S2E3 Transcript: Developing an Ideology of "Home"

S2E3 Transcript: Developing an Ideology of “Home”

Lori Pinkerton Rolet

Hello, and welcome to the Third Age Design podcast- sharing essential information on senior environments. I’m Lori Pinkerton-Rolet, if you recall, (and actually even if you don’t), our guest last month was Dr. David Sheard talking about emotional intelligence. Much of what we talked about related to what makes a place a home, particularly if it’s a shared space. Well, this month we’re taking this concept and looking into the research which has been done in this area by Dr. Anne Fleming of Robert Gordon University in Aberdeen, Scotland. In fact, her doctoral thesis there was on this exact topic, so we’re going straight to the expert. Her research reviewed information from the United States, Ethiopia, Ireland, Australia, and many other parts of the world. In other words, exactly the type of international information we research and share here at Third Age Design, which you will not find anywhere else. And speaking of Australia, the ‘land down under ‘goes under the microscope in this episode as both of our Hat’s Off tributes and Innovation Spotlight look at what’s happening there right now. As a designer, my favourite quote from Oscar Wilde, were his reported last words, which were, apparently, “This wallpaper and I are fighting a duel to the death, either it goes, or I do.” Another goodie is this one. “Experience is the hardest kind of teacher. It gives you the test first and the lesson afterward.” And that, dear listeners, is the purpose of Third Age Design, to share information and learn from the experience of other people– important research. In addition to our podcast, we have a website full of useful information. And if you go to ThirdAge (dot) Design and hit ‘join,’ you’ll automatically receive our ‘At Home Safety Checklist’ for older people, as well as receiving what we call ‘a Tad Extra’ each quarter–exclusive information for our members. Best of all, it’s entirely free. So, what are you waiting for? Okay, let’s get started. Our guest today was literally tracked down from her successful doctoral thesis entitled ‘Care Homes: the developing ideology of a home like place to live’, which she completed under the supervision of Dr. Angela Kydd of Robert Gordon University in Aberdeen, Scotland. Our guest is Dr. Anne Fleming who retired this past October, but qualified as an occupational therapist in 1983 from Queen Margaret College, Edinburgh. Her clinical practice focused on people with learning disabilities, with managerial responsibility for older people services, mental health, and paediatrics. And while working in the NHS, she completed her Master’s degree in inclusive environments at the University of Reading. As I’ve already mentioned, her Doctoral dissertation explored stakeholder perceptions of homeliness in care homes, and this work has been presented at international conferences. And I should just mention here that homeliness means something quite different in the United States. So for that country, please think of that word as being ‘homeliness’. Anne, welcome to Third Age Design.

Lori Pinkerton Rolet

Now, I think it’s very important information that you’ve researched. And I note that you qualified as an occupational t herapist, and then you did your Master’s in inclusive environments. Where do you think your interest in sort of senior environment specifically originated?

Dr. Anne Fleming

During pre- registration placement, particularly my placement with the social work department, where a lot of work was focusing on its adaptations that really highlighted how the environment could support people or no longer people services placements. And in my first job, I had what was then called to geriatric assessment or two, and a lot of the acute medical patients are elderly people. So, you’re going ageing, who visits again, looking at how the environment could support their performance, or not, as the case may be. So, I think, from very early stages in my career, I became aware that older people quite often had different needs. And then when I was in the Scottish National hospitals, it was it’s time. I got very involved in the repositioning, which was the closing down of us back institutions, and rehousing people in a different variety of colour, limitation, some purpose built to their specific needs, some purpose built towards a group needs. I then got involved in the design of the community hospitals. And for that reason, I thought that the Masters inclusive environments would be very beneficial for me.

Lori Pinkerton Rolet

And, did you decide just that inclusive environments was really the way to go as opposed to interventions that make more medical looking in, in design?

Dr. Anne Fleming

Inclusive environments are more likely to fit the needs of everybody. And we’re looking at a very mixed population with very diverse needs. They looked at individual needs, but also adopted a lot of the principles of the inclusive environment.

Lori Pinkerton Rolet

That makes a lot of sense. And then when you decided to do your Doctoral dissertation, why did you decide that this concept of home was a particularly important area of research?

Dr. Anne Fleming

That took me about three months to settle on studentship that was offered was the impact of the national care standards and care homes. So, after searching literature, and really studying the national care standards, the word home lay or home light, or I know that totally different, meaning different countries came across that and various conferences. The word making it homely or homely, I just thought, can you do that? When you’ve maybe got three different generations of people living in it, who maybe have got nothing in common with each other? Who probably have totally different ideas of his home? Like, it seems to me strange to use that when it’s something that was really difficult to measure?

Lori Pinkerton Rolet

Well, that is, I mean, that is what I got out of reading your paper, as I understand you started with about 280 papers being resourced. Then 151 of them were excluded when you initially read, and then another 53 after they were read in full. Why do you think this is so difficult to pin down and analyse? Is it because of what you just said that there’s so many different people with a different approach to what home means to them?

Dr. Anne Fleming

I think that’s a big part of that, because they all have very individual ideas to find and what makes up the home is very, very complex. And I at one point, I was thinking that you’ve got all these different things that contribute. But it’s a bit like a kaleidoscope. Every time you look at it, people pieces in different places. So you’re getting different patterns, but maybe containing the same elements, but organised differently. So it’s very complex. But also, I think the concept of homes create dynamic changes over time. So if you look at the work by I hope I’m pronouncing this correctly, Rybczynski, is looking over five centuries as a development from a communal living and offered everybody to reconsider who knows? Was not home a female domain and the men meant to work? Now we have people working at home. So that’s structure, the organisation of the home has to become different to facility. So the idea of a ‘home’ is changes over time, and will be different for different generations. And I think that makes it very difficult then to say what makes the place home.

Dr. Anne Fleming

Yeah. I mean, I can remember my grandparents still having an outside lavatory, where, like people would anticipate having an Ensuite. Yes. A relatively short space of time.

Lori Pinkerton Rolet

But there were some common themes that I could see in your work. One was that a default position seemed to be that a place was considered a homelike or homely if it was not institutional, and if it was small in scale. Yeah. And then it goes on. The paper goes on into kind of eight main themes, but it talks about some things that seem to contradict one another. Yeah, in the findings. So first of all, just going back to that first point, your analysis and conclude of the work. Do you agree that that really is the default position? That if you were to generalise homelike, homeliness is something that is not institutional and small in scale? Would you agree with that statement?

Dr. Anne Fleming

I don’t really, we just done before carrying out my interviews with stakeholders. But I think no, it’s possible for somewhere large and scale to provide a place where people feel they belong, which I think is probably a better way of describing homeliness. I think the institutional that has more to do with like the power relationship, that people don’t feel, that the staff have all the power, that they feel able to complain, that their needs, their wishes are respected, which you would hope would be the case. I don’t feel the size of this family an issue. The other thing that I think changed my mind was the way people viewed the care home. If they viewed their room as their care home, then they were less likely to feel at home that they belonged there. But if they viewed the whole facility, as their home, then they were much more likely to feel I’m in the right place at the right time for me. So that was quite a strong message that the participants gave.

Lori Pinkerton Rolet

And some of that, then I’m understanding you correctly relates to how engaged they are, with what’s happening.

Dr. Anne Fleming

Yeah, it not might not be terribly active participation. There was fun care home, where the staff says, there were three seats in the sort of foyer near the office near the front door. And they said it is like a race in the morning for people to get those seats. Because they can see who’s coming in and going out. You know that these are the main seating positions, rather than a tea room, or a living room, or a dining room. It’s not necessarily interacting with who is coming and going, but being aware of what’s going on. And there was another place where the balcony and the first story was a favourite spot, because we could see the local neighbourhood children going coming from school, open the new bikes on Christmas Day. And that feeling of being connected to the wider community from there, again, will be not a lot of active participation, but feeling connected.

Lori Pinkerton Rolet

So if you were to advise a group of operators and people commissioning new buildings, and designers and architects, which is basically who we’re speaking to right now, if you were to say, changes that you might make to the structure of a building, or the layout of the building, based on that sort of research, what advice, if any, would you give?

Dr. Anne Fleming

I would suggest they got to know as much about the people that would be living and working there as possible. Certainly try and have them engaged in the design. I think looking at post-occupancy evaluations as it can find any from other builds, I certainly find these quite difficult to get hold of. Think about the functionality of the space. You know, what is that space there to do? I mean, some some spaces, it’s quite obvious. It’s a dining room, it’s a kitchen, bathroom, bedroom. But as a living room, a public space, could be a more semi-public space to be want ones of different sizes, for different functions. Does it have to be very clinical? Did you have a bar? For example? I know some care homes that do particularly popular with a male residents. What about the outside spaces? What does that mean for the people that are going to be living there? Can they participate in the garden is there a shed where the men can participate. Particularly the men, I think, like to have a shed. I think it’s about looking very closely at the functionality of the different spaces and what people might be doing them. And then I think if you can possibly involve the people who will be living there that really helps to inform that.

Lori Pinkerton Rolet

Functionality. Yes, I did have that opportunity once where we were building a new home for a group of people. And they would be moving from the old one to the new one. And we were able to participate in that way but very often you don’t get that get that option, unfortunately. But I think you’ve raised this point about people seeing what’s going on in the building. And yes, if everybody’s off in a side lounge, then you’re disconnected from that sort of central hub of activity. So it seems to kind of respond back to this idea, perhaps a little bit of a, of a hub, just taking what you’re saying, you know, further. But with these other opportunities, such as sheds, (I quite like a shed too), but such as sheds or whatever, these other more personalised opportunities are, but maybe off of this central key space, rather than here’s your lounge off to the side, you will go there. Does that? Does that respond to what you’re saying?

Dr. Anne Fleming

Yes, very much.

Lori Pinkerton Rolet

So. We always, as designers and architects, we always fall on the side of safety over something being homelike, for reasons which should be obvious. But in your work, you mentioned that carpets are often recorded as a source of falls, but that they also contribute to a homelike quality of a space. Yeah. When you were doing your previous research into inclusive design, did this lead you to just a personal preference of either vinyl or carpet? Because, I have to tell you, we have this conversation on every job. And I just had it yesterday. Yeah. Um, where did you end up on this option yourself?

Dr. Anne Fleming

I think there’s a place for both, possibly even a wider range of flooring materials. You know, what’s wrong with a wooden floor, or engineered board, or tiles– doesn’t have to be vinyl or carpet, you know, maybe look at what else is available. The type that I think can be really good. It does reduce noise, for example, where you’ve got trolleys, chairs and stuff rattling up and going. But then that carpet is more difficult to clean than vinyl. So maybe you can think about what is this thing used for? I think the colour in the pattern of the carpet needs to be very carefully considered. Most of the falls are framed with carpets–have been because the carpets have not been well maintained. So maybe it’s come up from the gripper. Or it’s free, or there’s a hole in it. It’s that kind of thing that tends to cause falls. But you also need to think about people’s conditions. The carpet has much less reflectivity than the vinyl. So you’re not going to get like pools of light glare that might make it look weird and slightly circular, make you feel more secure when you’re mobilising. But think about the pattern. If you’ve got dark dots, for example, on the carpet, and somebody has a visual impairment that might look like a hole. Or if you’ve got broad stripes, that might look like stairs. Right? And that will become confusing. Again, people on the autistic spectrum, if it’s a very busy pattern, they’re going to be so busy looking at that in detail, they’re not going to be looking at where they’re going. I think you have to think again about what is going to suit most people. But individual preferences arelovely and, you know, that can be applied to all injuries for general areas. I think again, sort of included some vital principles really to be considered. And I think the use of colour is as well, like Hilary Dalke’s work. I don’t know if you know her?

Lori Pinkerton Rolet

I know her very well, actually.

Dr. Anne Fleming

Well, I think her work in colour is a useful if you’ve got food coming in where maybe, maybe that’s a better place for vinyl or tiles that are easy clean. But I think the softening effect of carpet in a lot of other areas to make it feel more cosier, and more like what you would have at home. I don’t think we need to limit it to either carpet or vinyl.

Lori Pinkerton Rolet

I see what you’re saying. And I will just say to the listeners, I will add on to the references for this podcast. links to some of Hilary Dalke’s work as well because it is very important bit of research. One thing that particularly interested me in your study was several of the authors that you were researching said home is associated with tradition, family values, comfort, and that how objects on display provided familiarity for a person’s identity and for their sense of control over their environment. So , I’m just going to throw this out there, are we as designers, are we making a mistake by curating the front of house objects? So if there’s shelving, we’ll put a lovely vase, or we’ll put, you know, purchase things or find things in order to decorate the front of house. And we will always, because there are so many different people in so many different ideas of home, we will always pick things which are not offensive to anyone. But that also means that they might not be meaningful to anybody. So,do you think in terms of forming the sense of home, that designers should continue to dress those areas and let residents just do their own space? Or do you think we might need to step back a little bit and only do some areas? Or, let residents do all of it?

Dr. Anne Fleming

I think possibly stepping back. And also, it’s going to depend on what objects you choose. I’ve seen places where the views the sort of local history to design objects to go. So one near Glasgow airport, you know, there was models of a plane and two things that sort of had a relevance to the local area. Maybe rather than a nice place.

Lori Pinkerton Rolet

Something with a bit of a purpose, yeah.

Dr. Anne Fleming

To talk about where we went in the local community, if they’ve chosen a care home, local to their lives, because it seems to help maintain that connection. And some people elect to go and live in a care home, maybe 120 miles away to be closer to family. But that can also lead to a disconnection because they don’t know anybody in that area, and they’re very dependent on family coming to visit them. In their own area, then that sense of connection can be easier think to maintain the objects that represent in that community, then that’s going to help us a sense of connection.

Lori Pinkerton Rolet

Right? And this the word connection you’ve used several times in our in our discussion, and I’d like to kind of end on that point as well. One you raised it earlier that it’s about people feeling connected feeling, you know, seeing who’s coming in and out, having engagement with the wider community or use the example of you know, the children outside. And there was a bit of information in your paper that there was an Irish study, which compared a’ quote unquote’, traditional nursing unit with a more ’home‘ model, where people were very interactively occupied. Yeah. And I found it absolutely startling that when they compared the nutritional intake between people in a more traditional nursing unit and more of a homelike unit, there was more intake, people were eating better in a more homely environment, actually, there was a physical manifestation of that environment. And your conclusion, which related to a piece of research by Heathcote was this idea of dwelling is both a place and a process. Could you just speak to that just a little bit more to end on because I think this is really sort of a broad overriding principle of your work, as I saw it.

Dr. Anne Fleming

I was kind of surprised that you found that surprising. What they have done in the more home like you know, was developed the role of a homemaker. They were there to support people in food preparation, baking scones, or making a meal. Like people again, can choose what level of participation they had. But if you’re involved in that food preparation, think of all the sensory stimulation that is going to be promoting appetite. So you’ve got the visual stimulation, you’ve got the olfactory stimulation, you’ve come under new smells, you’ve got tactile stimulation, if they’re helping with the preparation, you’ve got aural as in hearing, because you can hear the (unknown phrase) or whatever. And then you’ve got a little as a taste if you’re tasting the cheese as you go along. And all of that plus the reminiscing that goes on and all I like this, that’s going to stimulate your appetite, much more than just sitting at a table and having a meal put in front of you.

Lori Pinkerton Rolet

And you have responsibility. Because when you’re at home, in your own home, there are things you need to do. There are things you need to take responsibility for. And some of the care homes, certainly that I’ve been to, everything is done for you. You don’t even have, you don’t have a purpose except to get through the day. And you might attend an activity. but you’re not engaged. Is that right?

Dr. Anne Fleming

Absolutely. And a lot of people living on their own, can see yourself, it’s tedious. And keep that from eating that (same thing) for three days. It’s kind of de-motivating. If you’re doing it, eating is very much a social activity. That is why we all like to go for a nice meal, plus the fact and gratefulness and you don’t have to cook or wash up. It’s a fairly social thing to do, or ‘how’s your meal?’ ‘Do you want to try this?‘ So, I think if we can maintain that socialisation and the process, again is going to stimulate reminiscence participation, it’s going to improve self-esteem. If you’ve contributed as at one home, the chef was helping some ladies make marmalade, Seville oranges, which was wonderful. And they were so proud. We’ll be having that marmalade– that we need to think that confidence can be lost if you don’t have the responsibility to do things anymore.

Lori Pinkerton Rolet

And where would you stand then on laundries, for certain types of items that that people can do themselves rather than going through the laundry service? Is that another opportunity?

Dr. Anne Fleming

Particularly for personal items, maybe like heavy loads of sheets, towels, and such (done for you). Like a family for personal life. And lots of places do have that option.

Lori Pinkerton Rolet

Yes. And I’ve always thought that was it was nice, again, to have that option and to kind of use it or lose it mentality that yeah, you know, it’s you take responsibility for yourself by doing things and also you meet others around the dryer and have a chat, you know, it becomes a social stimulation as well.

I cannot thank you enough. And I have a link to your work, people will need to download, and get engaged with an academic portal. But we’re giving the links for people to look into this in greater detail. It’s a really important background information with some wonderful conclusions that you’ve drawn and appreciate the work and appreciate your time with us today. Thank you.

We’re focusing on the Land of Oz this month. It’s blessed with months of great weather. It does have the occasional deadly poisonous critter, but other than that, Australia seems like the perfect place to retire. So this month, we’re looking at their initiatives towards retirement living, and unsurprisingly, it’s been rather easy for one to come to our attention as this month’s ‘Hats Off’ feature. The publication “Best Practice Principles for Senior Community Design” has been issued online in conjunction with the Property Council of Australia, and the well-known Australian, pan-Asian architectural practice Thompson Addset. This is an exemplary document highlighting the central need for community and diversity in the culture of senior communities. This goes back to exactly our interview earlier today. It states that the main driver of social connectedness and linkages is inclusion without barriers that isolate residents from their village neighbourhood or the broader community. Exactly what Anne Fleming was talking about. I can’t recommend this report highly enough. And you’ll find the full report via the resources link to this podcast at www.Third Age.Design.

And today, our ’Innovation Spotlight’ shines on the University of Queensland and DMA Engineers. Together they put on an award-winning charette entitled ‘Reimagining Aged Care in a Post-Pandemic Era.’ How timely! This annual charette pulls together designers, innovators, and planners to discuss how to create change. The University of Queensland Director of the healthy ageing initiative, Professor Laurie Beys says “The biggest challenge for care is how we think about the design. There are many fundamental structures that need to be changed. And really what’s holding us back is our imagination and our willingness to change the assumption and to create a different future.” You’ll find more about this creative initiative at the resources link on this podcast at www. ThirdAge (dot) Design. And remember, if you hit ‘join’ while you’re there, you’ll automatically receive our exclusive Home Safety Checklist for the Third Age.

Just a quick look then at our TAD International Events Calendar. Some events are in person, some are also available online. So please check the website to see what’s been added recently, and what your options are. But I’d like to highlight the Retirement Industry Conference taking place at the Boston Park Plaza Hotel in Boston, Massachusetts, in the United States from the 11th to the 13th of May. June 15 to the 17th-we’ll find the second European Conference on Ageing and Gerontology or E Gen 20 which is a lot easier to say, taking place at the Institute of Education, University College London, UK, where the built environment is featured among the topics. And the fifth annual Future of Aged Care Summit 2022 will be held at the Sofitel Sydney, Australia from the 15th to the 17th of June. You’ll find more about international shows and conferences on the Events page at ThirdAge (dot) Design, and drop us a line via the Contact page if you have an event you’d like to see listed there.

Thank you to my guest, Dr. Anne Fleming, to our amazing producer Mike Scales for putting up with me, Valerie Adler of The Right Website. To Peter Thorne, who composed our theme music and is playing the piano with Mary Blanchett on flute. And finally, to you. Thank you for being part of a community who believes we can improve senior environments together by sharing information. I’m Lori Pinkerton-Rolet, and I hope you’ll join me for the next one!

Listen to this podcast and get links and resources HERE.

S2E3 Transcript: Developing an Ideology of “Home”