Dr Jan Weststrate points to a concept that has worked well for aged care in the Netherlands: “omdenken” which means “flipped thinking”. The principle allows managers, planners and designers to solve problems by focusing on opportunities rather than trying to solve the problems. And he believes it has potential to work here in New Zealand, too.

This was one of the messages he and his wife Marian delivered at a recent public talk about design in aged care at the Wellington City Gallery, organised by the Wellington Branch of the New Zealand Institute of Architects.

a living room as how this would look like in the fifties.

The Westrates, both experienced nurses who’ve worked in the Netherlands, the UK and New Zealand and now run quality care consultancy Care-Metric, are well positioned to speak on this topic.

Dr Weststrate says there are three basic principles central to designing care for older people: autonomy (nothing about me without me), reciprocity (contributing to society) and dignity.

He says there are some differences between the Netherlands and New Zealand, including the population (the Netherlands over 17 million people compared with New Zealand’s 4.7million) and the sector make-up. Over 70% of New Zealand facilities are “for profit” while the Netherlands has a not-for-profit model with only 2% for profit. The differences also extend to the countries’ ideologies.

“Culturally, the Netherlands has a more feminine and long-term thinking culture while New Zealand has a more masculine, short term thinking culture.

“These differences significantly influence how both countries look at the needs of their aging populations. However, both countries face the same issues – an ageing population, increased in dementia and social isolation, an ageing healthcare workforce, staffing shortages and a desire to keep people living in their own homes for as long as possible.

This opens the way to look at successful principles for elder care rather than merely copying ideas that may not necessarily work, says Jan.

This is where “omdenken” or flipped thinking comes in.

Marian Weststrate provides the following examples:

“In 2016 the Dutch government decided people with a low-level care needs would receive care at home rather than in an aged care facility.  This caused a major issue for aged care providers and created a significant number of unoccupied rooms.

“The opportunity was to think about the groups in society who actually needed rooms. The answer was students! The rationale was that while students had no money they had time. At the same time many facilities were short staffed so unoccupied rooms could be used for students at no charge in return for them providing 30 hours a month to residents.”

More than ten aged care organizations engaged in the scheme.

“The residents love what they get from the students, who help them with technology, shopping and other tasks. This combination of young and old was ‘a marria

ge made in heaven’,” says Marian.

“The old system of 20-30 people living in rooms on one corridor doesn’t cater for the social and emotional needs of older people. It increases social isolation, boredom and apathy. Although there might be all sorts of activities to going on this is not what people over 80 are used to.”

The creation of clusters of 6-8 residents (male and female) with different needs but similar cultural background (urban, rural, highly educated, creative etc.) had also been successful. Each cluster has a shared living room reflecting the cultural background of the residents as well a number of small bedrooms. Residents have their meals in the living room, decide together what they want to have for dinner and staff help them prepare it.

These small scale living arrangements provide a family atmosphere where the elderly are less bored and not so isolated. If they want to be on their own they can withdraw to their bedrooms.

Another great initiative is the renovation of old buildings no longer in use – turning them into aged care facilities.

“People with dementia probably feel more at home living in older buildings reminiscent of their life than in flash new buildings. Creating an interior that reflects the fifties and the sixties is likely to feel more normal than a modern IKEA interior,” says Marian.

Moreover, the Westrates maintain that helping the elderly feel comfortable is a guiding principle as well as a challenge for modern society.

“If we want to provide real resident centered care there are multiple opportunities to explore – creating small scale living arrangements is just one. If the outcome is good for the residents, the money will follow,” says Jan.

Jan and Marian Weststrate organise annual healthcare study tours to the Netherlands to visit a number of aged care facilities that demonstrate these care models. This year’s tour runs from May 6-10. There are still a few places available for those interested. For more information email: marian@care-metric.com.

Banner: Elderly sitting around a table preparing their dinner. An example of elderly keeping their autonomy and dignity.


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