industry & reform
• embedded enabling technologies that
create larger-than-life benefits for frail
people, and
• staff who are partners in driving the
innovation, skilled in the new service
models and free from the institutional
service model that has reduced them
to servants.
Our friendly architects also told us (off
the record) that we might do better if the
architects had a housing background,
rather than a residential aged care
specialisation.
All looks pretty obvious once the client
is the resident. Surely with the amount
of newbuild going on in the sector
someone’s already done this. Not really.
There is a move to serviced apartments
and retirement villages adding care to their
offering, with Life Care saying “it’s unlikely
you’ll ever have to move again”. But the
nearest is the unique, and completely
ignored, Colton Court residential care
in SA, which offers high-care residents
a fully equipped home, with family and
community coming in their front door and
services in the back. Residents conduct
most of their roles in their own ‘homes’
but wanted some modest community
right on their doorstep. Just take a look at
what residents bring with them to preserve
their current lifestyle … spouses, cooking
appliances, sewing machines, dogs,
gardens, exercise equipment, furniture …
the list goes on.
But it took the virus to show us how
technology could add significantly to this
frail life maximising.
The lessons on how older people in
their own homes raced to adopt lifeimproving
technologies during the
pandemic contradicted so much of
what we believed about them and the
usefulness of technologies for them. The
trick is going to be for providers to build
their own narrative about why technology
matters in their residential care. This ‘why
technology matters’ narrative should
grow from just being about the product to
capturing the value of product and service
ecosystems that share cost and create
unique products, co-invention with the
residents, and innovation-themed staff
networks that test the boundaries in and
out of organisations.
Anyone who has visited or lived in
residential care knows that the staff are
everything. They are usually caring and
skilled in caring, yet rarely champions
for maximising frail lives that these new
service models will require. No amount
of training will change them from doing
what the institutional service model
demands of them. Changing the model
will. So if post-COVID residential care
wants these champions, staff at all levels
will need to work in spaces ‘owned’ by the
residents, be partners in the organisations’
innovation efforts, be connected to others
in and out of the organisation around
learning and doing innovation, and trained
in calling out and rejecting ageism.
Released from the shackles of the
current service model, and ever close to
the residents, staff can become a brandnew
force for change in a sector that
doesn’t have much force for change.
One of the most interesting questions
during the pandemic has been to imagine
“
The trick is going to be
for providers to build
their own narrative
about why technology
matters in their
residential care.
safer residential care that lowers the risk
to all residents without locking down the
whole place. Smaller ‘group homes’ have
been proposed, more homelike in both
amenity and domestic role-possibility …
but still requiring lockdown for safety.
Single home units isolate cross-infection
risk and allow each resident and family to
negotiate their level of social isolation and
social distancing, just like older people do
in their own homes.
So, would these ‘apartments for
maximising frail lives’ be viable to build
and run? Building more of what we already
have certainly won’t be. Let’s prototype
lots of iterations and see.
We might be able to use more domestic
construction, or not increase the footprint
as we exchange public for private space.
We might achieve much higher quality
of care, life and safeguarding while
containing the costs, particularly if we
stop excluding families and community.
We could use different pricing structures
for housing ownership, and a daily fee
that allows people to buy more or less
depending on their abilities, supports and
changing conditions. People might even
be happy to pay more if they liked what
they were buying for a change. And better
for investors to invest in products the
market likes, than ones they hate.
We asked people of all ages would they
choose ‘apartments for maximising frail
lives’ or conventional residential aged
care. Couldn’t find a single taker for the
old model.
This is a transformation of a service
for a very vulnerable group and the
developing but highly regulated market
mechanisms will need the support
of a national transformation effort
to succeed.
This effort will assemble the globally
best technologies, co-inventors, building
and product designers and innovationready
provider clusters to land prototypes
that could only come out of such a
purposeful bringing together. It’s urgent
that we start this work now before too
much more residential care is built that will
forever disappoint.
So, the virus certainly opened our
eyes to the problems of low safety and
quality in residential care by making it
even worse during a time when they
were under public scrutiny, and turned
our minds to what should now be
expected alternatives. Will we go there?
Certainly, with some of the technology,
but otherwise probably not. The sector
will dine out on their near-zero infection
success compared to other countries,
forget the life impact it had on residents
and staff, and resist the once-in-a-lifetime
insights into what we are actually doing to
vulnerable people.
The extreme ageism in residential care
is largely unconscious and at the end
of the day residential care will continue
to be designed and run by missiondriven
people who never live in them,
with the virus now making this even less
likely. Leadership with lived experience
never was, and still isn’t, on anyone’s
agenda.
A national investment in a globally
sourced transformation effort on
‘apartments for maximising frail lives’ will
be our best bet. ■
Mike Rungie specialises in the intersection
between good lives and aged care. He
is a member of a number of boards
and committees including ACFA, Every
Age Counts, Global Centre for Modern
Ageing and GAP Productive Ageing
Committee.
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