Homes In Melbourne Research Articles

The “Dream Weekend”: Feminism and the Domestic Interior at the Merchant Builders’ Display Home (1977)

ABSTRACT In 1977 the North American feminist artist Lynn Hershman conducted a three-day installation and performance piece titled “The Dream Weekend” at a Merchant Builders’ display home in Melbourne’s Vermont Park. The site-specific installation explored the aspirations and realities of the dream home through the staging of the life of a suburban woman in states of girlhood, confinement, and escape. Using new archival material, this paper documents Hershman’s project, exploring how a sharp feminist critique of the normative ideologies of the domestic interior was able to be staged and accommodated within the display home. Examining unpublished correspondence between the artist, the curators and personnel from Merchant Builders, this paper analyses the differing perspectives each brought to concepts of Australian suburbia and the progressive Merchant Builders’ home. It documents the conspicuously cosmopolitan and eclectically furnished interiors designed and styled by Nexus, a subsidiary interior design company of Merchant Builders. We argue that the Merchant Builder homes and interiors expressed new late twentieth-century subjectivities emerging from heightened environmental consciousness and individual identity. The complexities of the artwork’s siting drew out the complications, tensions, and collisions of this encounter between a progressive housing company and the feminist rejection of the suburban home.

Access to a dementia-friendly garden on behavioural and psychological symptoms of dementia, falls and psychotropic medication use in residents of an aged care home in Melbourne, Australia.

Residents of care homes need access to outdoors. This may improve behavioural and psychological symptoms of dementia (BPSD) and quality of life in residents living with dementia. Barriers including lack of accessibility and increased falls risk, which may be mitigated using dementia-friendly design. This prospective cohort study followed a group of residents in the first 6 months after the opening of a new dementia-friendly garden. Nineteen residents participated. The Neuropsychiatric Inventory - Nursing Home Version (NPI-NH) and psychotropic medication use were collected at baseline, 3 and 6 months. The facility's falls rate during this time and feedback from staff and residents' next of kin were collected. Total NPI-NH scores decreased, though not significantly. Feedback was positive overall; the falls rate decreased. Usage of the garden was low. Despite its limitations, this pilot study adds to the literature about the importance of access to the outdoors for people who are experiencing BPSD. Staff remain concerned about falls risk despite the dementia-friendly design, and many residents do not access outdoors frequently. Further education may help to remove barriers to encouraging residents to access the outdoors.

Trajectory and Predictors of Mental Health Symptoms and Wellbeing in Newly Admitted Nursing Home Residents

ABSTRACT Objectives This study determined changes in multiple aspects of mental health and wellbeing in newly admitted nursing home residents, and identified risk and protective factors. Methods Participants were 204 residents recently admitted to one of 42 nursing homes in Melbourne, Australia. A subgroup of 82 participants were followed up eight months post-admission. Depression, anxiety, stress, adjustment, and quality of life were assessed at baseline and follow-up. Predictive factors (demographics, health, transition factors, nursing home characteristics) were examined in multiple regression analyses. Results Rates of depression and anxiety were high at both baseline and follow-up. Low self-rated health and medical comorbidity predicted poor wellbeing at baseline. Higher perceived control in the relocation to the nursing home and engagement in meaningful activities were associated with better post-admission outcomes. Baseline psychotropic medication use predicted lower anxiety at follow-up but did not impact depressive symptoms. Conclusions There were no significant changes in mental health and wellbeing from one to eight months post-admission. The negative effect of residing in a for-profit nursing home requires further investigation. Clinical Implications Individual activity scheduling and an opportunity to participate in relocation decision-making and planning may support resident wellbeing post-admission.

Advance Care Planning Practices in the Nursing Home Setting: A Secondary Analysis.

Advance care planning is intended to support residents' preferences regarding health decisions, even when they can no longer participate. Little is known about the power discourses influencing how residents, family members, and health care workers engage in advance care planning and how advance care directives are used if a conflict arises. A large critical ethnographic study was conducted exploring decision making when a resident's health deteriorates in the nursing home setting. Advance care planning practices were not the focus of the original study, but the richness of the data warranted further exploration. A new research question was developed to inform a secondary analysis: How does advance care planning influence the relationship between resident values and clinical expertise when determining a direction of care at the time of a resident deterioration? A secondary analysis of data from an ethnographic study involving 184 h of participatory observation, 40 semistructured interviews and advance care planning policies, and document review undertaken in two nursing homes in Melbourne, Australia. Advance care planning may result in inaccurate documentation of residents' preferences and devalue clinical decision making and communication with residents and family members at the time of deterioration. Advance care planning may contribute toward a reductionist approach to decision making. There is an urgent need for the development of evidence-based policy and legislation to support residents, families, and health care workers to make appropriate decisions, including withholding invasive treatment when a resident deteriorates.

The effectiveness of the Program to Enhance Adjustment to Residential Living (PEARL) in reducing depression in newly admitted nursing home residents

Background: Depression is common in nursing homes, particularly among newly admitted residents. This cluster randomised controlled trial evaluated the effectiveness of the Program to Enhance Adjustment to Residential Living (PEARL) in reducing depression in this group.Methods: Participants were 219 newly-admitted residents (mean of 4.4 weeks since admission) in 42 nursing homes in Melbourne, Australia, with a mean age of 85.5 years (SD = 7.3). Nursing homes were randomly allocated to the intervention or standard care condition. Level of depressive symptoms was evaluated at baseline (T1), one week post- intervention (T2), 2 months post-intervention (T3, primary end point), and 6 months post-intervention (T4). Changes in depressive symptoms in the intervention and control groups over time were compared using a multilevel model, with nursing homes modelled as random intercept.Results: In intention to treat analyses, depressive symptoms reduced from T1 to T3 to a greater degree in the intervention condition (Mchange=2.56, SDchange=5.71) than in the control (Mchange=0.63, SDchange=5.25), with a significant, small-medium treatment effect size (p=.035; Cohen's d=0.36). The reduction in depressive symptoms from T1 to T4 was not significant (p=.369; Cohen's d=0.32).Limitations: The findings require replication, particularly comparing PEARL with an active control condition.Conclusions: PEARL is a simple, brief program that was effective in reducing symptoms of depression in newly admitted nursing home residents.

329 - A psychological needs-based intervention to reduce depression in newly admitted nursing home residents

Background:Depression is common in nursing homes, with newly admitted residents at a particularly high risk. Current prevention and treatment approaches have failed to impact on the high rates of depression and new approaches are required. We have developed a novel intervention that addresses individual psychological needs in newly admitted residents, which is implemented in collaboration with residents and facility staff. The Program to Enhance Adjustment to Residential Living (PEARL) is a 5-session intervention based on Self-Determination Theory that aims to tailor care to enhance residents’ autonomy, competence and relations.Methods:A cluster randomised controlled trial was conducted to determine the effectiveness of PEARL in reducing depression in newly admitted nursing home residents, compared to a treatment as usual control condition. A total of 216 residents with normal cognition or mild-moderate cognitive impairment, living in 42 nursing homes in Melbourne, Australia, participated in the study. The sample included 76 men and 140 women, aged 62-99 years (M = 85.5, SD = 7.3). The primary outcome was level of depressive symptoms, assessed using the Cornell Scale for Depression in Dementia at baseline and at 8, 16 (primary endpoint), and 31 weeks follow-up. Multi-level modelling, accounting for within-facility clustering and repeated assessments, was used to determine the effectiveness of the intervention, employing an intention-to-treat approach.Results:At 16-weeks, fewer symptoms of depression were observed among those in the intervention group (M = 7.0, SD = 5.6) than in the control group (M = 8.6, SD = 6.5). Multi-level modelling of unadjusted data showed a significant condition (intervention, control) by time (T1, T2, T3) interaction (p = .021), indicating that the PEARL intervention led to a reduction in the occurrence of depressive symptoms. The treatment effect was maintained at 31 weeks follow-up (p = .004).Discussion:This study provides evidence that an intervention designed to address newly admitted residents’ individual psychological needs reduced symptoms of depression in subsequent months. This brief, simple intervention may be suitable for broad implementation across long-term care settings. However, future research to determine if the intervention can be implemented by trained facility staff in situ is warranted.

A randomised controlled trial of nasal decongestant to treat obstructive sleep apnoea in people with cervical spinal cord injury.

Prospective, double-blind, randomised, placebo-controlled, cross-over trial of nasal decongestion in tetraplegia. Tetraplegia is complicated by severe, predominantly obstructive, sleep apnoea. First-line therapy for obstructive sleep apnoea is nasal continuous positive airway pressure, but this is poorly tolerated. High nasal resistance associated with unopposed parasympathetic activation of the upper airway contributes to poor adherence. This preliminary study tested whether reducing nasal decongestion improved sleep. Participants' homes in Melbourne and Sydney, Australia. Two sleep studies were performed in participants' homes separated by 1 week. Participants were given a nasal spray (0.5 mL of 5% phenylephrine or placebo) in random order and posterior nasal resistance measured immediately. Outcomes included sleep apnoea severity, perceived nasal congestion, sleep quality and oxygenation during sleep. Twelve middle-aged (average (SD) 52 (12) years) overweight (body mass index 25.3 (6.7) kg/m2) men (C4-6, AIS A and B) participated. Nasal resistance was reduced following administration of phenylephrine (p = 0.02; mean between treatment group difference -5.20: 95% confidence interval -9.09, -1.32 cmH2O/L/s). No differences were observed in the apnoea hypopnoea index (p = 0.15; -6.37: -33.3, 20.6 events/h), total sleep time (p = 0.49; -1.33: -51.8, 49.1 min), REM sleep% (p = 0.50; 2.37: -5.6, 10.3), arousal index (p = 0.76; 1.15: -17.45, 19.75), 4% oxygen desaturation index (p = 0.88; 0.63: -23.5, 24.7 events/h), or the percentage of mouth breathing events (p = 0.4; -8.07: -29.2, 13.0) between treatments. The apnoea hypopnoea index did differ between groups, however, all except one participant had proportionally more hypopnoeas than apnoeas during sleep after decongestion. These preliminary data found that phenylephrine acutely reduced nasal resistance but did not significantly change sleep-disordered breathing severity.

Domesticity On-Demand: The Architectural and Urban Implications of Airbnb in Melbourne, Australia

The home-sharing platform, Airbnb, is disrupting the social and spatial dynamics of cities. While there is a growing body of literature examining the effects of Airbnb on housing supply in first-world, urban environments, impacts on dwellings and dwelling typologies remain underexplored. This research paper investigates the implications of “on-demand domesticity” in Australia’s second largest city, Melbourne, where the uptake of Airbnb has been enthusiastic, rapid, and unregulated. In contrast to Airbnb’s opportunistic use of existing housing stock in other global cities, the rise of short-term holiday rentals and the construction of new homes in Melbourne has been more symbiotic, perpetuating, and even driving housing models—with some confronting results. This paper highlights the challenges and opportunities that Airbnb presents for the domestic landscape of Melbourne, exposing loopholes and grey areas in the planning and building codes which have enabled peculiar domestic mutations to spring up in the city’s suburbs, catering exclusively to the sharing economy. Through an analysis of publically available spatial data, including GIS, architectural drawings, planning documents, and building and planning codes, this paper explores the spatial and ethical implications of this urban phenomenon. Ultimately arguing that the sharing economy may benefit from a spatial response if it presents a spatial problem, this paper proposes that strategic planning could assist in recalibrating and subverting the effects of global disruption in favor of local interests. Such a framework could limit the pernicious effects of Airbnb, while stimulating activity in areas in need of rejuvenation, representing a more nuanced, context-specific approach to policy and governance.

Relationship of thermal performance rating, summer indoor temperatures and cooling energy use in 107 homes in Melbourne, Australia

Better understanding is needed of building thermal performance as a mediator between climate and health outcomes. There is concern that current dwelling energy conservation strategies that focus on keeping warm in winter may lead to overheating and heat stress in summer or an increased use of cooling energy. Drawing on public health methodologies to predict heat related health outcomes, this study has standardised three-day averaged mean indoor to outdoor temperatures from 107 homes in Melbourne, Australia, to test the influence of the residential energy efficiency rating on the living room temperatures in summer. At the heat wave threshold of 25°C, on average, better rated 6-Star homes were 0.89°C warmer than 4- or 5-Star rated homes. At this reference temperature, air-conditioned 6-Star homes used 15.84kWh/day electric cooling energy more to achieve the same living room temperature as 3-Star rated homes. The findings confirm the results of simulation studies that found increased fabric insulation may be associated with increased summer indoor temperatures, risk of heat stress and cooling energy in a mild temperate climate. Hence, it is recommended that residential thermal performance ratings should evaluate the dwelling's performance for each season independently and that cooling through natural ventilation and shading be promoted.

Intelligent autonomous system for residential water end use classification: Autoflow

Over half of the world's population will live in urban areas in the next decade, which will impose significant pressure on water security. The advanced management of water resources and their consumption is pivotal to maintaining a sustainable water future. To contribute to this goal, the aim of this study was to develop an autonomous and intelligent system for residential water end-use classification that could interface with customers and water business managers via a user-friendly web-based application. Water flow data collected directly from smart water metres connected to dwellings includes both single (e.g., a shower event occurring alone) and combined (i.e., an event that comprises several overlapping single events) water end use events. The authors recently developed an intelligent application called Autoflow which served as a prototype tool to solve the complex problem of autonomously categorising residential water consumption data into a registry of single and combined events. However, this first prototype application achieved overall recognition accuracy of 85%, which is not sufficient for a commercial application. To improve this accuracy level, a larger dataset consisting of over 82,000 events from over 500 homes in Melbourne and South-east Queensland, Australia, were employed to derive a new single event recognition method employing a hybrid combination of Hidden Markov Model (HMM), Artificial Neural Networks (ANN) and the Dynamic Time Warping (DTW) algorithm. The classified single event registry was then used as the foundations of a sophisticated hybrid ANN–HMM combined event disaggregation module, which was able to strip apart concurrently occurring end use events. The new hybrid model's recognition accuracy ranged from 85.9% to 96.1% for single events and 81.8–91.5% for combined event disaggregation, which was a 4.9% and 8.0% improvement, respectively, when compared to the first prototype model. The developed Autoflow tool has far-reaching implications for enhanced urban water demand planning and management, sustained customer behaviour change through more granular water conservation awareness, and better customer satisfaction with water utility providers.

Quality mobility care in nursing homes: a model of moderating and mediating factors to guide intervention development.

The current qualitative study aimed to understand factors in mobility care to inform practice improvements. Data were collected at three nursing homes in Melbourne, Australia, via interviews with 10 senior staff and 15 residents, focus groups with 18 direct care staff, and observations of 46 mobility events. Thematic and content analysis of data occurred. Findings included factors (a) intrinsic to residents, (b) intrinsic to staff, and (c) extrinsic to residents and staff, such as equipment and organizational factors. A model describing associations between factors and their roles as moderators and mediators of resident mobility was generated. Staff assistance, residents' mobility effort, and equipment used during mobility were posited as complete or partial mediators of resident mobility outcomes. Barriers that may compromise the quality of mobility care in nursing homes emerged. The model provides direction for improvements in mobility care that integrate safety, mobility optimization, and person- and relationship-centered care.

Dental caries in Victorian nursing homes.

The poor oral health of nursing home residents is the cause of substantial morbidity and has major implications relating to health care policy. The aim of this study was to measure dental caries experience in Australians living in nursing homes, and investigate associations with resident characteristics. Clinical dental examinations were conducted on 243 residents from 19 nursing homes in Melbourne. Resident characteristics were obtained from nursing home records and interviews with residents, family and nursing home staff. Two dental examiners assessed coronal and root dental caries using standard ICDAS-II criteria. Residents were elderly, medically compromised and functionally impaired. Most required assistance with oral hygiene and professional dental care was rarely utilized. Residents had high rates of coronal and root caries, with a mean 2.8 teeth with untreated coronal caries and 5.0 root surfaces with untreated root caries. Functional impairment and irregular professional dental care were associated with higher rates of untreated tooth decay. There were no significant associations with medical conditions or the number of medications taken. Nursing home residents have high levels of untreated coronal and root caries, particularly those with high needs due to functional impairment but poor access to professional services.

Survey of residential power-frequency magnetic fields in Melbourne, Australia.

Pooled analyses of epidemiological studies have reported an association between prolonged residential exposure to power-frequency magnetic fields of >0.4 μT and an increased risk in childhood leukaemia. In order to compare residential magnetic fields in Australia with those in other countries, a survey was conducted in 296 randomly selected homes in Melbourne. Magnetic fields were assessed by performing spot measurements throughout the house and 24-h measurements in rooms where children spend large amounts of time. Children's exposure in Australia was generally comparable with that in other countries with average fields of 0.05-0.06 μT (95 % CI 0.05-0.06 μT). Prolonged exposure of >0.4 μT was shown in ∼2 % of the homes (95 % CI 0.2-3.6 %) mainly being due to close proximity of the house to transmission lines. Based on the results of this survey, the public health impact of a causal association between residential magnetic fields and childhood leukaemia is expected to be small.

The emergent relevance of care staff decision-making and situation awareness to mobility care in nursing homes: an ethnographic study.

To explore mobility care as provided by care staff in nursing homes. Care staff regularly assist residents with their mobility. Nurses are increasingly reliant on such staff to provide safe and quality mobility care. However, the nature of care staff decision-making when providing assistance has not been fully addressed in the literature. A focused ethnography. The study was conducted in four nursing homes in Melbourne, Australia. Non-participant observations of residents and staff in 2011. Focus groups with 18 nurses, care and lifestyle staff were conducted at three facilities in 2012. Thematic analysis was employed for focus groups and content analysis for observation data. Cognitive Continuum Theory and the notion of 'situation awareness' assisted data interpretation. Decision-making during mobility care emerged as a major theme. Using Cognitive Continuum Theory as a guide, nursing home staff's decision-making was described as ranging from system-aided, through resident- and peer-aided, to reflective and intuitive. Staff seemed aware of the need for resident-aided decision-making consistent with person-centred care. Habitual mobility care based on shared mental models occurred. It was noted that levels of situation awareness may vary among staff. Care staff may benefit from support via collaborative and reflective practice to develop decision-making skills, situation awareness and person-centred mobility care. Further research is required to explore the connection between staff's skills in mobility care and their decision-making competence as well as how these factors link to quality mobility care.

A Collaborative and integrated approach to mobility care in nursing homes

Objectives: Staff assistance during residents' mobility should be safe, meet residents' needs and provide residents with a positive experience that contributes to their quality of life [1, 2]. This project aimed to determine directions to integrate quality and safety within mobility care. Methodology: A critical, focused ethnography [3, 4], conducted in four nursing homes in Melbourne, Australia, included interviews with fifteen residents and eleven senior staff, twenty hours of observations of resident transfers in public areas, and three focus groups with eighteen care and lifestyle staff. A relationship-centred framework [5] was applied to two hypothetical cases. Discourses related to mobility care were analysed. Results: Residents valued independence and safety. Themes of residents' positive adaptation to mobility loss through motivation to remain mobile and acceptance of staff assistance emerged. Another theme was residents' acquiescence to loss of autonomy and control during mobility. Staff decision-making emerged as a theme from focus groups. Cognitive Continuum Theory (CCT) [6] was applied to these findings. Analysis of discourse highlighted conflicting messages regarding safety versus quality during mobility care. Conclusion: The Senses Framework and CCT provided directions for collaborative and integrated approaches to mobility care focused on shared decision-making, leadership and culture change.

‘I accept it [staff assistance]; no choice’: an ethnographic study of residents' attitudes towards mobility within nursing homes

Mobility contributes to the quality of life and independence of residents in nursing homes. To perform resident-centred mobility care, staff need to understand residents' physical capacity and perspectives of care. The aim of the study was to explore residents' perspectives of intrinsic factors influencing their mobility and associations between these factors with a view to informing resident mobility care practice improvements. The study was part of a larger ethnographic project exploring safe resident mobility care in nursing homes. Semi-structured interviews with nursing home residents supplemented by non-participant observations were conducted over a 20-month period from July 2010. Fifteen residents consented to be interviewed in three nursing homes in Melbourne, Australia. Unobtrusive observations of 46 mobility events took place in three nursing homes over 5 months from September, 2011. Participants identified intrinsic factors that influence their mobility including mobility capacity, strategies to cope with mobility loss, motivation and efforts to remain mobile. Three themes related to resident attitudes and responses to mobility loss emerged: acceptance of mobility loss and staff assistance; motivation to remain mobile; and acquiescence and loss of control during mobility events. A conceptual model developed from the study outlined associations between resident attitudes and mobility and quality of life outcomes. Discussion was framed by theories of ageing and adaptation: selection, optimisation and compensation; learned dependency; and learned helplessness. Resident acceptance of mobility loss, and required staff assistance and realistic determination to remain mobile contribute to residents' quality of life. Mobility care based on considerations of resident choice, autonomy and the value of mobility is important.

Understanding urban residential end uses of water

The 'end use' of water is a breakdown of the total household water usage such as water used for toilets, showers, washing machines, taps, lawn watering, etc. Understanding end uses of water will enable water planners, water authorities and household owners determine where water is used/wasted, how much and how often. This paper describes the end uses of water from a number of single-family homes in Greater Melbourne, Australia. The study involves the analysis of water consumption data recorded at 5-s intervals from logged households collected by Yarra Valley Water in Melbourne in 2004. The study determines how much water is used for outdoor and indoor purposes in a single-family home in Melbourne and compares the water usage during winter and summer. Hourly patterns of major end uses of water are also developed. The aim of this study is to improve the understanding of the end uses of water and to assist where to focus water conservation efforts that would be most effective financially and environmentally, and be acceptable to everyone.

Edentulism and dental caries in Victorian nursing homes

The aim of this project was to investigate edentulism and dental caries in nursing home residents in Victoria, Australia. The Australian population is ageing with a growing number of people living in nursing homes. These residents are at increased risk for dental caries, have more teeth present now than at any time in the past 50 years and often have difficulty maintaining adequate oral hygiene. Clinical dental examinations were conducted at 31 nursing homes in Melbourne and regional Victoria between May 2005 and June 2006. A total of 510 residents were examined out of 1345 eligible participants. Socio-demographic and medical history was collected via questionnaire. Just over half of the residents were dentate (53.9%), and dentate residents had a mean of 14.4 teeth present and 2.66 untreated decayed teeth. Residents who required total assistance with oral hygiene had more decayed teeth and fewer filled teeth than residents who did not require assistance. Nursing home residents in Victoria are retaining an increasing number of natural teeth and have more tooth surfaces at risk for dental caries. Untreated dental caries was a significant problem for residents, particularly for those who are dependent on others for their daily oral hygiene care.

Thermal Performance of the Cairnlea Ecohome – A Sustainble House

Sustainable housing is one of the many pathways to reduce the impacts of climate change. Among developed nations, Australia has made significant progress in this area. Legislative and financial incentives are in place. High quality rating tools were developed to measure and administer legislative requirements. There are a good number of demonstration homes across Australia to promote sustainable housing. The Ecohome was a demonstration home in Melbourne and a part of a multidisciplinary research team looking at sustainability and innovation in outer suburban residential developments. Assessment of thermal performance is a key component of outcomes of a sustainable house. In this emerging field, a set of thermal performance indicators are proposed and may be utilized when outside and inside temperature monitoring data is available. Key indicators include attenuation factor, time lag, percentage time in comfort zone, heating and cooling demand and degrees warmer. The Ecohome at Cairnlea in Melbourne was monitored during 2004 to 2006 for a total period of more than fourteen months. Thermal performance was assessed using these indicators.

Dwelling with Media Stuff: Latencies and Logics of Materiality in Four Australian Homes

Extending research into material, media, and cultural geographies of the home, our interest turns to the spatiotemporality of dwelling with information and communication technologies. We pose a number of questions: How do inhabitants and their media stuff adapt to the more rigid physical spaces of a building? How does the building respond to the more rapid changes to dwelling produced by this media stuff? And how are these differing times synchronised? In answer to these questions we present four case studies of homes in Melbourne, Australia, each representative of a particular strategy of synchronisation. They are: the found home, the imagined home, the designed home, and the renovated home. We identify logics informing these homes: the first naturalises the choices made, the second rationalises choices, and the third is one in which dwelling and (re)building are intertwined.