Study limitations and future research

While this study focused on lived experiences in Australian RACFs, it also made clear the symbiotic relationship between people, philosophy of care, and building design that is often overlooked in research especially by non-architects.

As discussed in Chapter 3, with the majority of existing research on RACFs situated in the fields of nursing, gerontology and environmental psychology, there is limited understanding of the role that design and building procurement processes play in supporting the lived experiences of residents, their families and staff. Van Hoof et al. (2014) and Devlin and Arneill (2003) identified a gap between the world of researchers and the domain of design and construction, which may in part be due to the dearth of RACF research undertaken by architects. This study interrogated issues of compliance and design constraints, briefing processes and the design language engaged during briefing and how the focus on safety and functionality negatively impacted wellbeing and overlooked lived experiences. Further research is required, ideally with multi-disciplinary research teams, including architecture academics and practitioners.

The limitations of a single case study are that it is only one spatial configuration, organisational culture, and a specific demographic, making generalisation difficult. Consequently, comparative studies of RACFs with different types, sizes, and spatial configurations and layouts may be useful. While I agree with Torrington (2007) and Chaudhury et al. (2013) that a mixed method approach may afford additional knowledge, it is critical that people with dementia are directly involved.

Research to date for people with dementia has focussed on Dementia Care Units (DCUs) and

identified small-scaled RACFs as best practice. Typical Australian RACFs, however, have over 60 beds with 50 to 80% of residents with a diagnosis of dementia. The efficacy of this model requires further research. Critically, research should explore how a sense of ‘at-homeness’ can be achieved for people with dementia in larger RACFs.

Lived experiences and the impact of the built environment may have some variation between different types of dementia. While this was not apparent nor within the scope of this study, and research to date is about dementia generally, future researchers could investigate if people with specific dementia diagnoses such as Alzheimer’s disease, vascular dementia, or Lewy Bodies have different environmental responses.

Longleaf was located in a relatively wealthy capital city suburb with the majority of residents having lived previously within a few suburbs of the RACF. Many had adult children and spouses living within visiting distance and family participants were among the most engaged families in the wing. Findings are likely to vary in rural and regional settings with different community demographics.

Future research should include more culturally diverse populations than the predominantly white Anglo-Saxon participants in this study. Further, notions such as being ‘at-home’, as well as rituals of death and attitudes about ageing, dementia, and dying are likely to vary across different social demographics, nationalities and possibly gender.

Future studies may also consider exploring differences in lived experiences between typical and less typical RACFs, such as high-end or small, privately owned and government operated RACFs with diverse staffing ratios and organisational cultures.

This study was limited to 10 months with residents in the later stages of their illness and provided a general overview of the RACF. There is little understanding of the phenomenology of specific spaces such as the ideal bedroom for dying or lived experiences of bathrooms. Briefly discussed issues in this study such as territory, privacy, and room personalisation would benefit from more detailed research. Specific studies of the family needs and the benefits of accommodating them and different possibilities for supporting death and body removal would add to our understanding. This study identified that there are mixed views on the advantages of single and shared rooms and that needs may vary over time. Longitudinal studies about changing requirements from the point of admission up until death are suggested.

Although I have touched on concepts of a ‘good death’, due to the paucity of research about end-of- life experiences, it may even be that what constitutes a ‘good death’ differs in RACFs from other settings. Further research is required about death and dying experiences in RACFs including comparisons with the experiences of families when their relative is transferred to die in hospital. Including the perspective of bereaved families may provide insight into individual interpretations of ‘good’ deaths.

Each of the core phenomenological concepts of humans’ fundamental need to ‘dwell’, to feel that they belong and a sense of connectedness with self, others, place, and the world are briefly touched on in this overview study. Further studies that focus on each of these phenomenological concepts would provide deeper understandings.

While I have made recommendations for design improvements in Chapter 8, there was no scope in this project to incorporate and then assess before and after changes to the environment. Future interventionist research, including the improvements recommended in Chapter 8, would provide valuable comparative studies.

The similarity of the design of Longleaf to many typical RACFs that are relatively unchanged in concept since the 1980s suggests it was designed without consideration of current research or knowledge of ‘best practice’, changing community expectations and demographics, and other complexities and subtleties of designing for people with late-stage dementia. While Fleming et al. (2012) move some way towards understanding why dementia design principles are not applied in RACF design, further research about research translation is recommended. I agree with Sloane Devlin (2008) that architectural practitioners have difficulties accessing, and perhaps understanding, academic journals, suggesting that research findings need to be more accessible for the broader community.