Date of Award


Degree Name

Doctor of Philosophy (College of Health Sciences)

Schools and Centres

Health Sciences

First Supervisor

Doctor Anne-Marie Hill

Second Supervisor

Doctor Caroline Bulsara


The growth in ageing populations in addition to an increase in rates of chronic diseases such as dementia, has led to projections that this upsurge will be matched by increased demand for residential aged care placements for the foreseeable future. Currently, significant proportions of aged care government funding both locally and internationally are directed towards the residential sector. Australia has recently released Aged Care Quality Standards whereby the outcomes to residents need to be verified specifically across a range of domains (including the living and built environment) in order to maintain this government funding. Building new facilities is not always a financially viable option for aged care organisations, so refurbishment of existing stock needs to be considered. However, it is often not clear how residential organisations are to identify, prioritise and undertake minor refurbishment initiatives in ways which both addresses the needs of the residents and also fulfils rising consumer expectations.

The purpose of this research was to determine how minor refurbishment of residential aged care facilities (RACFs) could be undertaken in a prioritised, consistent and sustainable manner to ensure the outcomes enhance the abilities and wellbeing of the people who live within them. This work sought to contribute to the future development of a resource for providers who are planning minor refurbishments at RACFs.

A sequential mixed methods research design using a pragmatic approach was undertaken to identify the elements of minor refurbishments; examine the ways in which they can be objectively assessed; determine the most suitable assessment approach and tool to be used in the assessment; and pilot the tool at a RACF. Data were gathered from diverse sources including narrative review of minor refurbishment elements, systematic review of environment assessment tools, e-Delphi survey, nominal stakeholder focus groups and the pilot tool findings including content validity index (CVI) and rater concordance measures. The research encompassed three phases. Phase 1 identified the elements of minor refurbishment and the existing environment assessment tools which could assess these elements. Phase 2 examined these tools at international, national and local levels and piloted and evaluated the identified assessment tool at a RACF. Phase 3 synthesised all the data to formulate recommendations when undertaking minor refurbishments.

Seven minor refurbishment elements were identified and were represented in four environment assessment tools. International and national experts examined and ranked the tools for the local stakeholder groups to consider in their review of the tools. Evaluation of Older People’s Living Environments (EVOLVE) was selected as the tool to pilot at a RACF. Although initially developed for assisted or retirement living, the tool was found to be transferrable to RACF, including demonstrating good concordance and good correlation between the four raters. The tool results reiterated the value and importance of the minor refurbishment elements with a particular focus on lighting.

The minor refurbishment elements of colour/contrast, flooring, furniture, lighting, noise, signage and wayfinding are complex and often interwoven. Differing levels of expertise are also required to translate the assessment findings into outcomes that can provide the appropriate support to residents living in residential aged care. This research ideally positions RACF managers to undertake minor refurbishment initiatives in an informed and systematic way. This can facilitate appropriate prioritisation and allocation of often tightly contested funds. Future research that evaluates measuring and undertaking minor refurbishments is recommended.

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