiet spaces and soundproofing and height adjustable desks are also part of the fitout. CAE’s access consultant also acknowledge that flexibility of space is essential. “Until people use a building following a redesign, you don’t know if it’s going to meet the needs of everyone.

The title of the article is, Design appraisal & audit helps RCOT turn office into profitable asset. There is more information on this fitout including the staff kitchen. Check out some of their other case studies.

Note that the website has the Recite me app that is easily activated with the mouse. You can turn this off at the right hand corner of the website.

Age friendly cities toolkit

The World Health Organization has updated their resources on age-friendly cities and communities and added a toolkit. In 2007 the Age Friendly Cities and Communities (AFCC) program was rolled out. A Global Network of Age-Friendly Cities followed in 2010. The strength of the program was an early form of co-design with older people in local communities. That is, it promoted a bottom-up process with top-down policy support.

The guide has suggestions for meaningful engagement of older people in creating age-friendly environments. It includes detailed examples of existing national AFCC programmes, and practical steps for creating or strengthening such a programme. The vision is for all countries to establish a national AFCC programme by the end of the UN Decade of Healthy Ageing (2021–2030).

The toolkit is a separate set of resources to the guide.

Front cover of the toolkit with lots of different icons depicting all the aspects of a community with trees, buildings, parks and people in an age friendly city.

The glossary lists all the words and labels used for older people and is a useful resource in itself. As with many official guides there are a lot of words and explanations about the history and ideas. The eight domains of action are the same as the 2007 version of the guide. The Framework for implementing national programmes is in section 3.

You can access all the relevant documents and information on the WHO’s National programmes for age-friendly cities and communities web page. If you want the free toolkit you will need to sign up to get it.

A Global Network of Age Friendly Cities

There are more than 1400 members of the Global Network, and looks like it will continue to grow. The network acts locally to encourage full participation by older people in community life and active ageing. The program is an important step in meeting the goal of the UN Decade of Healthy Ageing. Setting the scene for improved participation by older people benefits everyone. What’s good for older people is good for all people.

The Age Friendly Cities and Communities program puts older people at the centre and covers all aspects of life. It’s where policy meets people. The vision is that older people can transform themselves by transforming the environments in which they live, work and play.

London Street Accessibility Tool

The City of London Street Accessibility Tool is like an educational access audit report. It shows street designers how street features impact on the different needs of pedestrians. The focus is on people with mobility impairments and wheelchair users, which means everyone wins.

The tool recognises that there are sometimes competing needs: what’s good for one group might not be good for another. Co-design is the best way to find the trade-offs to prevent unintended exclusion.  The tool comes in three parts: two Excel spreadsheets and a PDF downloadable from the City of London website.

A photo showing a footpath lined with black bollards with white tops from the Street Accessibility Tool.
Road and footpath image from the City of London Street Accessibility tool.

Two photos from the “Instructions for Use” PDF document.

Doing the analysis

The PDF document begins with a table of different pedestrian types with and without assistive mobility devices. They cover mobility, sensory and neurodiverse conditions. There are three steps for using the tool.

The case study for the tool is London Wall, a street in London. A 500m long section is analysed for accessibility and is split into six sections. Each section has detailed access advice for improvements with photographs overlaid with dimensions and text to illustrate issues.

Down to the detail

The first spreadsheet has detailed dimensions, colours, and placements for elements such as tactiles, street furniture, and kerbs. All the necessary technical detail is here. 

What pedestrians said

The second spreadsheet is a route analyser and has a column of photos with user feedback about the issues they see. The feedback sheet highlights the “why” of planning and design. It provides insights for planners and designers in a way that that is missed in 2D drawings.

The direct quotes from people with disability provide the necessary insights for planners and designers. However, those responsible doing the actual construction should also have this information. All the access planning and designing goes awry if the “why” isn’t understood by all involved. 

Here are two quotes from the spreadsheet on route comments:

I feel quite wary. This is an unmarked crossing as far as I can see, I can’t see any wait signs. Somebody has stopped for me I can see a cyclist, I’m now onto some more tactile paving, this is the sort of crossing I am totally unfamiliar with. Person using a white cane

This is all fine but the paving stones are a little even so I’d be looking down and watching my speed so I don’t knock into one. Person using a wheelchair

A page of photographs of a section of London Wall in the City of London Street Accessibility Tool.
A page from the London Street Accessibility Tool

Ross Atkin Associates and Urban Movement for the City of London Corporation developed The City of London Street Accessibility Tool (CoLSAT).

Safe public spaces for girls

Public spaces aren’t equal places. That is, some people don’t feel safe or welcome in particular places. It seems this is the case for teenage girls. According to some Swedish research, public spaces aren’t used equally by girls and boys. So creating safe public spaces for girls is a challenge for urban and landscape designers. 

A night time image of a swing set comprising large rings. They are illuminated in purple and blue.
Swing Time – Höweler+Yoon. Photo by John Horner

Until the age of seven, boys and girls use public facilities, such playgrounds, on an equal basis to boys. According to a 2020 Girl Guides UK survey, 62 percent of girls aged 11-21 years said they didn’t have an outdoor sport or facility they felt safe to use. What would encourage them to go out? Safer places, less catcalling and more things to do they said. 

Teenage invaders?

Girls like to use swings but they are placed with the equipment for young children. If teenagers use them they are seen as invaders – not welcome. Branko Miletic in Architecture and Design magazine says,

“Come to think of it, teenagers are seen as invaders in most public spaces: they are too old for playgrounds, don’t have the money for malls or cafes, and also run the risk of harassment in public facilities overrun by boys and men. But they also yearn for physical activity and movement, connecting with friends, having fun conversations, walking and biking, and indulging in sports and games at their own pace, without being judged or commented upon in a public space.”

Multi-use areas such as skate parks, basketball courts and kickabout areas are designed for ‘young people’. However, boys and young men tendt to dominate these areas. Boys tend to dominate single large spaces while girls are more comfortable in broken-up spaces. In terms of seating, boys want to watch the action while girls like to face each other to talk. 

Ask the girls

The answer, of course is to involve girls in the design process. Ask them what they want in a public space. A local authority in Sweden together with architects constructed a model designed with girls. The design revealed a preference for places with colour, sitting face to face, protected from weather, and to see without necessarily being seen. 

Public spaces must cater for all ages. It’s not just about physical activity, it about social interaction and feeling safe. It would be interesting to do a similar study with older people so we can create intergenerational spaces too. 

The title of the article in Architecture and Design is, Designing safe public spaces for teenage girls.

 

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