Issue 120 | Jan-Mar 2020

The Evolution of Eldercare

Nursing homes need to respond to the changing social and healthcare needs of our seniors, and a multi-agency team featuring researchers from NUS has risen to the challenge.

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Raising The Silver Standard

Ageing is a key demographic challenge many Asian countries face and Singapore’s population is among the fastest-ageing in the world, with the number of residents aged 65 and above projected to jump from 580,000 in 2020 to 890,000 in 2030, according to the Singapore Department of Statistics. Recognising the importance of addressing the changing needs of our seniors, design and healthcare professionals from local agencies as well as NUS have come together to develop four key evidence-based design principles that will pave the way for a new generation of nursing homes.

Nursing homes are often thought of as gloomy places (institutions of treatment and rehabilitation) where old people spend their days lying in bed in a cold, hospital-like setting, isolated from the rest of society. Although newer nursing homes have addressed some aspects of public perception, a team of researchers hopes to radically change this prevailing image, which contributes to the stigma of living in one. The elderly are in reality, a very diverse group with the whole gamut of nursing and social needs. Recognising the need to respond to the evolving needs of seniors in Singapore, the researchers have formulated design principles for building innovative nursing homes based on an extensive study they conducted. Associate Professor Fung John Chye (Design and Environment ’82), Director of the Centre for Ageing Research in the Environment (CARE), from the NUS Department of Architecture, who led the study says, “We want to change the way care is delivered in nursing homes by shifting the focus from medical treatment to the fulfilment of psychosocial needs. Design plays an important role in attaining this aspiration. Called “Designing Future-ready and Sustainable Nursing Homes for Person-centric Care Models in Communities”, the interdisciplinary study investigated human-centred design, person-centric care, integration with community and deployment of relevant technologies, and it aims to provide guiding principles for reference in designing future nursing homes.

EMBRACING NEW WAYS OF CARE

The interdisciplinary and multi-agency team (see box) did a comprehensive study of five local nursing homes using various investigative methods. Researchers studied the physical environment of the homes, including sensory aspects such as temperature, lighting and sound levels. They profiled their users, which include residents with varied needs, family members and friends, professional caregivers and volunteers. Through ethnographic observations of how the different user groups interact with one another and with the environment, they analysed workflows and mapped activities in relation to the space and time they were carried out. Through focus group discussions with various stakeholders (such as nursing home staff, operators and residents, residents’ families and healthcare experts), researchers gained a better understanding of the current conditions, challenges, unmet needs, aspirations and emerging ideas in this area.

Researchers also visited nursing homes and other aged care facilities in Japan and Australia, which have many features and practices that local homes can potentially adopt. Assoc Prof Fung shares, “In one nursing home we visited in Japan, to facilitate community engagement, the front is open to the public and features a candy store shopfront, while activities that promote interaction between residents and community are also organised.” It also has a flight of stairs that connects two levels to encourage ambulant residents to be more active. Among the many unconventional practices other elderly care facilities employ is allowing seniors to plan their own schedule instead of requiring them to follow a stipulated one. For example, another centre has a no-money-involved casino where seniors can play in as part of their care plan. Instead of encouraging a dependence on diapers, one home adopts a no-diaper policy and toilet-trains its residents to maintain their dignity and promote self-reliance.

Associate Professor Fung John Chye (second from right in the front row) along with fellow researchers and agency representatives during a study trip in Tokyo, Japan.

We want to change the way care is delivered in nursing homes by shifting the focus from medical treatment to the fulfilment of psychosocial needs.

In the nursing homes they visited in Australia, family members of residents are not only encouraged to maintain familial bonds over free lunches and birthday celebrations but also allowed to sleep over. They take the goal of empowering residents seriously and actively discourage a culture of dependency. For instance, residents make drinks for themselves at a self-service station, help to answer phone calls in the homes and find information on topics of their interest for display in the homes’ public spaces. The research team’s hard work culminated in the formulation of four key design principles that are recommended for nursing homes in the future. These principles based on person-centric care aim to promote self-reliance, engender purposeful social relationships, support different users and cater to future change.

PRINCIPLES IN PRACTICE

Putting these principles into practice will pave the way for the construction of a new generation of nursing homes that are a far cry from their current versions. Instead of the hospital feel due to their traditional role of rehabilitation, they will feel more like home, giving residents a sense of normalcy. To encourage self-reliance, residents will have more autonomy over their environment. One way this can be done is to allow them to adjust the lighting and temperature of their rooms. Instead of self-contained spaces, future nursing homes will be more open to their surroundings. This will facilitate interactions between residents and the communities their nursing homes are located in. “We want to dissolve boundaries between the residents and the community, and this can be done by introducing soft boundaries such as bushes,” Assoc Prof Fung says, adding that future nursing homes should also offer flexibility in space modification, such as changing the configurations of bedroom spaces so as to accommodate different numbers of residents.

Two architectural firms, FARM Architects and Silver Thomas Hanley International, were ultimately selected to develop pilot nursing home designs using these principles. At the heart of FARM Architects’ design is the notion that home is where people feel the most comfortable in. Its version returns to the fundamentals that make a home rather than making it more advanced. Silver Thomas Hanley, on the other hand, envisions a space with the kampung spirit. Both designs reiterate the belief that nursing homes – both in their functionality and appearance — should be welcoming and place residents’ well-being as the paramount priority.

While operational costs ultimately depend on features and the degree of person-centredness of these homes, Assoc Prof Fung thinks technology can mitigate manpower costs in the long term. What is more of a challenge than resources, he says, is changing mindsets. Stakeholders have to be willing to adopt these ideas and “potential residents and their family members have to be mentally prepared for non-traditional care models”. Community engagement is also important to integrate nursing homes into the community. 

elder-5aThe interdisciplinary “Designing Future-ready and Sustainable Nursing Homes for Person-centric Care Models in Communities” study combines expertise from the fields of architecture, industrial design, sociology and medicine to develop design principles for future nursing homes. Organisations that NUS collaborated with include the Urban Redevelopment Authority (URA), Ministry of Health (MOH), MOH Holdings Pte Ltd (MOHH), Agency for Integrated Care (AIC), Geriatric Education Research Institute (GERI), National University Hospital (NUH), Ren Ci @ Ang Mo Kio, Building and Construction Authority (BCA), and CoNEX Systems Pte Ltd.  
This material is based on research/work supported by Singapore’s Ministry of National Development and National Research Foundation under the L2 NIC Award No. L2NICTDF1-2017-5. Any opinions, findings, and conclusions or recommendations expressed in this material are those of the author(s) and do not necessarily reflect the view of the Singapore Ministry of National Development and National Research Foundation.

Text by Rachel Kwek. Renderings by FARM Architects Pte Ltd.

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