Universal design is the principle for aged care

This article was written by Rhod Ellis-Jones for the Summer-Autumn Hello Leaders print publication.

While the Government and authors should be commended on the Final report on the development of the draft National Aged Care Design Principles and Guidelines, we need to go much further if Australia is to meet its commitment to the United Nations Convention on the Rights of Persons with Disabilities and achieve a truly inclusive society. That goal requires what is known as Universal Design.

Watch one episode of the BBC’s Grand Designs and you could be forgiven for never building anything, ever again. Kevin McCloud’s carefully timed questions never fail to make the owner-builders – who have willingly subjected themselves not only to the project but prime-time scrutiny – shake, vacillate, and equivocate. Honestly, why would you?

Well, many do. And we are all better off for the innovation and courage their bravery or folly teaches us, and the legacy of the home as a unique addition to the streetscape or evolution of architectural design and practice. 

In September this year, the Australian Government released its Final report on the development of the draft National Aged Care Design Principles and Guidelines, which is a key recommendation of the Aged Care Royal Commission. 

The purpose is to help guide aged care providers and architects when building or renovating facilities. It is practical, easy to interpret and apply, and should support the achievement of a consistent quality of building form and experience. Importantly, it provides a reference for providers commissioning architects or builders (for new builds or modifications) and for families to assess the mindset, effort, and realised space of the provider.

Ellis Jones has been conducting research for aged care providers and older persons advocacy organisations since 2006. The consistent themes through successive studies are a deep desire for life to change as little as possible, with continuing contact with family and community, access to green space and creative pursuits, independence in choosing what to do and when, and personalisation of spaces. This is consistent with the report’s four design principles of: enable the person; cultivate a home; access to outdoors; and, connect with community.

The great potential of Universal Design

As Dr Jane Bringolf, Chair, Centre for Universal Design Australia, says, Universal Design is ‘design for everyone, everywhere, all the time’. In an aged care setting, it considers not only residents, but the workforce, health and care partners, and visitors. At its foundation is the premise of inclusivity, not accessibility. 

Inclusivity is a philosophy, mindset, and practice through which places, activities and communication are experienced equally by every person. Afterall, to be included and to belong, is a basic human need.

Universal Design is a design philosophy that ensures that products, buildings, environments, programs, services, and experiences are innately accessible to as many people as possible, regardless of their age, level of ability, cultural background, or any other differentiating factors. It has its origins in the work of American architect and disability advocate, Ronald Mace, in the 1970s. 

Applying Universal Design in practice

In aged care, Universal Design can help in many important areas:

• Place identity and placemaking: co-designing aged care homes and shared spaces that represent the social identity of a community, and considers the relationship of places to the belonging, purpose, self-worth, and identity of inhabitants.
• Organisation and service strategies: placing inclusivity at the heart of decision-making, and leadership behaviours.
• Building design: human centred, participatory design of buildings that welcome all people.
• Service design: Designing with users and health sector partners to achieve universality.
• People and culture: establishing inclusive workplace and resident culture, and designing jobs, systems, process, and technology.
• Communication: welcoming language, accessible content, and digital and physical experiences that are experienced equally.
• Brand differentiation: inclusivity expressed through brand strategy and activation to achieve competitive differentiation and advantage.

Universal Design extends from residential to in-home care services. Once aware of the meaning and principles, workers see opportunities to improve client outcomes by adapting their homes and changing the language and approach to client engagement. 

Learnings from important projects

This year, I’ve had the privilege to work on two important design projects: service and enterprise design for veteran aged care provider, Vasey RSL Care; and, for Paralympics Australia, a Universal Design Guide for sports organisations.

Here are some key learnings:

• Australians are proud of their egalitarian values. People connect by expressing common values, giving fully to the design process, and gaining reward from the exercise. Volunteers are generous with their time, and advocate for outcomes.
• A key barrier to getting started is a lack of confidence talking to people and communities that are unfamiliar. Naturally, there is a fear of saying and doing the wrong thing. This is easily overcome with basic (and readily available) training.
• There is a pervasive belief that accessibility, in building and internet standards, is enough, when it is only a minimum requirement and misses the opportunity for innovation.
• Universal Design is an opportunity and benefits everyone. When you invite diverse people into a design process, you get diverse perspectives. That means learning new ways of thinking and doing things, which leads to new ideas and outcomes. Australians are diverse, and Universal Design considers that diversity – not just people with disability, but people from different ages, cultural backgrounds, genders, and many other identities. For example, a wheelchair ramp installed at an aged care home doesn’t only benefit people in wheelchairs, but also tradespeople with gear, delivery people with trolleys, and parents with prams.
• Redesigning jobs for people with disability significantly broadens the talent pool, addressing critical labour shortages while also demonstrating inclusivity.
• Inviting health and social care representatives, as well as people with lived experience, into the design process enriches the dialogue, produces valuable insights, and establishes the basis for ongoing partnerships in a community of practice. 
• Adapting buildings can be expensive, disruptive and take time. It is often viewed as a necessary cost, rather than an exercise in service and experience innovation, and cultural change, that accrues to the brand and bottom line. Reframing for financial, social, and environmental impacts accurately defines and evaluates building adaptation projects and opens a range of value creating opportunities before, through the project, and ongoing.
• Achieving inclusivity is a journey. Setting expectations that change is participatory and takes time creates the space for learning, experimentation, and improvement.

Start with the inclusive mindset

The best way to get your team started, is to establish an inclusive mindset, generating momentum and commitment to applying Universal Design principles.

An inclusive mindset is about making sure diverse perspectives are heard, understood, and applied; and, decisions are reached collaboratively.

People with an inclusive mindset are curious, kind, aware, and open-minded. They are comfortable asking questions, listening to answers, and working within a diverse team. They have self-awareness that their views, and the way they see the world, may not necessarily be shared by everyone else. And that’s a positive thing; it’s a chance to grow.

An inclusive mindset means using inclusive language: words and phrases that avoid biases, slang, and expressions that discriminate against groups of people based on race, gender, socioeconomic status, and ability.

Like other behaviours, an inclusive mindset is developed over time. The important thing is to get started and practice it. Be comfortable ‘learning while doing’ because, if you use inclusive language, people will always forgive any mistakes and help you on the way.

Start every meeting and every task with the question: ‘How might we be inclusive’.

Needs and aspirations

In the introductory pages of the Australian Government’s report, the authors share a consistent theme of their research has been ‘a home reflects people’s needs and aspirations’. In my family, that theme has been expressed and repeated by my grandfather and mother who both became increasingly fixated on designing a new home well into their twilight years.

Although perplexing to their concerned family members (who never want to renovate again), it clearly represented a chance to produce a home that perfectly matched their ‘needs and aspirations’, and an expression of their identity.

Participatory co-design of aged care applying Universal Design principles and goals, enables older people to express themselves, aware to the constraints of an aged care setting. Innovation happens within constraints. Often, we are happy with seeing incremental change, and clever solutions, that don’t cost the Earth.

Kevin McCloud has said, “Every decently-made object, from a house to a lamp post to a bridge, spoon or egg cup, is not just a piece of ‘stuff’ but a physical embodiment of human energy, testimony to the magical ability of our species to take raw materials and turn them into things of use, value and beauty. I don’t look at what people do with their homes in terms of money, but the social and personal value of what they’re trying to do and achieve.”

That’s why people keep signing up to Grand Designs. It’s who we are. And it is the great opportunity Universal Design presents for aged care.

Rhod Ellis-Jones facilitates participatory research, human centred service and experience design, and enterprise strategy to the aged care sector. Please visit www.ellisjones.com.au for more information.