The opening of the Selwyn Foundation’s new Moxon Centre at St Andrews Village in Cambridge saw over 80 people from the public come and admire the new building, complete with its independent living options, care suites and social facilities.
But as Hilda Johnson-Bogaerts explains, the care philosophy underpinning the new design is what drives the new centre.
Selwyn’s participatory care model didn’t happen overnight. Rather it was the result of extensive research and pilot testing to arrive at some key conclusions, the main one being: the care approach needs to be supported with the architectural design.
For Selwyn this meant ensuring the care suites looked, felt and operated like a regular home. They wanted to steer away from institutionalized models of care and deliver more personalized care.
Johnson-Bogaerts says they explored many different options. They toyed with the Eden Alternative’s Green House care model. They looked at the experience-based care philosophy as described in Fred Lee’s ‘If Disney ran your hospital – 9 ½ things you would do differently’. They explored Professor Hans Becker’s research on ‘Use it or lose it’ which is about recreating an integrated life experience. They read ‘Pursuit of the Sunbeam’. They looked for inspiration from de Hogeweyk, the dementia village in the Netherlands famed for its household set-up. They studied the Health 2.0 movement which focused on participatory medicine and encouraged health professionals to support and coach residents as they took control of decisions about their health.
And from all of this emerged a philosophy of care that sat right with Selwyn – one that puts the resident in the driving seat for their own health and wellbeing, and sees them living a life in a home-like environment.
“We grabbed all the good stuff and thought about what would work in New Zealand. It has to work with HealthCERT, the sector standards and cultural practices.”
Johnson-Bogaerts says they learned from their research and their pilot ‘At Home in Selwyn’ that you couldn’t sustain such a care philosophy without supporting it with a built environment that echoed the person-centred message. In other words, for a resident to feel truly at home and in control of their life, it is contradictory to have nurse stations and ward-like corridors. It has to be holistic.
As a result there are no nurse stations, or indeed ‘staff only’ areas in Selwyn’s new Moxon Centre. The assisted living suites are described as ‘households’. Instead of lots of tables in the dining room as you would commonly find in a rest home, in the Moxon suites there is one long dining table for the residents to sit around, like you would in the family home at mealtime. Some staff were resistant to the idea at first, claiming some residents preferred not to eat with others, but they stuck to their guns, intent on making the households as home-like as possible.
“We wanted to escape that hospital-like environment. It had to look like home and feel like home. We wanted to give agency back to the person,” says Johnson-Bogaerts.
The design incorporates sophisticated assistive technologies to help achieve this. Things such as systems for automated rostering and purchasing consumables, advanced nurse call systems, and ceiling hoists in every room all help to meet resident needs in a way that is unobtrusive. There are Smart TVs in every room allowing residents to connect with family.
Instead of differentiating staffing roles, care partners for each household are expected to help organize meals, deliver personal care and effectively run the household.
This is a departure from the norm and Johnson-Bogaerts says they have invested a lot of time into training and education, particularly around communication and interpersonal skills.
“Procedures should be person-centric, not task-focused,” she says.
Moving to a new system hasn’t been entirely easy.
“It’s been very challenging. We’ve really had to drive hard and stop ourselves in our tracks and ask ‘how does it look at home?’ while complying with standards at the same time.”
Selwyn is very interested to observe how residents take to the new set-up. Their next area of research is around wellbeing of residents. Not quality of life, Johnson-Bogaerts clarifies, but on looking at which care environments deliver residents the best opportunity to feel happy and in control of their health and wellbeing.