Aged care expert Janine Grossman shares her insights on designing supportive, person-centred environments for people in aged care, in line with Australia’s National Aged Care Design Principles and Guidelines.

The National Aged Care Design Principles and Guidelines, released in July 2024, aim to improve the quality of residential aged care in Australia through thoughtful design - by fostering environments that enhance residents' well-being, autonomy, and connection to the community.

Developed in response to the Royal Commission into Aged Care Quality and Safety, the guidelines focus on moving away from institutional models toward homelike and person-centred settings. They are voluntary and provide flexible solutions for both new constructions and retrofits of existing facilities.

The guidelines are built on four key principles:

Enable the Person – Help people live in a place that looks after their health, wellbeing and sense of identity.
Cultivate a Home – Create a familiar space where people have privacy, control and feel they belong.
Access the Outdoors – Support people seeing and spending time outdoors in nature.
Connect with Community – Encourage people to connect with their family, friends and community and to stay involved in meaningful activities.

The guidelines offer practical examples, rationales, and checklists to assist providers in making impactful, cost-effective design changes.

These principles align closely with the work of Janine Grossman, Director of Professional Services at Montefiore, who is deeply committed to improving the quality of life for older adults. With more than 20 years of experience in aged care – and a specialised focus on caring for people living with dementia and Holocaust Survivors – she has been instrumental in shaping client-focused approaches that prioritise dignity, comfort, and well-being.

In this interview, she shares insights on designing environments that better support people who have survived trauma and people living with dementia.

What made you want to work in aged care?
When I was studying social work, all my placements and early jobs were focused on working with children, specifically those who had been removed from their homes due to abuse and were living in care. I loved that work and was passionate about it.

When we immigrated from South Africa to Australia, I had two young children and was looking for a social work position that would allow me to balance work and family life. The first job I found was at Montefiore, working in aged care.

From that moment on, I became passionate about learning and growing in this field. I’ve now been with Montefiore for 28 years - essentially, my entire time in Australia. I fell in love with aged care, and my passion for it has never faded.

Not many people stay passionate about their job for that long!
Aged care has changed so much over the years, with new legislation and evolving standards. In many cases, we’ve introduced best practices before they even became legal requirements. What drives us is always looking for ways to improve. Montefiore is an organisation that prides itself on providing excellent care, but also believes we can always do better. Every day, we ask ourselves, how can we improve the lives of our residents?

You work with Holocaust Survivors. How do their experiences influence the way you approach dementia care?
When I first started, I wasn’t familiar with the specific needs of Holocaust Survivors in aged care. In South Africa, I had done a placement in an aged care facility, but never came across any Survivors or the topic itself.

Once I began working here, staff would come to me with concerns. They’d say, “This resident keeps talking about hiding children in their cupboard and needing food for them. Are they hallucinating?” We didn’t understand what was happening at first.

I started researching and found work being done on Holocaust Survivors and post-traumatic stress in old age. I connected with Dr. Paula David at Baycrest in Toronto, where they had a high number of Holocaust Survivors. She had studied the triggers that can resurface when Survivors enter aged care.

Together with Renee Symonds, a Clinical Psychologist and Montefiore board member, we trained staff to not only recognise triggers but also understand why they happen. For example, showers can be traumatic for some Survivors because of what going to the shower meant in camps, so we offer alternatives like baths.

This work became deeply meaningful to me. I had the privilege of hearing Survivors’ stories, and I wanted to do everything possible to help them feel safe. We developed a handbook and a whole program to reduce trauma when they enter aged care.

Moving into an aged care facility can be triggering in itself - leaving your home, your possessions, your familiar community. It mirrors what many Holocaust Survivors experienced when they were forced to leave everything behind. To address some of these triggers when designing our Randwick facility some 18 years ago, we included the following features:

Private ensuites to preserve dignity and privacy.
A hairdresser on-site, as grooming became a significant part of identity and self-care after the war.
We’re mindful of smells - urine or strong disinfectants can be triggering.
Even music choices matter. Some classical composers’ works were played loudly in concentration camps, so we avoid those.

Families also struggle with guilt when placing a loved one in care, so supporting them is a big part of our work too.

What are some design features that help people living with dementia feel comfortable?
Traditional nursing home environments - long corridors, nurses’ stations - aren’t supportive for people living with dementia. Research has led to a shift towards smaller, home-like environments.

A great example is De Hogeweyk in the Netherlands, a “dementia village” designed to let residents live as normal a life as possible. It has small apartments with shared kitchens, lounges, and dining areas rather than hospital-like settings.

In Australia, we’ve seen a rise in group homes for people living with dementia - actual houses in the community that are modified for safety and independence. Residents go out for coffee, shop locally, and maintain a familiar lifestyle.

Some key design features that help people living with dementia:

A familiar, home-like environment – central kitchen, lounge, dining area.
Private bedrooms with ensuites – to maintain dignity and personal space.
Easy access to outdoor spaces – residents should be able to walk outside freely.
Unobtrusive security features – to prevent wandering without feeling restrictive.
Carpets instead of hard flooring – to make spaces feel more like home and reduce noise.
Large dining tables – to encourage social interaction.
Soft lighting and reduced noise levels – to create a calm atmosphere.

We also consider sensory elements, such as ensuring call bell alarms aren’t too harsh and keeping background noise minimal.

*Image from the National Aged Care Guidelines*

Do the new National Aged Care Design Principles and Guidelines make a difference to your work?
We were already implementing these principles before they were formalised because I’ve been researching dementia-friendly design for over 15 years.

The guidelines, which came out after the Royal Commission into Aged Care, are fantastic for facilities that haven’t yet adopted these best practices. They help guide providers towards better environments for residents.

That said, retrofitting older buildings to meet all the new criteria is challenging. If we were building from scratch, we’d follow even more of the recommendations. But the guidelines provide a strong roadmap for the future of aged care design.

Is designing for dementia different from designing for aged care in general?
Dementia-friendly design benefits everyone in aged care.

Even though not every facility can shift entirely to small-scale dementia-friendly housing, we can incorporate elements that improve quality of life for all residents. For example:

Memory boxes outside each door – helps residents find their rooms.
Smaller, familiar communities within larger facilities – promotes a sense of belonging.
More natural light and outdoor access – improves mood and well-being.

When we built our Randwick facility, we not only incorporated design changes but also changed our entire philosophy of care to make spaces more home-like.

Is designing for aged care just about the buildings?
No. You could have the best-designed facility in the world, but if the organisation’s philosophy and staff training don’t align with person-centred care, the building itself won’t make a difference.

Aged care needs a well-defined model of care that supports:

Strong governance – clear policies that prioritise residents’ well-being.
Operations that reflect the philosophy – ensuring daily routines enhance quality of life.
Ongoing staff training – so that every team member understands and applies dementia-friendly approaches.

It’s about more than just the physical space - it’s about creating an environment where people can truly live well.

You can download the National Aged Care Design Principles and Guidelines here: https://www.health.gov.au/resources/publications/national-aged-care-design-principles-and-guidelines?language=en

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