RURAL SOLUTIONS FOR RURAL PEOPLE Creating an appropriate environment for rural Australians living with dementia Peter Birkett Andrea Dunlop

Conflict of Interest Disclosure Peter Birkett MBA, B.Comm.,R.M.,R.N. Andrea Dunlop M.Hlth.Sc.,B.App.Sc.(OT) Have no real or apparent conflicts of interest to report

Overview Charlie’s Story Policy Context in Australia Rural Inequity Harnessing Knowledge Werruna the Never Ending Environment

Charlie’s Story… Charlie is a 63 year old Australian farmer. Charlie has dementia. He is cared for by his wife Maggie. They are struggling in the absence of specialist support services. But where are they?

Policy Context in Australia First class health system 2006 National Framework for Action on Dementia Higher incidence of dementia in rural areas Limited access for rural and remote people Lowered rural life expectancy Mind the Rural Gap

…Charlie’s Story… Charlie deteriorates and now requires 24 hour care. Charlie must leave his farming home. But where does he go?

But Charlie is a risk when he drives. …Charlie’s Story… Charlie is calmer and less aggressive when he is outside in the paddock with his animals. But Charlie is a risk when he drives.

A Rural Solution Farming community need One third of residents with BPSD Organisational risk – Failure to provide Harnessing the community Avoiding constraints Our vision

Werruna A five year development of a secure rural residential environment for people with advanced dementia

Limitations from Yesterday Corridors & racetracks Small buildings Hidden facilities Vinyl floors Locked doors Glass offices ???

Environment is Important “A dwelling is much more than shelter. Ideally it should provide safety, refuge and accessibility, as well as a sense of belonging, purpose and wellbeing” (Satariano, 1995)

Farm spaces Meandering paths Lake & windmill Werrunadementia unit 10 places Existing Facility – 45 places

Position of bedrooms

Communal living space Central double sided open fire place Artist studio Glass conservatory Dining & activity space

Light Turrets Coloured light streams

Minimising Unnecessary Noise Internal feature brick work Elimination of corridors Rubber backed carpet – no vinyl Soft furnishings Soft closing doors Avoidance of public address system

Art for Wellbeing A purpose designed art space and a resident artist encourage alternative means of expression

Familiar Rural Origins Reflecting Familiar Rural Origins

…Charlie’s Story Charlie now has a choice. A rural option. Charlie now calls Werruna home.

A Rural Perspective Translating knowledge Fostering innovation Community responsiveness Farmers as health consumer Rural solutions

‘Rural people are entitled to have services that reflect the fabric of their life while maintaining connections with their families and local communities’ Charlie’s message…

Hesse Rural Health Winchelsea, Victoria, Australia www Hesse Rural Health Winchelsea, Victoria, Australia www.hesseruralhealth.org.au Peter Birkett and Andrea Dunlop