By Sarah McCarthy
Sarah is a senior Access Consultant for Architecture & Access, and has worked as an access consultant since 2012. She is a qualified interior designer with over 15 years experience in the retail, health and education sectors.
Sarah’s experience working as an interior designer has given her a good understanding of the building and construction industries as well as a deep understanding of the way in which people move through the built environment
Sarah has recently written and published this article in the ACAA (Association of Consultants in Access Australia) online publication, Access Insights.
The residents of aged care facilities have varying needs and abilities. Therefore, when it comes to designing residential aged care facilities, a one-size-fits-all approach isn’t necessarily the best way forward. There are a multitude of factors to be taken into consideration such as the residents’ level of mobility, cognitive ability and dignity as well as staff requirements for assisting residents and the use of equipment within the bathroom.
Over the past two decades in Australia, the number of people aged 85 years and older increased by 117%, to a total of 515,700 people^ nationwide. With this staggering figure in mind, now seems like a good time to ensure that we are designing aged care facilities, in particular in resident’s ensuites, to best accommodate the individual.
Compliance with the regulatory code requirements doesn’t necessarily provide the best outcome for the end user and often neglects the residents varied individual needs. This is in part due to the fact that AS1428.1 is founded on data collected by J.C Bale which is based on people who use a wheelchair between the age group of 18 to 60, “and may not be appropriate for people outside this range” according to Part 1 of AS1428.1, 2009. It therefore does not take into account the variables of aged care residents who use a motorised wheelchair or scooter and who are perhaps, less physically able than a 60 year old.
This implies that very few people in Aged Care facilities are having their needs addressed by the rigid Australian standards for accessible bathrooms, which is some ways makes this data irrelevant for a large majority of the inhabitants.
In reality, most residents who use a wheelchair in residential care facilities are unlikely to be independently transferring whilst using the ensuite and are in fact more likely to need assistance form staff members when showering and using the toilet. This begs the question, have some of the fixtures and fittings within AS1428.1, 2009 compliant ensuites become obsolete?
One architect I spoke to believes that “we are missing a design guideline for aged care facilities” and through his extensive work in the Aged Care sector, has found that more and more often he is being asked to design ensuites without fold down shower seats or compliant accessible pans. Feedback from facility managers and staff suggests that shower seats are potentially dangerous as they lack the support as well as comfort of a shower chair. Furthermore, perhaps shower mixers should be located further away from the shower rail to assist those staff members who are showering the residents.
The AS1428.1 compliant accessible pan does not suit most residents, including those who are independently mobile with adequate mobility as it provides unilateral support. Increasingly, architects are being asked to specify a standard pan with detachable drop-down grabrails such as the Ifo pan. This style of pan with can be easily retro-fitted in existing buildings where sufficient wall strength cannot be economically provided, in addition, the drop-down grab rails can be installed and uninstalled as the individual’s needs change.
Furthermore, the armrest style grabrails are positioned at a height of just over 700mm which allows users to push down when standing which provides a functional and more appropriate option for some independent users. However, on the opposite end of the spectrum, some staff members find that the armrests are obtrusive, and they question the strength of the loadbearing on the armrests.
As Access Consultants, it is clear that further discussion is required in this field. We are rarely engaged at the concept design phase to give our professional advice on the layout and design of accessible ensuites and as a result are often left with the job of writing performance solution reports to address the deviation from the code for the non-provision of compliant fixtures as well as reducing the number of accessible SOUs in the facilities.
For a Class 9c aged care building, according to the NCC/BCA Part D3.1, five accessible SOUs are required where a total of 100 rooms are provided, this increases to nine rooms where 200 rooms are provided. This number is substantial when we take into account that they are not providing a functional solution for most residents.
As we are all aware, the cost of increasing the room size of ensuites can be prohibitive, therefore, if residents are going to age-in-place then all bathrooms will need to be significantly larger to accommodate equipment which will be required as their mobility declines. Portable hoists, shower chairs, wheelchairs and commodes will often be utilised, all of which take up a significant chunk of the floorspace. Currently the standard room ensuites have limited capacity to fit all the equipment that may be required as well as including one or two staff members and their spatial needs when caring for residents. Fortunately, some aged care facilities are designing rooms with ceiling hoists which will alleviate some of the stress on limited space.
This presents an opportunity for the key stakeholders to re-address the design and layout of residential care ensuites and perhaps by engaging Access Consultants, occupational therapists, healthcare professionals and the elderly we can start the discussion to design bathroom spaces that are safer, more inclusive, aesthetically pleasing and functional for older Australians.