Natasha Chadwick and Alasdair A MacDonald report on a new, award-winning inclusive model of residential aged care that doesn’t segregate people by physical or cognitive diagnosis. Instead, residents with a range of care needs, including advanced dementia, and with similar values and lifestyle preferences, share a home together.

The number of people living with dementia continues to increase each year, including those with a younger onset diagnosis (Dementia Australia 2018). Paradoxically, much of the aged care industry continues to provide products and services that are not in line with the Aged Care Roadmap (Aged In essence, the Roadmap talks of greater consumer choice, which is nothing new to the industry; government, peak bodies, providers and consumers all have spoken (and continue to) about moving away from the traditional institutional models of residential aged care. No longer will the consumer accept a blanket one-size-fitsall approach – nor should they.

However, when it comes to dementiaspecific residential aged care, unfortunately there has been little or nochange in what is being delivered. Terms such as ‘dementia-specific unit’, ‘locked unit’, ‘secure unit’, ‘the dementia wing’, ‘the dementia section’, ‘high-care and low-care dementia floors’, to name just a few, are sadly familiar to us all.

In 2012, after more than 20 years working in aged care, Natasha set out to develop an alternative to traditional residential aged care that wasn’t institutional, segregated and task-driven. A global search for best practice, looking at models of residential care in the US, the UK and Europe, including the Hogeweyk dementia village in The Netherlands, consistently brought us to the same conclusion: the model would need to be customised to suit the Australian market, and there would be no separate units or areas for people with dementia; instead, they would be integrated with residents living without dementia.

In late 2017, after almost six years of research and development, we opened the NewDirection Care Bellmere Microtown™ in Queensland – a new model of residential aged and dementia care that we believe will revolutionise the ,sector. At the end of the day the solution was pretty simple – enabling residents the freedom of home, access to outdoor spaces and the wider community, and no longer segregating residents based on their physical or cognitive diagnosis.

Trialling the concept Before building the Bellmere Microtown we trialled this idea of inclusive, ‘smallscale living’ with a pilot program in 2014 in Wynyard, Tasmania. Two small houses were built, each with seven bedrooms, a working kitchen, laundry and living room, enabling seven residents with and  without dementia to live together in a regular house and take part in day-today activities such as cooking and cleaning. There were no longer routines, but instead residents started to freedom and empowerment. They  reported a significantly positive experience and improvements in their quality of life.

Key findings and outcomes from the program, which is still running in Tasmania, included:
• It was clear that residents do not need to be segregated by diagnosis, but instead grouped according to their lifestyle and values. This led to the development of our proprietary Lifestyle Survey (explained in more detail later in the article).
• Residents were supported and encouraged to do day-to-day household tasks such as cleaning, laundry, cooking, gardening, etc, as much as possible.
• The optimum resident-to-staff ratio, which changes as the care needs of each house changes (eg, a maximum of two staff per shift in homes while the care needs of residents are high and a minimum of one otherwise.
• The development of the House Companion™ role, including a customised training program.
• House Companions being able to assist with medication administration, resulting in the removal of medication trolleys.
• A customised food safety program specific to the model.
• Introduction of non-chemical cleaning.
• Removal of certain routines such as • Reduced incidents of ‘sundowning’, responsive behaviours and improved sleep among residents.
• Increased appetite and participation in menu planning and cooking.
• Creation of a resident community garden and use of produce in cooking.
• Full compliance with the accreditation standards.
• Costs per resident were shown to be in line with those in traditional models of residential care.

The Bellmere Microtown

The success of the model in Tasmania led to the development of NewDirection Care Bellmere, which opened in September 2017. The $30 million residential aged care facility is a worldfirst Microtown, located between Brisbane and the Sunshine Coast. It has 17 individually styled homes located on six streets over 2ha and is home to 120 residents. The Microtown recreates life in a small Australian town and is designed for people of all care needs, including those with advanced dementia and younger onset dementia, to live together.

Sixteen of the houses have seven people living in each and one home has eight residents. They live together based on their values and lifestyle; they are not segregated according to their diagnosis, nor are residents with dementia isolated in ,a secure location. Houses closer to the town square are defined as ‘urban’ or ‘modern’ and designed for residents who have come from a city environment or lived in an apartment, while those further down the street and closer to the community gardens and chook pen are very traditional and more suited to residents from country areas or a farming community.

Unlike traditional institutional care environments, where many areas are restricted or out-of-bounds, there are no locked secure dementia units, no corridors lined with rows of bedrooms and large common areas, nor industrial-sized laundries, or a central commercial kitchen preparing generic, canteen-style food served at fixed times by dining staff in a large and loud dining hall.  Neither are there nursing assistants or personal carers helping residents with eating and personal care at fixed times, or Registered Nurses (RNs) running around with medication trolleys.

Instead, the Bellmere Microtown looks suburban community – the houses all have picket fences, mailboxes, garden hoses, a barbeque, clothes line, and frontand backyards, positioned on wide, landscaped streets, each with their own name and house number.

Each resident has their own private ensuite bedroom (some with double or queen beds so couples can live together) and share the home’s domestic-style kitchen, laundry, dining room and sitting  rooms as a family unit. They decide their daily routine, right down to the menu and are free to explore as much as they wish throughout the Microtown.

As with any other suburb, the Microtown has a town centre or shopping precinct with a cinema, corner shop, café, beauty salon, barber, GP, dentist, and a wellness centre for residents and team members. Families and the wider external community also have access to those same shops and services as they are open six to seven days a week. We also have created partnerships with community support groups who provide volunteer services such as local churches offering spiritual support, local schools for intergenerational programs, and some

Indigenous groups to provide connections for residents’ specific cultural needs. The community garden, tended by residents and an onsite gardener, provides seasonal produce for their own use.  Residents also tend to the chickens, feeding them and cleaning the pen. Pets are welcome if the other residents in the house all agree as a ‘family unit’. The animal is assessed for suitability by a vet, a support plan is completed, and an agreement is put in place between the resident/family and NewDirection Care. At present one of the houses has a pet dog and another has a bird that are looked after by residents and House Companions, providing company, love and a sense of community for all.

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