Ageing in Place: what does this mean?

Ageing in Place is a philosophy of care which came into being following the introduction of the Aged Care Act, 1997. Prior to this, residential aged care was provided in nursing homes (now termed high care) and hostels (low care). The hostel and nursing home systems were quite different, as the administration and payment systems were operated separately, care subsidies were based on distinct and separate “resident classification” systems and more significantly and having a greater impact on the resident and families, was the need to transfer to nursing home care should care needs increase to high level care. This also meant that partners with different care needs could not be housed together, nor could parents caring for children with a disability whose care needs were different.

Following the 1997 legislation, residential aged care homes were able to deliver care to residents of all care levels and needs subject to meeting specific requirements of the quality assurance framework (which included accreditation and certification). The Resident Classification Scale (RCS) was born; a single funding instrument to replace the two distinct, separate funding tools.

There is no single recipe or right way to provide ageing in place. Ageing in place is all about the provision of responsive and flexible care in a familiar and appropriate environment to meet each individual’s needs as they change. The philosophy is that care is provided allowing the resident to remain in her or his unit or room until they die, with all care needs and services being brought to the resident, rather than the resident having to move or relocate to find the appropriate service and care. Even where ageing in place has been embraced as the care model, sometimes it is not possible to provide all care needs, especially where there are special needs such as dementia, challenging behaviours or acute hospital care is required.

The Structural Reform Package which included the Age Care Act, 1997, did not make ageing in place a mandatory care model or principle in Australian residential aged care services. Services must provide the care for which their buildings and staff are capable and qualified to give. There are, and will continue to be, many aged care services which provide for either low care or high resident needs but not both.

The benefits to the residents and their families when being accommodated in a service with the ageing in place philosophy are mostly positive. High value is placed on the services’ capacity to provide ageing in place and deliver continuity of appropriate care within a familiar environment, with familiar staff and systems, often without the need to relocate whatsoever. The residents once overcoming the “need to move and change their address” often consider that they have found a new “home”, which enhances their move and being settled.

This has particular importance for couples planning to move from the family home as they may be able to remain together even if their care needs differ significantly over time.

Other benefits include the slower turnover of the resident population, so residents are not so disrupted by the comings and goings. Ageing in place allows relationships to have time to mature and develop relationships between residents and also between residents and staff. This in tune enhances the harmony within the home.

The diversity in resident population, as we find in our communities outside residential aged care services, and in which our aged care services belong, is another benefit of ageing ion place. All residents benefit from the exposure to other residents covering the full range of care needs. Low care residents have been noted to enjoy helping in the care and support of residents with higher care needs, and high care residents benefit from the atmosphere created by promoting independence of the residents with lower care needs. As high care residents require more highly trained staff the lower care residents are able to benefit from their skills and expertise. We look forward to our new building being able to accommodate the ageing in place model od care.

There are many case studies and examples of successful ageing in place services. The document titled “ageing in place a guide for providers of residential aged care” published by the Commonwealth Department of Health and Ageing, 2002, includes the history of ageing in place, planning for ageing in place, and then other organisational facets such as staffing strategies, design principle and much more. There are also many more recent publications about dementia and special needs accommodation and design.

Please do not hesitate to contact me should you require further information about this or any other aspect of residential aged care and our services, or any related further reading and literature.; …and do remember, as I have said in previous columns, going into aged care residential services is not a death sentence; it is just a change of address.

An ageing in place address sounds just perfect.