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Age in Place and with Dignity

Access to the community for older people should play a pivotal role in town planning and reflect aged friendly and dementia enabling design principles.

Adjunct Professor Warren Harding, Chairman of Alzheimer’s WA says

“Aging in place, with dignity, is a human right” as we prepare for the imminent release of the two Royal Commissions into Aged Care Quality and Safety and People with Disabilities which will shine a light on a human services sector, too often marked by poor nutrition, wound management, incontinence management, sexual and elder abuse.

The entire retirement living, residential care and nursing home industry must adopt a “value care” mindset as more care is delivered in the community.   One of the important values to the 48,000 Western Australians living with dementia is to remain connected to their community. This can include Memory Cafes which play an important role as café owners, retailers, service providers and sporting clubs can work with Alzheimer’s WA to create a Dementia Friendly Community where people with dementia are supported to continue living with joy, meaning, purpose and in safety.

With the number of older Australians set to more than double over the next 40 years, he applauded the new WAPC planning guideline and scheme amendment by the WA Government which introduces two new land use types – residential aged care facility and independent living units. The Policy calls for aged care accommodation to be integrated within local communities, serviced by adequate transport networks and located close to health and community services to support options for ageing in place and meet the everyday needs of residents. This will be a significant catalyst for long term planning and infrastructure investment, said Prof. Harding.

In a 2017 report on the Economic Cost of Dementia in Australia 2016-56, Professor Harding quoted that in the absence of a significant medical breakthrough, more than 6.4 million Australians will be diagnosed with dementia in the next 40 years, at a cost of more than $1 trillion. Over 70% of people living with dementia still live at home and in the community and this is a challenge for all tiers of government- Federal, State and Local.

Prof. Harding said that social stigma can have a devastating impact on the lives of people with dementia as it not only brings cognitive changes but also changes how family and friends respond to that person. Moving into a residential aged care home can lead to a sense of disconnection from friends and a person’s local social networks and community connections. This disconnection can be reduced by locating aged care homes close to local community and especially close to amenities, schools and shops.

Councils must show leadership in Ageing In Place planning to enable people to live through the different ages and stages of their lives. This needs to be translated into an active, safe, inclusive community enjoying a high standard of local services and facilities.

International research shows that the environment can help a person with dementia hold on to their world by maintaining ties with familiar and comfortable surroundings. It is widely recognised that the environment can have a significant positive or negative affect on a person living with dementia.

One of the many things we have learnt COVID 19 is that it demonstrated the challenges of traditional aged care and residential care design. The latest thinking is based on small household, person centred models of care to create social interaction, as well as easier pandemic isolation. Key principles of best practice include intimate and friendly environments, links to the community, socialization which enhances the quality of life to meaningful activities to remain active and involved in the world around them.

Reminiscence for people living with dementia can be highly beneficial to their inner wellbeing and their interpersonal skill; sensory stimulation is important as it can convey emotional support, affection and respect and also play a major part in helping people living with dementia communicate and of course safety: can be the defining factor for a person living with dementia.

Prof Harding forecast an increasing use of Assistive Technology in the home,  and rapid advances in digital health and wearables can support safer and more independent living to predict falls, detect frailty, monitor nutrition, movement and exercise. The current aged care and health care environment is demanding innovation for better client care and financial sustainability, he said.

Internationally we are seeing a societal shift through better planned urban living, aging and well-being, adaptive and caring neighbourhoods with emerging housing typologies having a positive impact on the health, wellbeing and social engagement of users, particularly connectivity with the local community where they lived, worked and raised a family.

He said, Ageing in Place principles must be imbedded in our local planning to ensure independent living units, residential care and new high end aged care allows older Australians to live close to where their children work, their grand children attend school, university and play junior sports.

The increased demand on housing and health care services will shape future community development, and it is essential that our planning system adequately supports the critical need for more aged care accommodation, he said.

Warren Harding

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