What would happen if everyone over 90 could choose when they wanted to move into a nursing home?

This article is written based on Swedish conditions but can hopefully provide inspiration in other countries as well.

It is difficult to know whether the nursing homes being built right now are for yesterday or tomorrow. Much of the architecture and planning seems to be based on the idea that regulations and people's wishes will not change. If moving into a nursing home was a free benefit for everyone who had turned 90 and was not based on a welfare decision, the design would look completely different. The residents' power to choose a nursing home would increase and the quality of different nursing homes would be examined more closely.

Foto-Erich-Karnberger-Mostphotos-webb

Planning a Care Home for the Elderly


When a new care home is to be built, there are numerous requirements. It must be fireproof, have evacuation routes and firefighting equipment. There are requirements for healthcare hygiene standards and the size of the apartments, that it should be accessible for people with functional variations, disabled toilets, door width, and much more.

However, when it comes to balconies and windows, safety considerations seem to end. There have been several accidents where elderly people have fallen from, for example, a balcony with low railings. Similarly, architects and clients seldom think about the experience of arriving at a residence. It happens that newly built houses have a quiet, grey and empty entrance and that there are technical solutions that are not at all adapted for the nursing assistants who are to work with them.

Every summer comes a period of heatwave. This means suffering and some years even an excess mortality among the elderly and frail. Air conditioning should be a natural feature in a residence where elderly and frail people are to live and be cared for.

In Vellinge, Förenade Care has been commissioned to develop an existing residence into a dementia village. The idea is that those who live in the care home should be able to move freely indoors and outdoors. Their concept includes exercise and wellness facilities, a café and shop within the care home. Everything is adapted for people with dementia. Here, the municipality has adapted an existing care home.

Think of what can be done if these thoughts are included from the start. You can have small clusters of houses that are located around a carpentry workshop, a music studio or sewing room. To have beautiful walking paths with oases in the garden where those who wish can sit and hear the murmur of running water or drink a cup of coffee in the company of friends. Surely the use of medication would decrease, as well as falls and other healthcare injuries. There are role models in the Netherlands and Denmark.

Conscious architecture with colour schemes and common areas can reduce the feeling of confinement and give the residents freedom of movement. At the same time, care homes are still being built based on old ideas of what a care home should look like. Night lights in the toilet can help maintain the ability to independently care for one's needs. Pictures in the corridor can facilitate orientation and finding one's own apartment. Perhaps it is possible to create a community without long corridors.

Roof terraces, spa departments, gyms, common dining rooms and libraries are other things that can contribute to comfort and create a sense of community among those who live in the unit. With a stimulating environment, residents can more easily maintain functions and staff can spend more
time on social interaction, when the need for other care services decreases. Most of us never get the opportunity to build new, even if we can dream. But there is surely a lot that can be done within the framework of your care home.

What happens if those who have turned 90 get to decide for themselves when they want to move to a care home?

If people who have turned 90 get to decide for themselves when they should move to a care home, it would entail several potential consequences and considerations:
Increased autonomy and self-determination Such a model would emphasize the self-determination and autonomy of older adults. They would have the right to decide when they feel it is the right time to move to a care home, which would strengthen their sense of control over their lives.
Requirements for adaptation and flexibility If older people over 90 get to decide when they should move, care homes would need to be flexible and adapt to the wishes and requirements of the elderly.
Resource planning and financing Enabling such decisions would require that there are enough care homes and nursing places to handle the variation in when the elderly choose to move. It would also require financial planning to cover the costs of care and housing.

There are municipalities, for example, Västerås city, that apply this.

Reflection questions - design of care homes
Care staff:
- Are there things you could easily do at your residence to create comfort and activity?
- How do you want elderly care to work when you one day in the future might need care and service?  

Manager, nurse, occupational therapist and physiotherapist:
- What can you do to increase comfort, activity and other things that contribute to the joy of life at the residence?
- Are there measures you can take to increase the stimulation for the residents to maintain functional ability, reduce fall risk or otherwise improve the environment?

Residents and relatives:
- Is your care home stimulating?
- Are there activities or services you are missing?
- Do you see improvements that could easily be implemented in the care home?  


Erland Olsson
Specialist nurse
Sofrosyne
Better care every day

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