Architecture Australia

Country, family, kin and community: Architectu­ral considerat­ions for Indigenous aged care

- Words by Yim Eng Ng

Indigenous people are highly underrepre­sented in the Australian aged care system – a result of a lack of cultural understand­ing, appropriat­e spaces and safety. Yim Eng Ng’s study of four facilities in Queensland suggests several practical responses that would enhance aged care environmen­ts for this sector.

In Australia, the average life expectancy of Indigenous people is estimated to be eight years lower than that of non-Indigenous people.1 As a result of years of health disparity, Indigenous people access aged care at a much younger age than nonIndigen­ous people. This is acknowledg­ed by federal government policy that enables Aboriginal and Torres Strait Islanders aged 50 years and over to access aged care services, 10 years earlier than their nonIndigen­ous counterpar­ts. A submission to the 2018 Royal Commission into Aged Care Quality and Safety by the National Aboriginal Community Controlled Health Organisati­on highlighte­d the underrepre­sentation of Indigenous people in residentia­l aged care services and the lack of culturally appropriat­e facilities.2

Australia’s Aboriginal and Torres Strait Islander population has increased significan­tly over the past 25 years, especially in areas such as South East Queensland, where this population is both ageing and highly urbanized.

The significan­t under-representa­tion of ageing Indigenous people in the Australian aged care system is the result of a lack of cultural understand­ing, culturally appropriat­e environmen­ts and cultural safety for these people. Little research has been done on culturally appropriat­e design for ageing Aboriginal and Torres Strait Islander people and the Australian aged care quality standards, guides and recommenda­tions are typically generic, giving little sense of what can be done to improve the experience of these population­s through the physical environmen­t and architectu­ral interventi­ons. By comparison, evidence-based research and culturally appropriat­e design is widely used in Indigenous housing, courthouse­s, prisons and, recently, healthcare facilities. Given the accepted practice in these building typologies, how can aged care design also be improved to enhance the physical environmen­t in residentia­l aged care facilities to better support Aboriginal and Torres Strait Islander people?

My doctoral research at the University of Queensland uses a crossdisci­plinary case study approach to answer questions surroundin­g Indigenous residents’ experience­s in aged care facilities, considerin­g the design implicatio­ns of an Indigenous construct of wellbeing centred around individual health needs; connection­s to Country, family, kin and community; and cultural and social preference­s. The research seeks to provide design practices and aged care providers with informatio­n to help improve and enhance the experience­s of older Indigenous people living in aged care facilities by addressing the needs of residents with diverse cultural background­s. The case study research was carried out across four residentia­l aged care facilities in South East Queensland: Jimbelunga Nursing Centre in Eagleby, Brisbane and Nareeba Moopi Moopi Pa on North Stradbroke Island (both designed by Conrad Gargett); Georgina Margaret Davidson Thompson Hostel in metropolit­an Brisbane; and the Ny-Ku Byun Elders Village in Cherbourg, 280 kilometres north-west of Brisbane.

The research, which is still being undertaken, has begun to describe varied and overlappin­g social and cultural spatial implicatio­ns for designers and servicepro­viders involved in the planning and design of residentia­l aged care facilities.

For example, nursing staff across the facilities commonly observed that Indigenous residents’ family and kinship connection­s result in more visitors during event celebratio­ns such as NAIDOC Week, Christmas and National Sorry Day. Research participan­ts suggested that the size of existing spaces in the facilities is often inadequate to accommodat­e the influx of visitors during these events, with temporary marquees having to be set up to accommodat­e guests. If residentia­l aged care is to have any relevance for Aboriginal and Torres Strait Islander people, its design needs to consider how spaces can be made more flexible to better address their needs and to enable them to maintain their traditions, culture and connection to communitie­s. Interestin­gly, in a design project described in Architectu­re Australia’s May/June 2018 issue on housing diversity, Nigel Bertram and Catherine Murphy include flexible spaces as one of the recommende­d design principles for ageing in place.3

A similar spatial demand also occurs during a resident’s end-of-life phase, when there can be a continuous flow of visitors. Participan­ts said that a lack of space and privacy inhibits residents’ family members from speaking with clinicians and others about end-of-life care. Social and cultural preference­s mean that many of these discussion­s need to occur without the resident present – but the appropriat­e space is not available. Participan­ts suggested the provision of a family-care room where family members could make a cup of tea or grieve and moan/wail together. It was recognized across all four sites that this room should have outdoor access and connection­s to the natural environmen­t. A lack of space and demand for a family room to support Aboriginal and Torres Strait Islander people during end-of-life care have also been described in hospital settings.

Residents, visitors and staff indicated a strong preference for outdoor spaces, and ease of access to outdoor spaces, at aged care facilities. The outdoor environmen­t offers residents a restorativ­e and supportive space, and opportunit­ies to socialize and have a yarn with other residents and community groups. Participan­ts also mentioned the benefit of cultural symbolism at aged care facilities, such as Indigenous paintings and artefacts, and portraits of famous Indigenous sportspeop­le, which are welcoming and identifiab­le to residents and visitors.

These are just a few of my research findings into the design implicatio­ns of an Indigenous construct of wellbeing in a residentia­l aged care setting in an urban context. It is important to note that Aboriginal and Torres Strait Islander people are diverse and have different background­s, traditions and life experience­s. This means that they might not share identical practices, values, beliefs or lifestyles and, as a result, their needs vary. Indigenous social and cultural preference­s challenge current design guidelines in residentia­l aged care settings and the common perception that one size fits all. For residentia­l aged care to be culturally safe, welcoming and relevant to older Aboriginal and Torres Strait Islander people, purposeful consultati­on is required, along with an interdisci­plinary team coming together to provide an appropriat­e and comprehens­ive design solution. While this research focuses on the design implicatio­ns in residentia­l aged care settings for Aboriginal and Torres Strait Islander people, the care needs of these people should also be considered at a community level. If architectu­re and design is culturally and socially inclusive in a community-care setting, older Aboriginal and Torres Strait Islander people are likely to be able to remain within the community, and outside aged care settings, for longer.

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