Aged Care Insite Issue 114 | Aug-Sep 2019 | Page 33

practical living “We’ll look at the social aspect ... We have to improve that.” But it does a lot more. There are three factors that we look at in salutogenics. We want to improve the overall sense of coherence, which is the power to deal with adversity, and there are three factors that add to it. First of all is manageability – the ability for a person to manage on their own. The second thing is comprehensibility – the ability for a person to understand what is going on and to know how to manipulate the environment in order to get a benefit, whatever benefit they require. The third and most important thing is meaningfulness. This creates the person’s desire to get better, to do things in the first place. If we don’t have meaningfulness, then why should we even get out of bed? Why should we look after ourselves? Why should we care if there’s nothing to care for? We look at ways that we can structure these three qualities into the environment. We make manageability easier by making places easier to manage. We make comprehensibility easier by giving people the resources they need to do what they want to do. If people want to leave, we have to give them a means to do so. Finally, meaningfulness we create by creating really good opportunities for family to come and visit, for their religious practices, for people to be able to cook and do things that they would normally do in their regular lives, to have hobbies, and keep pets, and dig gardens – the sorts of things that make life worth living. That is meaningfulness. You wrote a piece recently about some work you did retrofitting an aged care facility. Can you tell us some of the things that were involved? This facility had only just been built. I was brought in before the place even had a single resident. They finished the thing, and then the new managing director went in and said, “This place looks great. It looks so beautiful, but it’s not appropriate because it’s not salutogenic. It doesn’t give our residents what they need in order to thrive.” So she called me and said, “Can you come in here? I need to do something with this place.” So I came in and we looked at a whole raft of things that we could do. Each one of those things we costed separately, and we added a value to it. So it was a matter of, “This would be really valuable, but really costly. Let’s put that away for later. This would be really valuable, but really cheap. Let’s start this tomorrow.” We used that methodology to create a whole list of things that we could do, and they involved taking down unnecessary fences. Literally, the courtyard was fenced three ways to cut cohorts of people up, and we had to remove visible exits because if you’ve got dementia, you will be tempted by anything that you can see. But if you can’t see it, you’re less tempted by it. You also mentioned issues around outward-facing gardens? The building was placed in the middle of the lot with gardens around it that looked out onto these highly activated streets. There’s a lot going on in those streets – interesting stuff, including a train station, and for somebody with dementia, they want to go and join that. They want to get on that train. They want to go to those places of religious worship. They want to go to those shops, but there’s a great big fence in between with spikes on the top so they can’t scale it, and that is like torture. So one of the things we had to do was cover that fence with pictures, because we couldn’t move the building, and we couldn’t expand the fence because there’s a road there, so we had no choice but to put murals up and turn the focus from looking outwards to looking inwards by creating something extraordinary on the inside of the fence, by making gardens that are worth gardening in rather than the kind of thing for walking around in with hedges. The place had bus stops. This is something that people do in aged care, and it originally was a great idea. You have a bus stop, and you sit at the bus stop, and you wait for the bus to come, and the bus doesn’t come, and it creates that waiting behaviour that people naturally develop, and it turns it into something that’s potentially meaningful. But if the bus stop is there and it’s facing a busy road with buses going down it and the buses never stop, and even if somebody does stop in a car or in a bus and there’s a great big fence in between you and the road, it’s like torture, so we had to get rid of the bus stops. A great idea but badly executed, so it wasn’t a great idea anymore. We also designed an aviary so that people could have this experience of being surrounded by birds. The aviary is eight metres long, so it’s quite big, and people can get this kind of amazing aesthetic experience. We changed the dining room. If you’ve ever been to a dementia facility, you’d probably know that most of them have these kind of dining halls with really harsh lighting with tables, and they try and force‑feed people. Under that lighting, I lose my appetite, much less somebody who barely has an appetite. They want it a little bit darker, and they wanted more aesthetic, and the acoustics were terrible, so we redesigned the dining hall into a restaurant with little booth seating. We used the booth seating to absorb some of the acoustics and to make a kind of aesthetic environment, which actually says “mmm, yum”. So it’s lots and lots of tricks. What do we need to do to make sure this is becomes common practice? Do we need to be teaching this, or is this taught in architecture degrees? It’s not currently taught much. It should be common practice, but it’s new. I wasn’t the first person to bring salutogenics to architecture, but I think I was probably the second, and that person who originally did it has English as a second language and is based in Sweden. When I did it, I really did it in English, and I made it much bigger, or at least I was there at the right time. What’s the next thing then for salutogenic design? Well, it’s going to actually take time for things to get built. Salutogenics is becoming a thing, and people are starting to learn about it in this space, and so now they have to start building things, and it takes 10 years between plans on paper actually turning to a built environment where people move in, so you have to give it time. The first papers on salutogenics in health architecture appeared in 2006, and they weren’t for dementia. I started writing about it in 2010, so it’s still percolating through. Built environment is slow, so give it time and it’s going to happen. But people also have to be advocates for it. People should go in there and say, “Where is the salutogenics thing? How are you making salutogenics happen in your buildings? How is the building itself contributing to the better outcomes of the people that I love?” You have to ask those questions. If you don’t, the management can wheedle out of it. ■ agedcareinsite.com.au 29