Article featuring Burradoo dementia village by The Saturday Paper

Ageing with dignity is impossible if all we can expect is dilapidated institutions with neglectful or abusive staff – the model for aged-care housing should be community based, connected and full of new pleasures.

When my mum got old and sick and the hospital withdrew all help, we sought alternative care. Naturally, she wanted to help choose. So, half-blinded by tears – of rage as well as sorrow – we drove her around the suburbs, from one private institution to another. Many were full. In the end it was between a marble mausoleum with a maître d’, but also with corridors that reeked of cabbage and faeces, and a marginally less stomach-turning cottage-and-shrub affair of closed windows, stifling air and strict matronly condescension. My mother’s stay was nasty, brutish and short. I found it impossible to accept. My idea of growing old aligns more closely with Alan Arkin’s cheeky, drug-taking grandfather in Little Miss Sunshine. So I sat down with friends to design an alternative. Sickness and decline might be inevitable, we theorised, but even old people are also creative, funny, purposeful and social. Housing for the third age shouldn’t just be the same old, same old, transposed to a minor key. It should be adventurous, collaborative and aesthetically tuned.

We drew a three-to-four-storey building on an inner-city block surrounded by apartments and terraces, fringed with hole-in-the-wall cafes and centred on a shared garden court lush with fruit trees, vegetables and chooks. The roof would be solar or green, the residents multigenerational and the shared spaces would include a bar and a well equipped workshop-cum-studio. I imagined becoming decrepit, taking a ground-floor at where the local cafe owner could pass my coffee through the window. The reality of getting old in Australia is far grimmer. Some cultures revere their elders for their wisdom and authority. Our seniors not only receive no reverence – the final report from the Royal Commission into Aged Care Quality and Safety confirmed more than a year ago that “substandard care and abuse pervades the Australian aged care system”. Our seniors are too likely to experience routine neglect, malnutrition and abuse, possibly sexual. Quoting a Department of Health study that estimated a staggering 33,000 to 45,000 instances of alleged abuse by staff or other residents in a single year, 2019-20, commissioners Tony Pagone and Lynelle Briggs used unusually strong language to declare it “a disgrace [that] should be a source of national shame”. You might think, with 16 per cent of Australians over 65, this would be a voting issue. But no. Although we all want to live forever, no one wants to go there ahead of time. When you do get there, it’s too late. You’re otherwise occupied and voiceless. Nothing changes. True, growing old isn’t everyone’s idea of a picnic. But need it be quite so bloody awful? Aside from sickness, its worst aspects are its losses – loss of agency, connection and dignity.

The system we have, far from ameliorating these, exacerbates them. None of us wants this. So why do we choose a system that ignores the upsides of ageing and entrenches its woes? Neoliberalism bears much of the blame. However normalised, it is an extremist ideology, demanding and exacerbating imbalances of wealth and power. As the Organisation for Economic Co-operation and Development (OECD) and others agree, the neoliberal decades have made virtually all Western countries more unequal. This is especially evident in services such as prisons and aged care, where the profit motive intensifies the power imbalance between the “caring” and the “cared for” and leads, unsurprisingly, to cost-cutting, neglect and abuse. That’s what goes on inside these “care homes”. But how much of it would change if the places themselves weren’t isolated, profit-driven, internalised, artificial and mind numbingly dull? Consider location. We talk of “ageing in place”, which in itself seems to cast old people as some sort of sessile rock-dwelling life forms. Yet we condemn most people to an eventual future of privatised profit-driven “care”, far from friends, on the urban fringe. This is wrong. Aged care, like public housing, belongs in the hubbub. Not only because of practicality and fairness – because those who are least mobile and most need services such as transport and healthcare should be closest to them. But also because social connection is critical to healthy ageing. We know that social connection reduces diabetes, cardiovascular and other chronic diseases, as well as cancer, is associated with lower drug use and enhances healing. United States Surgeon General Vivek Murthy estimated in 2018 that loneliness reduces life expectancy by 15 years, equivalent to obesity or smoking 15 cigarettes a day. Loneliness has worsened during Covid and is worse again in regional Australia. Private providers typically choose not to service sparse populations and centres often close, so that older people who’ve had, or fear having, their driver’s licence revoked due to age become even more isolated from friends and family just when they most need connection. Naturally, this is especially true of women, who live longer and with fewer financial resources. In country towns as well as big cities, then, inner locations make sense.

Yet market forces, driven by the bottom line, do not deliver them. Our outer suburbs are constantly prowled by developers seeking knock down rebuild sites with the right zoning and access attributes to accommodate aged-care homes. Are there alternatives? Half a century of neoliberalism has generated the widespread belief that market forces are god-given, inevitable. But that’s false. Indeed, the only reason public planning exists is to counteract unfettered capitalism. For a start, we could look elsewhere. Almost eight years ago, for example, the British parliament passed the Self-build and Custom Housebuilding Act 2015, requiring local councils to do what they could to encourage self-build housing by groups and co-ops, including counting it towards developers’ affordable housing obligations. Norway, with 100 per cent pension coverage, is generally regarded as having the best aged-care system, closely followed by Sweden and Denmark, where people report high levels of civic freedom, social connection and transport access. As British social epidemiologist Richard Wilkinson notes, “If Americans want to live the American dream, they should go to Denmark.” Many other cities actively encourage alternative, intentional and self-determining housing options. Berlin’s IBeB (2018) cooperative in the city’s former flower market is a tight-knit community, sponsored by the city-operated Berlin Property Fund. In the Netherlands, Apartments for Life are available to people over 55 and off er “staggered care” – where people can gradually shift from full independence to increasing care. Drawing on the use-it-or-lose-it principle, this model recognises that over provision can be more damaging than under provision and encourages small transgressions – sleeping until lunchtime, wine bar trysts, weekends in the garden or library.

Sydney-based architect Lara Calder, who specialises in this field, says the pandemic has shown that people need things “a bit earthy, scruffy, interesting. Real air and textures; cold as well as warmth. Discomfort, as well as comfort”. To this end, the Burradoo dementia village, which CalderFlower architects designed, deploys the non-medicalised “butterfly model” of care that prioritises emotional wellbeing within a familiar cottage garden setting. Still, Europe is more inventive. An innovative project in Beekmos, Houten, in the Netherlands houses older women near young mothers with children, so they can share wisdom, support and babysitting. Near Amsterdam, a specially designed dementia village without wards or corridors instead mimics real life. Organised around a town square with a theatre, gardens and post office, it is designed to improve memory by resurrecting design vogues from the residents’ youth. In the US, the Housing Authority of the City of Santa Barbara produces such lovely social housing – Mission style, natch – that they run popular tours of it, delighting locals and visitors alike. You may recall the 2010 BBC series The Young Ones, which put six ageing showbiz celebrities into a replicated 1975 share house complete with psychedelia, Bowie record covers, bell-bottoms and kitchen cocktails. Based on Harvard psychology professor Ellen Langer’s 1981 experiment to test whether you could trick your (old but otherwise healthy) body into feeling young again, it offered astonishing results; improved mood, acuity, suppleness, dexterity, posture, memory and sight.

Others of Langer’s experiments showed that taking responsibility, even for house plants, significantly increased people’s longevity. Australia does have some co-operative living and co-housing. Mostly, though, it’s pretty rural and too close to the old ’70s hippie model for me to find it comfortable. I imagine something more like Melbourne’s hugely successful Nightingale model, locating high density intentional communities on inner-city sites with clear eco-goals, share cars and ultrachic inner-urban architecture. Grow old gracefully? Pah. I’m still seeing a future studded with new pleasures – painting studios, chook pens, workshops, beehives, skydiving, lava lamps, saunas, raves, sunbathing and weed-weekends – spiced with urban bustle. There is a shop in Sydney’s Surry Hills named Grandma Takes a Trip – an ideal spot, come to think of it. Already the council, desperate to resurrect the ’hood, is raising heights on nearby Oxford Street. Maybe the whole strip should be lined with multigen shop-top co-housing, complete with leafy courts, solar roofs, tight street frontages and lively retail based on guaranteed pedestrian tenants.

Written by Elizabeth Farrelly December, 2022
https://www.thesaturdaypaper.com.au/life/2022/12/10/alternative-model-aged-care-housing#hrd