Site Location

Many ageing advocates argue that RLTC settings are in locations that sever connections between residents and their community, make inward and outward visiting harder, and make it difficult to integrate the setting with the community.

”The current practice of building nursing homes on green field sites outside villages and towns cuts residents off from community life and social interaction, and isolates those residing in them, thereby lessening their quality of life.
(Alone, 2018).

Anderson et al. (2020) note that a RLTC setting located within a residents’ home community may help with a continuity of self through continuity and connected-ness with place or community (Reed et al., 1998). Moreover, according to Christie (2020), a ‘sense of connectedness’ supports resilience in older people, particularly those living with dementia. This highlights the importance of location and connection to family, not only in terms of social interaction, but also in terms of a resident’s resilience and their ability to adapt to adversity.

“

Nothing easy about COVID and nursing homes! I live 10 away so initially when 2-5km rule was in place, I wasn’t able to visit my mother.
- Family member

“

We live within easy drive or walk if we’re stuck.
- Family member

“

The setting is located in [large town], which is approximately 25-30 minutes from [large city]. Families found the distance from [large city] long at times particularly if there is an elderly spouse driving. However, it is very convenient if you live locally.
- Staff

Key Findings

Visitor
access

Being located near to/within communities makes it easier for family members and visitors to access the setting; as such, it is important to consider site location when planning for and constructing new RLTC settings.

Amenity
access

Locating RLTC settings within existing communities, allows for easier inward and outward visiting, enabling residents to more easily access local amenities and strengthening settings ties with the local community.

Community
Engagement

More research is required to examine personal preferences of residents (in terms of their going out and about) and how site location can offer meaningful opportunities for improved engagement with the community.

Recommendations

Central Location

Settings that are located centrally within a community will benefit from proximity and access to the community, local amenities, services, local parks, green spaces, public transport and walking and cycling infrastructure.  

Connection and Engagement

Connection and engagement with the community also depends on how the setting is managed and operated.  At all times resident autonomy should be respected, and any community engagement should be appropriate to the resident and a matter of resident choice. 

Access to Amenities

When choosing a location for a new-build or repurposed RLTC setting, proximity to the community, services, public transport and ease of access should be considered.

Maximise Community Relationship

While redesign or retrofit projects cannot change the location of existing settings, careful consideration should be given to location to ensure that the setting is maximising its relationship with the community in terms of social interaction and inclusion in community life. Knowledge about the location and adjacent local community will also inform design and operational decisions around infection control and community interaction during a pandemic.  

Pleasant, safe, and accessible public realm

Providing a pleasant, safe, and accessible public realm with good walking and cycling routes, and easy access to public transport for residents, staff, and visitors (often older people) improves the quality of life for those in RLTC settings. This may be feasible or appropriate for urban settings, but many of these public realm issues should also be considered in villages, towns, and suburbs. While these issues are outside the scope of most retrofit projects, setting owners or managers should be aware of these issues and should liaise with the local authority to highlight these issues if required, and to request local improvements. In some circumstances, where a setting is located within a larger development, the setting may have greater influence over the design, management and maintenance of the local public realm and should use this influence to improve the safety, accessibility, and attractiveness of the public spaces adjacent to the setting.

good air quality

Air quality at a neighbourhood scale is a quality of life, infection control, and resilience issue. RLTC settings should be located within neighbourhoods or locations with good air quality. Local authorities or developers can help to improve local air quality by reducing vehicle traffic (i.e., low vehicle environments through greater active travel via walking and cycling infrastructure and public transport) to minimise vehicle related pollution, and control local harmful emissions.