The idea that smaller aged care facilities perform better is not new; studies and anecdotal evidence have been demonstrating the benefits of smaller and more bespoke aged care facilities for years. And yet more large centres continue to be built, offering a less personalised experience and often a lower quality of life for their residents.
Research conducted by the University of Queensland for the Royal Commission and published last week, identified a disproportionate number of smaller sized homes in the highest quality group in the study. The best quality group included 40% of facilities that have only 1-15 beds, while 37% of facilities with 16-40 beds also made the cut. The correlation between size and quality of facilities was strong and consistent across ownership and provider types.
At home in aged care
Most older people would prefer to stay in their own home for as long as possible. When it becomes necessary for them to move into residential aged care, many older Australians feel like they lose the independence and sense of self they had when living at home.
Larger aged care facilities can often feel more like hospitals than homes, with limited ability for residents to take part in their own care, to go outdoors, and to set their own routines. Homes with over 100 residents are often very institutional in nature, which can be jarring for people used to having their own home and personal space.
Smaller homes often focus on feeling ‘home-like’, with small resident numbers, buildings that more closely resemble suburban houses, and plenty of accessible outdoor space. These facilities resemble villages or small communities. Smaller facilities can also have a focus on engaging residents in the running of the home. Residents of aged care homes often report a higher quality of life when they are able to engage in domestic activities, such as cooking and gardening.
This approach is consistent with person-centered care, a philosophy of care built around the needs of the individual. The model emphasises individuality and the building of relationships between residents and those who care for them. Staff in smaller facilities are often responsible for less residents, meaning they can develop stronger bonds and get to know the individual needs of the people in their care.
This is especially important for residents living with dementia. People living with dementia can greatly benefit from being moved into a residential aged care home that more closely mirrors the community and environment they lived in previously. Engaging people living with dementia in activities and avoiding strict schedules improves their outcomes and slows mental decline.
Home-like settings reduce hospital visits and overuse of medications
Although the University of Queensland study did not include data on hospitalisations from aged care homes, previous research has suggested that smaller homes with a stronger focus on high quality care have lower rates of hospitalisation.
A 2018 study from Flinders University considered the quality of life of aged care residents living with dementia. The study found that residents in smaller, home-like aged care settings reported a better quality of life and had a 68% lower rate of being admitted to hospital.
A second Flinders University study also found that residents who lived in a home-like model were 52% less likely to be exposed to potentially inappropriate medications. Medications such as antipsychotics and relaxants are frequently used in aged care settings, however the use of these is often not beneficial to the patient.
Successful models for smaller aged care homes
There are some aged care homes in Australia that epitomise the advantages of small-sized facilities. These homes have high customer experience ratings, improved resident outcomes, fewer complaints, and lower rates of hospitalisation and overuse of medication.
One example is Group Homes Australia, a service offering a new model for aged care. Residents live in a home that is designed to look and feel like a regular household, and there are only six to ten residents per home. Many of the typical features of aged care have been removed, such as staff uniforms, set meal times, and organisation logos or branding. The focus of Group Homes Australia is on creating a sense of home.
Similarly, aged care provider Wintringham implements innovative design to create a more homely, less institutional feel to its facilities. Their village-style settings offer landscaped surroundings and houses shared between three to six residents. The facilities are designed to create a family-style environment and allow residents to maintain their activities and be as independent as they choose to be.
Given the Royal Commission has shown what needs to be done for quality to be improved across the sector, will we be seeing a rise in smaller facilities in the future?