The listening for TPN took many years and included an extensive process of visiting all parts of the Lands to talk through the issues. An Aged Care Steering committee comprising NHC, the NPY Women’s Council and the AP Council was established and consultation was undertaken over six months with older people, their carers, clinic staff, community councils and women’s centres. Up to 50 Anangu attended, travelling hundreds of kilometres to participate in steering committee meetings.
Site selection was a key. The selection of the site and its cultural and spiritual significance were seen as much more important than the design of the facility itself.
It was important that the site was a place where all Anangu could feel welcome, recognizing that people will come from all parts of the Lands (which cover approx. 105,000 square kilometres) and so for many people TPN will be on someone else’s country. The consultation also included making an inventory of all the things that were required to make the facility work in each community, such as good power supply, good water supply, access to a health clinic, staff, good roads, a (food) store and an airstrip [2].
The team led by Paul Pholeros worked with Anangu to create a place that would be meaningful for them.
Having met with Anangu and APY Lands based aged care workers and explored what the design principles could mean in that place, the architects designed in response to these people in this context. The first thing to consider were questions which focused on what older Anangu want to do, what is important to them, their experiences, what they are able to do and their expectations. Anangu said that they wanted to participate in cultural business, travel, hunt and gather, teach young Anangu, visit their traditional country, attend funerals and conduct sorry business.
They wished to maintain family and community links, socialize, practice traditional arts (such as making artefacts, basket weaving and painting), sing, dance and tell stories, and sit by the fire with other Anangu. They said that it was important that they have shelter from the elements (of extreme heat, extreme cold, dust and rain), have sheltered shady places to sit with a view, have good food including bush tucker, feel safe and have secure storage for their belongings.
As we listened, we learned that Anangu expect to go outside no matter how sick they are and be able to lie near fires and live close to or on the ground. Anangu can live happily with very few belongings. While everything and everyone comes and goes from the building, it is not the focus but rather a place for storing things and retreating to in times of bad weather. It is
important that there can be separation between men and women and that family/social relationships which require distance between people can be respected. It is also necessary to be able to make a sorry camp, a place where people can move to and from when a person dies. It was apparent that while Anangu are more agile than other frail older people (seen for example in the way they climb into the back of vehicles and sit on the ground for hours) they are chronically ill with diseases such as diabetes, kidney, respiratory, skin, eye and heart disease and mobility problems.
Having gained a greater understanding of these ‘big picture’ questions, it was important to determine which aspects of the Fleming-Bennett design principles (highlighted in italics below) were most relevant when designing for older people on the APY Lands, and what the most appropriate response to these principles was.
Providing a fence around the site was an important part of unobtrusively reducing risk. Fences are seen as a positive thing on the APY Lands, perhaps in a similar way people from other cultures may view the wall of a living room. The fence prevents residents at TPN leaving and non-residents coming to TPN uninvited.
It also identifies this place as the older person’s place, thereby offering them peace and security. Anangu have an interesting appreciation of scale as they live with the vastness of the landscape and the smallness of a wiltja (traditional outdoor shelter). TPN is a small facility that has then been broken up into a number of small buildings. The buildings are designed to be small objects in a vast landscape, rather than be a significant presence. Anangu have a clear view of the places that are of interest and importance to them and so can choose where they wish to go. Stimulation is managed.
There are two circulation systems: a ‘front of house’ way for residents and a ‘back of house’ route for staff. This allows residents to be undisturbed by the servicing and operation of the building, and instead to focus on the areas that are of interest to them such as a bedroom unit and the living/dining room. For many Anangu it will be the outdoor environment which will offer the most meaningful stimulation and cues. Rocks, views, mountains and fire are all likely to assist wayfinding and orientation.
As a person moves around TPN there are constant views and engagement with the outdoor environment.
The outdoor environment is deliberately free from paths, and instead remains in a more natural state so people are able to move about outside following their own routes and creating new ways as appropriate. For Anangu, outdoor shelters (wiltjas) are a very familiar part of their lives. The outdoor environment was designed for these to be introduced and removed as appropriate over time. Rooms were designed to be of
a size that is familiar to Anangu, recognizing that they are used to being inside in a small space or outside in big country. The ensuite layout is similar to the layout of bathrooms in houses on the Lands. There are many ways people can be with others or alone at TPN. This recognised that much of life in Indigenous communities is lived in public. On the other hand, privacy between different skin groups and genders is very important.
The relationship between TPN and the community is best reflected in the selection of the site itself. Despite older Anangu’s strong desire to take part in the life of the Lands, it was seen as very important that older people were given a quiet place to live, away from the noise and humbug (or bother) of the community. For Anangu supporting movement and engagement means having easy access to the outdoors and being able to sit around, eat outside, sleep outside, and see the surrounding country with adequate shade and shelter. It means having access to fire to make a cup of tea, make a spear, to cook, to make artefacts, to keep spirits away, to provide warmth and to dance and sing. It means having a fire that can be moved during the day to suit the sun and wind.
Indigenous Aged Care Design Guide
Some years after completing Tjilpi Pampaku Ngura TPN, Paul Pholeros was commissioned by the Commonwealth Government to write an Indigenous Aged Care Design Guide (referred to hereafter as ‘the Guide’). Paul gathered the team who had worked on TPN together to create the Guide to assist in the design, construction, ongoing assessment and maintenance of aged care facilities for Aboriginal and Torres Strait Islander peoples. Paul’s work on the National Indigenous Housing Guide, in his role as Manager of Healthabitat, was fundamental to his appointment, as was the successful creation of TPN. The team (Paul Pholeros, Kirsty Bennett, Adrian Welke and Maureen Arch) made a key decision early in the project to organise the Indigenous Aged Care Design Guide around the Fleming-Bennett design principles [3]. These principles were chosen because they are evidence based, and widely accepted in ‘mainstream’ aged care.
The focus on evidence that informed the principles resonated strongly with the Paul’s work on the National Indigenous Housing Guide [4] and the use of these principles also encouraged connections to be made with the aged care sector as a whole, rather than treating Indigenous aged care as a completely separate field.
One of the small buildings of TPN
While the Fleming-Bennett principles were articulated to help respond to the needs of people living with
dementia, it was recognised that a building designed according to these principles provides a positive environment for all older people, staff and visitors.
The team identified that for the Guide to be most effective, it should assist people to create environments according to the design principles, rather than present ready-made solutions. This is significant. It is not a guide that assists designers and operators to replicate TPN.
TPN is a particular design response, for a particular community, geographical context, and time. The Guide provides information to help users apply the principles in a range of settings and communities. By taking a principles based approach, it was possible to produce a guide which could be used amidst the incredible diversity of Indigenous communities, in different contexts across Australia, from the central desert, to suburbia, inner city and the Gulf of Carpentaria.
I had seen the strength of a principles based approach (rather than a solution driven one) when I worked on a project in Alice Springs, NT in the mid 1990s. I was
told by the client that every part of the building was to be suitable for an Indigenous or non-Indigenous older person. At the start of the project, I spent months consulting with a range of people in and around Alice Springs. I visited Town Camps, met with local Indigenous Councils, senior citizens, and the older people who were already living in cottages on the site. One thing that came up repeatedly was the importance of cooking in people’s lives. While cooking was a common theme, the way people cooked was, however, quite different. For some people, a domestic kitchen was what they looked for. For others, it was a campfire, a chance to be outside and gather around. So we provided both.
When the time came for government approvals, I met with local departmental representatives from Territory Health to answer some questions. One related to the placement of the kitchen in the design. They argued it was well known that a kitchen needed to be the hub of aged care, and so they were concerned that it did not occupy a central position in our design. My response was to go back to the design principles. I explained that the reason a kitchen was important was because cooking was a priority in a person’s way of life, and so it needed to be familiar, and support engagement if it was to be meaningful. Placing the kitchen centrally in the building would work for some people, but not everyone.
The thing the residents would have in common was food preparation. The way they did it, what they ate, and where they liked to eat would vary greatly according to culture and lifestyle.
And so in our design when residents left their bedrooms they had a choice: ‘Do I go outside to the campfire?’ or
‘Do I go along the short corridor to the kitchen?’. Both were easy to see. The residents could choose where they wanted to go and what they wanted to do. The design responded to the principles, rather than turning to a solution that had been successful elsewhere, in a different culture and context.
In addition to providing design guidance, the Guide also includes an assessment tool. An Environmental Assessment Tool (EAT) had been created by Richard Fleming, Ian Forbes and Kirsty Bennett some years before to support the use and application of the principles in a systematic way [5]. Using that tool as a starting point, the team looked to create a tool that responded specifically to Indigenous older people’s needs. The Indigenous EAT is organised around the Fleming-Bennett principles. Existing EAT questions were reviewed. Questions were adapted where appropriate, and new ones were introduced to respond to particular needs and foci that were identified [3].
Front Cover of the Indigenous Aged Care Design Guide