As fertility rates decline, the worldwide population of persons aged 60 and over is expected to triple between 2007 and 2050, reaching more than two billion.  The Australian aged care system is a global benchmark for best practice and Australia’s expertise in the field is now being used to help other countries meet the challenges of an ageing population. 

David Lane is an architect who specialises in designing aged care facilities, so when asked what makes a good facility, his answer is surprising.

“It’s not about the building,” he says. “What makes a good aged care facility are the operational attributes andthe management structure which engenders a sense of home, warmth, security and comfort, so that people living there feel like they want to be there, that it is really a compassionate and joyful place.”

Nonetheless, the building helps create an environment where older people want to live, says Lane, a partner at ThomsonAdsett, an Australian architectural practice based in Brisbane, Queensland, with a global reputation for outstanding work in the aged care sector. The firm is ranked second in the global elderly living sector in Building Design’s renowned World Architecture 100 list, and works on projects in Asia and Europe as well as Australia.

The building design determines how efficient the services can be and how pleasant the environment is for the residents. “We’re very conscious of the interior appearance of the building and the way in which it conveys messages of home, comfort and warmth,” says Lane. “We think about the convenience of things: the way the lighting works, where the light switches go and that they’re easy to get to. Where you plug things in needs to be logical, the bathroom needs to be easy  to use: it all needs to be convenient and comfortable. Nothing should be too hard.”

The devil is in the detail in aged care, he says. “You need to think about what residents’ real day-to-day needs are. Simple questions are important, like where do I put my coffee cup in the morning if I want to sit in the sun because I’ve got arthritis?”

ThomsonAdsett was one of the early innovators in the industry as it started to transform institutionalised aged care into a more humane, more socially acceptable and nicer environment.

Lane and a client led the push for single bed rooms with en suite bathrooms, which were not permitted in Queensland aged facilities at the time. Everyone was housed in wards and Lane says while that was okay for a hospital stay of a few days, it dehumanised residents who would be spending their final years in a facility.

“I spent a lot of time speaking at public lectures, as did a number of people in the company, espousing these principles of home design and familiarity and respect and dignity and how it might play out in an institutional setting,” says Lane.

That approach led to the practice’s first engagement in Asia, where Lane designed an aged care premises for the Watakyu Seimoa Corporation in Japan. He went on to design the world’s first high rise fully integrated aged care facility for the Hong Kong Housing Society, which was finished in 2004. 

Asia is suffering an aged care crisis. Many countries have rapidly aging populations but traditional family-based aged care models are breaking down. China is forecast to have 450 million people aged over 65 by 2050, and its one child policy is leading to what’s known as the 4-2-1 problem, an inverted pyramid where the child on the bottom is looking after as many as six elderly adults.

“It’s the biggest market opportunity that Australia’s likely to see. It’s bigger than the real estate boom in China because it’s going to be such a long-lasting and powerful social force,” says Lane.

“Australia has a very sophisticated and highly-credentialed system of aged care, backed by over 60 years of experience. Some of it’s overly bureaucratic and got a little bit too much red tape but in world standards, it’s highly regarded; it’s in the top three in the world,” Lane says.  

Australians are regarded as good listeners who are very accepting of other people’s point of view, Lane says. “We listen and we’re patient, we are interested in hearing what they have to say and how we can translate that into their culture rather than telling them what’s wrong with their culture or what’s wrong with what they do and that we’ve got the best system,” he says.

It’s an approach he has employed in his work with entrepreneur Choe Lam Tan on projects in Australia and overseas. Tan’s Jeta Gardens project in Brisbane is Australia’s first retirement and aged care resort that bases its design, services and management on a blend of Eastern values and philosophies and Western standards of aged care.

For instance, the facility is decorated with Asian colours, and there is a major emphasis placed on food, because the way food is presented to a person of an Asian background is important, as are the smells and the social activity around food preparation. It’s also important to provide social areas for large family gatherings.“In the 5000 year old Chinese culture, we treat our parents like gold,” says Tan, who has lived 30 years in Asia and 30 years in Australia.

Jeta Gardens offers the full gamut of care, from independent living to residential aged care. Tan says he wants to see residents through from the ages of 55 to 100 and wants to make sure that married couples aren’t forced to be separated because of lack of suitable accommodation as their health changes.

Tan applies what he calls the “4H” model in the design and operation of retirement and aged care facilities: a hotel, a home-like environment, a holiday resort and finally an embedded hospital.

Tan duplicated his 4H model in Malaysia three years ago. The facility is an 80-bed aged care facility providing 24 residential care including dementia specific care. The key difference from the Australian model are that it has mostly multi-bedded rooms to make it affordable, as there is no government subsidy. It is also designed  to cater for the different cultural and religious needs of the multiracial residents.

Like David Lane, Tan believes Australia can draw on its experience in aged care to help meet the needs of the aging Asian populations. However, care has to be affordable and cultural and religious differences need to be respected.

“Aged care is more than just bed and breakfast, it’s about treating people like family members,” says Tan.