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. ■
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