A small community in Bellmere, just north of Brisbane, is turning the traditional aged care model on its head, providing a sense of independence, engagement and normalcy to its 120 residents, many of whom live with cognitive impairment such as dementia.

The micro-town has all the facilities you might expect: a cinema, corner store, cafe, beauty salon, GP, dentist and even a town centre.
“It’s essentially just like a little suburb but it caters to older people and people who are living with a disability,” New Direction Care CEO Natasha Chadwick told ABC Radio Brisbane.

“The way that we have developed the town is just like services that you would have in any suburb, in any community here in Australia.”

“I am a very big believer in inclusiveness, and I don’t understand that when someone gets a brain disease or impairment we, all of a sudden, think that they need to be in a secure ward and a secure area away from everyone else,” she said.

Instead of one large, hotel-style facility often seen in traditional aged care, the micro-town has 17 separate houses with seven people living in each.

“They enable people to have their independence and freedom and continue to be the person that they were when they were at home, before they had to move into care.”
Each dwelling has a trained “house companion” who is responsible for everything from meal preparation to medication management, and who is supported by a team of specialists.

“We have 24/7 registered nurses, allied health … podiatry, dietitians, physiotherapists, occupational therapists,” Ms Chadwick said.

“Pretty much everything that the Royal Commission is suggesting we should be providing as aged care providers.”
Dementia-friendly design

Ms Chadwick’s model was inspired by a similar village called Hogeway in the Netherlands, that caters specifically to people with dementia.

“The founders have been here to our microtown … and they loved it, but they also recognised it’s very different from what they do,” Ms Chadwick said.

“The concept of a small town is the same, but their model is very much focused exclusively for people living with dementia, whereas ours is inclusive.”

Ms Chadwick said about 70 per cent of the residents at New Direction were living with a cognitive impairment, many of them with dementia, including 20 per cent who were living with severe dementia.

“What we do find is that residents who are cognitively intact, they really help, and work with people who are struggling,” she said.
Dementia Australia’s Advocacy and Research executive director, Kaele Stokes, said physical design that promotes independence can have a profound and positive impact on people living with dementia.

“We know the physical environment can have a significant impact on people living with dementia, both in terms of enabling individuals and disadvantaging them,” Ms Stokes said.

“The dementia-village style of accommodation is one model which evidence suggests can have a positive impact on the autonomy, independence and wellbeing of a person living with dementia.”

Ms Stokes said Dementia Australia had long called for dementia-friendly design to be incorporated in residential aged care as well as more investment in dementia-specific training for all staff.

“Simple, relatively low-cost changes in colour schemes and basic design can make a significant difference to the quality of life of someone living in residential aged care,” she said.

Opening up traditionally closed-communities

Ms Chadwick said often aged care facilities became a “scary place”, closed-off to the community with outsiders only entering to visit loved ones.

She said the village model invited people to utilise the facilities like the cafe, store and gym, promoting an authentic community.

So, how much does it cost?

“Because we are funded by the Commonwealth … it doesn’t cost any more than it does to go to a traditional aged care community,” Ms Chadwick said.

“The difference is that we have to supplement our revenue because the Commonwealth revenue that’s currently provided to aged care is not enough for those services.

“So we supplement our revenue through other services that we provide out to the community, as well as to our internal community.”

The model is growing in popularity around Australia, but Ms Chadwick recognised there were barriers for some facilities to make the switch.

“Many of the larger providers, they have billions of dollars of assets in buildings and this kind of change is significant,” Ms Chadwick said.

“To have to change the way that those buildings have been developed: very traditional, institutional or hotel-style into a house, is going to take quite a bit of cash … as well as will, the culture change that we need as an industry.”

Ms Stokes said regardless of what kind of facility a loved one is moved into, great care should be taken to ease their transition.

“An abrupt change of environment, routine or engagement can be disruptive for a person living with cognitive impairment and their ability to adjust to change may be impacted,” Ms Stokes said.

“A carefully stepped out transition plan that reflects the individual preferences and needs of an individual, builds collaboration between the individual, their families, carers, healthcare professionals and staff, together with a well-designed environment, can help maintain abilities, reduce risks and provide meaningful engagement by providing essential prompts and accessibility to support a person with dementia.”

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