Community Care Ecosystems: A Universal Design Approach to Delivering Aged Care at Home

As health and aged care systems rapidly shift toward community-based models, the home has become the primary, yet least safeguarded, site of care delivery. While universal design has made substantial contributions to housing, public space, products, and transport, all important components of a community-based aged care system, this body of work has been organised predominantly around the independent individual, whether ageing or living with disability, whose autonomy is the design target. Less attention has been paid to how environments, including the home, are co-used by paid and unpaid caregivers, and to how care is actually delivered in, between, and around these spaces. The perspectives of aged care staff, who deliver aged care in, and also move between, homes are a valuable resource in understanding how to improve the sustainability of community aged care delivery. This study focuses on the experiences of Australian aged care workers as a critical lens for understanding the home as part of a community care ecosystem. This ecosystem extends beyond the dwelling to include urban contexts, care recipients, and paid and unpaid caregivers, alongside the spatial, material, neighbourhood, and policy conditions that shape care delivery. Environmental, social, and policy factors, including housing design, accessibility, neighbourhood context, and service and funding structures, collectively shape care outcomes and the capacity for older people to remain at home [5-7]. This paper presents exploratory, first-stage findings from a qualitative, practice-informed study. It draws on interviews with 20 aged care staff, including personal care workers and domestic assistance workers, working across two Australian states. From these findings, the paper develops a conceptual framework that positions universal design as a lens for understanding the delivery and organisation of aged care across multiple scales, from bathrooms, houses and gardens to streetscapes, neighbourhoods and precincts. Findings reveal how care delivery is shaped by a complex interplay of factors across these scales: within the home, staff report navigating inaccessible bathrooms, unhappy family members, hoarding conditions, and thermal extremes; beyond the dwelling, fragmented schedules and neighbourhood transport conditions shape the feasibility of care, while staff themselves facilitate older people's mobility and community participation. This paper argues that universal design offers a useful lens through which to interpret the multiple spaces and scales that constitute community care environments and practices, contributing a multi-scalar universal design perspective grounded in the realities of care delivery, with practical and policy-relevant insights for a more effective, equitable, and sustainable community-based aged care sector.