Obsolete Aged Care Models in Australia: The Shift from Institutional to Person-Centred Design
Australia's aged care sector has undergone profound transformation, driven by the Royal Commission into Aged Care Quality and Safety (2018–2021) and ongoing reforms under the new Aged Care Act 2024 and strengthened quality standards. Once dominated by large-scale, hospital-like facilities, the sector is moving away from obsolete institutional models toward inclusive, person-centred approaches that prioritize dignity, autonomy, and home-like environments. These changes align with universal design principles, eliminating barriers to access one step at a time and promoting participation interwoven into everyday life—for seniors, families, caregivers, and the broader community.
Obsolete models—characterized by centralized, task-oriented care in impersonal settings—are increasingly recognized as outdated, contributing to higher stress, reduced social interaction, and poorer well-being. In contrast, modern designs emphasize smaller household clusters, natural elements, and accessibility compliance with standards like AS 1428 and the National Construction Code (NCC), benefiting everyone from mothers with prams to delivery personnel through safer wayfinding, reduced trip hazards, and improved public spaces.
Characteristics of Obsolete Institutional Aged Care Models
Historically, Australian residential aged care relied on large-scale facilities resembling hospitals or institutions:
- Large-Scale, Centralized Layouts — Facilities housed dozens or hundreds of residents in long corridors with shared wards, prioritizing efficient care delivery over individual comfort.
- Task-Oriented, Medicalized Approach — Care focused on clinical routines, medication schedules, and compliance, often treating residents as patients rather than individuals with unique needs and histories.
- Limited Autonomy and Social Engagement — Rigid schedules, restricted movement, and minimal personalization led to isolation, agitation, and dependency.
- Institutional Aesthetics — Clinical lighting, uniform furnishings, and lack of natural elements created environments that felt impersonal and stressful.
These models, rooted in earlier policies like the Aged Care Act 1997, emphasized provider funding and operational efficiency over consumer rights. The Royal Commission highlighted substandard care, abuse risks, and systemic failures, exposing how institutional designs exacerbated issues like loneliness and reduced quality of life.
The Evolution to Modern, Person-Centred Models
Reforms have accelerated the shift to de-institutionalization and person-centred care:
- Household Model of Care — Small clusters of 8–15 residents sharing domestic spaces like kitchens, lounges, and gardens mimic home environments, reducing stress and encouraging autonomy.
- Home-Like and Biophilic Design — Emphasis on natural light, greenery, sensory gardens, and adaptable layouts supports cognitive health and emotional well-being.
- Rights-Based Framework — The new Aged Care Act reframes recipients as "individuals" with rights to dignity, choice, and tailored support, replacing provider-focused structures.
- Support at Home and Ageing in Place — Prioritizing community-based care over residential admission, with integrated services for independent living.
National Aged Care Design Principles and Guidelines advocate for small household models (15 or fewer residents) to achieve better outcomes at comparable costs. Evidence shows reduced restraint use, improved social interaction, and enhanced health in these settings.
Implications for Inclusive Design and Accessibility
Obsolete institutional models often ignored universal design, creating barriers like poor wayfinding, trip hazards, and limited outdoor access. Modern approaches integrate AS 1428 compliance, NDIS Specialist Disability Accommodation (SDA) principles, and adaptable housing (AS 4299), ensuring equitable built environments.
This benefits broader society: safer pedestrian paths, weather-protected walkways, better public transport access, and fewer traffic jams encourage neighborhood strolls, intergenerational interactions, and community connections. Older generations engage freely rather than feeling trapped, boosting national well-being.
Adapting Lessons for Malaysian Aged Care
Malaysia's emerging aged care sector—facing rapid population ageing and reliance on family caregiving—can learn from Australia's transition. Aligning with MS 1184:2014 Universal Design and UBBL By-Law 34A, hybrid models incorporating household principles, biophilic elements, and culturally sensitive features (e.g., prayer spaces, communal areas reflecting diverse ethnic norms) can reduce caregiver burden while honoring filial piety.
At AccessConsultants.asia, our qualified access consultants and architects—such as Alexandra (Sandy) Gray (expert in adaptable housing and training), Daniel Wong (specializing in inclusive senior design), Chong Yee Jean, Nur Syuhada, and Ahmad Syafiq (proficient in NDIS/SDA, NCC, and Malaysian submissions)—deliver expertise in bridging these best practices. We provide access audits, performance solutions, regulatory strategy for DBKL, JKM, and KPWKM submissions, and capacity-building workshops using real case studies to minimize risks and maximize inclusive outcomes.
Conclusion: Embracing Inclusive Futures in Aged Care
Australia's move away from obsolete institutional models toward person-centred, household-based designs demonstrates how eliminating barriers creates fairer societies. People with disabilities have families and networks too, and who doesn’t want more customers? By removing access obstacles, we promote participation interwoven into everyday life—a true smart city initiative.
For expert guidance on transitioning to inclusive, accessible aged care housing in Malaysia, Sydney, or our emerging Perth market, contact AccessConsultants.asia today. Let's eliminate barriers one step at a time and build equitable built environments together.