Frailty – what does it mean and how could it be measured?

     Judith Davey

16/06/2017 

“Frail” and “frailty” are words often used in relation to very old people. Looking them up in the Shorter Oxford Dictionary gives us “likely to be broken, perishable’ when applied to objects and “weak, liable to err or yield to temptation” when applied to people. Probably not too helpful! Are these concepts which can be useful in examining the situation and wellbeing of older people? Or is “frail” just another stereotype, often association with “elderly” – another term with connotations of inevitable decline? So I looked around for current definitions.

Biomedical definitions

There is a growing consensus among experts that frailty does exist as a distinct syndrome in a subset of older people who are at increased risk of hospitalisation, dependency and whose life expectancy is reduced.  But there is no overall agreement on indicators of frailty or how it should be defined. A common measurement is based on five specific criteria indicating adverse functioning, which include both self-reported and performance-based elements. Those who meet at least three of the criteria below are defined as “frail”, while those not matching any of the five criteria are defined as “robust”.

  • Low physical activity
  • Muscle weakness
  • Slowed performance
  • Fatigue or poor endurance
  • Unintentional weight loss

It seems more helpful to clinicians to identify frailty on the basis of physical rather than psychosocial factors as these are more tangible, more objectively confirmed and are more likely to be treatable by medical means. This approach is intended to help “the development of screening tools for health workers to identify vulnerable older people and inform interventions and preventive strategies.”

But what about psycho-social factors?

Should frailty be defined purely in terms of biomedical factors? Go to:

Psychological, social and environmental factors may be important contributors to frailty and very influential in terms of care policies and service provision.

In the Survey of Older People in New Zealand (SOP) in 2000 the authors defined frailty as “a complex syndrome of underlying problems” resulting in “vulnerability to environmental challenge”.  Put another way – medical, physical or mental health problems could compromise the ability to carry out key activities – washing, dressing, getting about, housework, keeping records, etc. In this concept frailty resulted from the interaction between bodily conditions and functioning.

Prevalence of frailty by personal characteristics

The findings of SOP, not unexpectedly, were that frailty increased with age, especially after 85 years. Prevalence was slightly higher for females than males and increased sharply for women from age 87.

The prevalence of frailty among Maori was higher than for New Zealand European and Pacific Island people. There was the same prevalence of frailty among Maori aged 65-70 as there is among non-Maori aged 81-84 years. This suggests a 10 to 15 year difference in the onset of frailty.

Marriage appeared to have a protective effect, with higher frailty figures for the widowed, divorced or separated. This illustrated the influence of the social environment on an older person’s ability to continue to maintain activities and functions associated with independent living. Complementary roles and coping patterns between partners develop over long periods of time together. This fits with the finding that there was a greater prevalence of frailty among older people living alone.

An interesting finding was the clear association between income and frailty– those with lower incomes had a higher prevalence of frailty – another link between health status and socioeconomic status. This highlights the cumulative effect of life events. Older people who are frail are more likely to be those with histories of lower incomes, less secure housing and social isolation. Does this suggest that home ownership has an important protective effect? “Addressing declining rates of home ownership for all groups throughout the lifespan can also be seen as contributing to housing security and wellbeing in later life, with associated health benefits.” This conclusion was arrived at getting on for 20 years ago!

 Intervention

Most studies on preventing frailty have been conducted after acute events such as strokes or fractures. Relatively few studies have been undertaken on intervention once frailty has developed. But these show that it is possible to prevent further functional decline.

The beneficial effects of exercise in the older population have been widely publicised. Given that inactivity and muscle weakness are major determinants of frailty, it is not difficult to imagine a simple and cost‐effective exercise‐intervention measure that may slow or reverse the process.

Positive psychological states may also be beneficial in the prevention of frailty. It has been suggested that the concept of positive health is more than simply the absence of disability or disease. Thus, approaches aimed at the production of a positive psychological state in those at risk of frailty may strengthen other interventions aimed at stopping functional decline.

Clearly, the definition and measurement of frailty cannot rely solely on bio-medical factors. The life history and environment of very old people are equally important, if not more so.

 

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What does Wales have which we do not have? Its initiatives for the wellbeing of older people

Judith Davey 

02/06/2017

The population of Wales, at 3.2 million is smaller than NZ’s, but it has a slightly higher proportion of its population aged 65 plus (18% at present), and it has some very interesting initiatives which promote the wellbeing of its older people.

We heard about them recently during a visit by Professor Judith Phillips, currently at the University of Stirling in Scotland, but formerly at Swansea and, significantly, the chair of the Expert Group on Housing an Ageing Population in Wales. But this is only one of the interesting initiatives to come from this small country, better known for leeks and daffodils.

The Older People’s Commissioner for Wales is an independent voice and champion for older people across Wales. Her work is driven by what older people say matters most to them and their voices are central to her initiatives. Her aim is “to make Wales a good place to grow older – not just for some, but for everyone.” The Commissioner’s office works in partnership with the Children’s Commissioner to promote the benefits of intergenerational projects and activities. It all sounds great – should we have such a position?

 What is more, Wales also has Future Generations Commissioner, whose role is to act as a guardian for the interests of future generations. This has come about under the Well-being of Future Generations (Wales) Act 2015, which also establishes Public Services Boards (PSBs) for each local authority area in Wales. Each PSB must improve the economic, social, environmental and cultural well-being of its area by working to achieve wellbeing goals through Wellbeing Plans[1]. In these plans the Older People’s Commissioner has set out objectives relating to older people, with clear targets. These include reductions in the number of older people –

  • falling
  • affected by domestic abuse
  • affected by loneliness and isolation
  • living in poverty
  • affected by fuel poverty.

And increases in the number of older people –

  • with dementia supported to live well in their communities
  • who are and feel safe in their local communities and are actively able to do the things that matter to them
  • who return to employment after the age of 50
  • take up of financial entitlements.

The Commissioner is clear that it is not a case of prioritising older people when developing Local Wellbeing Plans, but rather ensuring that older people receive equal visibility and attention and are considered by public services equally to other groups. The Act will make public bodies focus more on the long term, work better with people and communities and each other, and do what they do in a sustainable way.[2]

The Older People’s Commissioner for Wales hosts and chairs a partnership of individuals, community groups, national and local government and major public and third sector agencies. Its programme – Ageing Well in Wales – is first of its kind in the UK and complements the Welsh Government’s Strategy for Older People.

To get back to Judith Phillip’s group – The report of the Expert Group on housing an ageing population in Wales[3] has five key themes:

  1. Understanding the housing requirements of older people – assessing housing needs and aspirations as part of the wellbeing plan, including the need for specialist housing.
  1. Supporting the right choices – to “stay put” or “move on.” This includes expanding organisations which provide aids and adaptations which enable people to “ “stay put” or move to a safer, more energy efficient, affordable and connected environment.”
  1. Living with confidence in older age – taking a person-centred approach, ensuring that new homes are designed to accommodate the projected health needs and diversity of the ageing population.
  1. A planning system which reflects the needs of the ageing population – encouraging local planning authorities to create mixed age friendly/lifetime neighbourhoods; encouraging “the development of a range of innovative and healthy housing solutions, (including private sector initiatives) that meet the housing demands and needs of an ageing population and bring wider social, economic and environmental benefits.”
  1. Making housing more affordable and incentivising change. Ensuring that there are affordable homes available for sale and rent and increasing diversity of tenures. Looking for opportunities to make the best use of capital and revenue resources across the housing, health and social care portfolios

It is important to remember that housing, social care and health are all devolved to local authorities in Britain, rather than being under centralised ministries as in New Zealand. The new legislation in Wales emphasises that these three services should be integrated, recognising how they rely on each other to provide wellbeing in the real world, as opposed to being in bureaucratic “silos”. This seems like a laudable aim which I would like to see pursued here as well.

[1] http://gov.wales/topics/people-and-communities/people/future-generations-act/?lang=en

[2] Interestingly enough, in March I attended a symposium in the Beehive which considered these very issues. It was called Intergenerational Governance and was sponsored by the Institute for Governance and Policy Studies at Victoria University.

[3] http://gov.wales/topics/housing-and-regeneration/housing-supply/expert-group-on-housing-an-ageing-population/?lang=en

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Aged care services – future demand and other conundrums

Judith Davey 19/5/17

 

What affects the demand for aged care services?

  • Population Trends: The 85 plus age group is growing rapidly. This is where the proportion in residential care is highest and most people living in the community need some level of support. Trends in mortality rates are crucial; the lower the rate, the higher the growth in the older age groups. Migration rates are less important, certainly in the short to medium term.
  • Disability trends: The incidence of disability increases with age. Assuming the prevalence of disability continues as at present, it is estimated that the number of people 85 plus with high support needs will increase by 225% between 2006 and 2036.

Estimates of population and disability trends are available and are likely to be reliable. But these are not the only factors influencing demand. Others are less predictable:

  • Social change – will informal care givers be available? Paid workforce participation by the “young-old” is increasing and being encouraged. Can paid work and eldercare be compatible? Residential mobility means that potential family carers could be scattered through the country and around the world.
  • Public policies on the provision and funding of care services are important and can change, along with the relative focus on institutional and home care; and the monitoring and regulation of care services. Immigration policy, which is currently being debated, will influence the availability of care workers.
  • Funding of services and fiscal constraints depend on the overall economic situation, especially in a context of rising demand and rising expectations.
  • Advances in health practices and technology. What changes will there be in the prevention and treatment of dementia? Tele-monitoring may allow more self-management at home. Strategies aimed at preventive initiatives and healthier ageing could reduce levels of impairment and hence the demand for care. And I have written earlier on assistive technology.
  • Business and management practices can also change and will influence privatised and contracted services. These include, for example, consolidation of facilities and economies of scale, improved processes and working practice, but also whether aged care is seen as a profitable investment.

Several exercises by public, private and voluntary agencies have attempted to project the future demand for aged care services and aged care workers in New Zealand. All this work points to an increasing demand for aged care services, both at home and in institutions, and signals a likely shortfall in supply, especially in the available workforce. A Department of Labour report suggested that the number of care workers needed will rise to 48,200 in 2036. Current growth trends produce a total of 21,400, clearly not enough.

Health Workforce New Zealand estimate that from 2011 to 2026 the numbers of people receiving home support and residential care will increase by 61% and 54%, respectively. A significant shortfall in funds is predicted. Not enough money; not enough workers. This is before we even think about workforce development and training.

As well as the supply-demand conundrum, what are some of the other issues for the future?

  • Finding a “client-centre” focus, giving a voice to older people’s needs and wishes.

The 2016 Health Strategy talks about “people-powered” services – enabling individuals to make choices about the care or support they receive; understanding people’s needs and preferences.  How practical is it and can we afford to take into account all the preferences of older people requiring care, assuming that subsidies will remain?

  • Balance of home and institutional care –response to cost or wishes of older people?

Where should the balance be? There is a growing concern about an increasing focus on people with higher level care needs and the withdrawal of services from those receiving low-level home care. How compatible is this with a preventive approach?  The ASPIRE trials suggested more intensive home care, giving more responsibility to “unregulated” care workers. Is this realistic? Will upskilling come along with higher pay?

  • Management and regulation

How do we reach an effective balance between “light touch” and heavy-handed regulation? Which will deliver better quality and better protection from abuse? Is there a trade-off between efficiency and choice?  How can innovation be promoted in a climate of claims and counter claims about funding in the sector?

  • Sharing responsibility

Who should be expected to provide and fund care for dependent older people in the future and how should responsibility be shared between individuals, families, communities, the voluntary sector, private sector and government agencies? How should the costs be shared? How do we identify and build on the strengths of the different sectors in the aged care field?

Clearly complexity and pluralism is operating in the provision of care for older people. Most research demonstrates that family and formal care are more effective when they complement each other. But, responsibility must be clearly defined –how? Issues of unmet needs, poor quality, abuse, “buck passing” and gate-keeping arise where responsibility becomes contested or where shared responsibility is difficult to negotiate.  Can multi-disciplinary case conferences and planning support person-centred care, and incorporate the perspectives of carers and other family members?

A lot of questions – calling for realistic discussion if older people are to receive the care they deserve.

 


[1] Based on notes for a workshop at the NZCCSS Conference in Wellington in 2012, led by Judith Davey.

 

 

Posted in Care and other services for older people | 3 Comments

Population Ageing: Peril or Promise – Let’s be positive

May 8th 2017

We all know that people are living longer and healthier, but the ageing of the population often tends to be viewed in negative terms, calling it a “burden”, even a “tsunami.” I may have used it before in my blogs, but one of the most extreme statements I have found was in the Sydney Morning Herald in April 2002 –

”The ramifications (of ageing) could be serious as the elderly become an additional burden to the traditional scourges of poverty and disease.”

Let’s try to be more positive. A World Economic Forum report in 2012 did so when the authors listed the “Opportunities arising from a longer, healthier life.”[1]

  • A longer and more flexible working life. The number of people of traditional working age is shrinking. In New Zealand, along with many developed countries, there will soon be more people leaving the labour force than entering it. Mature-age workers, 60 or 65 plus, are becoming a valuable resource, and far-sighted employers are seeking to keep them on, recognising their experience, wisdom and loyalty. The balance in working conditions will change in favour of practices that promote higher levels of labour force participation among older people. These include flexibility, technological adjustment and access to retraining.
  • Volunteering and community contributions. There is little doubt that many older adults make a valuable contribution to society through voluntary community engagement. This may take the form of civic engagement – representing consumer views; support for vulnerable groups; environmental protection; and assistance with education, healthcare and recreational services.
  • Enhanced social skills. Research shows that many older adults are better at interpersonal communication and less prone to immediate emotional reactions than persons of a younger age. Grandparents often act as mediators in family conflicts. “People skills” are also particularly valuable for a service-based economy. I am sure I am not alone in appreciating the informed advice of older handymen in the hardware shops.
  • Redesigned environments. As I have mentioned in recent blogs, creating age-friendly environments not only enhances the social participation of older adults, but improves living for all ages. It also stimulates business innovation in designing a more varied and flexible built environment. And new building and retrofi­tting gives rise to employment opportunities in construction, transport and related industries.
  • New markets, new consumers. It is estimated that people over the age of 60 hold more than 50% of the wealth in developed societies, with a similar trend occurring in emerging countries. This was found to be true for New Zealand in “The Business of Ageing.”[2] The considerable economic potential of the “silver market” is only just beginning to be tapped.
  • Intergenerational financial transfers. Contrary to the view that older generations are a burden on younger ones, most transfers run down the generational tree rather than up it, when viewed across the life course. Parents and grandparents give their children and grandchildren the best start in life they can. Such financial transfers can help to reduce barriers to home-ownership which are becoming serious in this country. Also, older taxpayers show no indication of refusing to pay for large infrastructural projects for which they may never reap the full personal benefi­t. As the World Economic Forum says, “It may be more accurate to talk about generational altruism rather than generational burdens”.
  • Caring and family cohesion. Older people, particularly women, engage in unpaid care work. This contribution not only frees up others for the workforce, such as their adult children, it currently saves their national economies considerable costs. According to the 2013 Census, there were almost 10,000 grandparents acting in parental roles and very many more who help with part-time childcare. When a shrinking population of working age is combined with increased female participation, certain sectors – such as the aged-care workforce – will come under particular strain unless these skills are recognised. The recent decision to improve pay equity in this workforce is a welcome step in this direction.

 

 

  1. John R. Beard, Simon Biggs, David E. Bloom, Linda P. Fried, Paul Hogan, Alexandre Kalache, and S. Jay Olshansky, eds. (2012) Global Population Ageing: Peril or Promise, World Economic Forum,

2. Ministry of Social Development (2011) The Business of Ageing: Realising the economic potential of older people in New Zealand, 2011 to 2051. Ministry of Social Development and Office for Senior Citizens, Wellington. Also – The Business of Ageing: 2013 update. 

Posted in Attitudes and values (culture, sexuality and spirituality) | 1 Comment

Is age-friendliness for everyone? Or just for older people?

Judith Davey

21/04/2017

“towards a society for all ages”

This was the slogan for the United Nations’ International Year of Older Persons in 1999.

But if you google anything about the year, not to mention “age-friendliness,” the photos you see will almost always depict older people. What does ‘age-friendliness’ actually mean? Is the inclusion of ‘all ages’ a way of advancing design, housing features and urban developments that take specifically older adults into account while asserting that this will lead to universal good/benefit? Do age-friendly initiatives really create an environment which benefits all ages?

It is interesting to note that, well before the International Year of Older Persons, the World Health Organisation (WHO), now the main global protagonist of age friendly cities and communities, changed its focus from “the elderly” to “ageing,” to remind everyone that good health is everybody’s business.

More recently, the New Zealand Health of Older People Strategy changed its title to the Healthy Ageing Strategy. Do these changes recognise a shift in thinking, to a wider view? If we say “older people” or “seniors”, this focuses attention on a fixed group, identified by age or life stage. ‘Ageing’ attempts to resolve this limitation by focusing on a process which everyone is undergoing from the moment they are born and makes it easier for everyone to identify with it. It also avoids the problem of having to suggest an age at which people can begin to be considered “old”.

WHO has continued to support this trend, stating “An age-friendly city emphasizes enablement rather than disablement; it is friendly for all ages and not just ‘elder-friendly’”. Indeed, the notion that ‘age-friendliness benefits all ages’ forms one of the arguments to support investment in urban improvements, especially the physical aspects of urban design: better footpaths and pedestrian crossings, parks and recreation facilities, and transport services, aiming for a ‘community for all ages’. Is this a great idea to promote “buy-in “or does it run the danger of eclipsing the specific needs of older people?

Intergenerational factors
Using “ageing” as the focus brings in intergenerational issues. Some studies in the Age-friendly Cities and Communities (AFCC) literature emphasise the importance of opportunities for social integration and interaction between older and younger people. This shifts the age-friendly focus away from older people to one where social and physical facilities benefit everyone. For example, a study of younger and older adult bus users found that creating an age-friendly bus service would benefit all users. Measures to combat social exclusion often include intergenerational interaction and opportunities to develop activities that span the generations. Social relationships are important to the well-being of people of all ages. And promoting intergenerational solidarity is helpful in combatting arguments which pit the generations against each other, such as tax and retirement income policies.

 

[1] WHO (2007) Global age friendly cities: A guide. World Health Organisation, Geneva.

who.int/ageing/projects/age_friendly_cities_network/en/ NETWORK

[2] Broome, K., McKenna, K., Fleming, J. and Worrall, L. (2009) Bus use and older people: A literature review applying the person-environment-occupation model in macro practice. Scandinavian Journal of Occupational Therapy, 16 p.3–12.

 

Participation in volunteering can be a way to promote intergenerational relationships. These could include projects in which ‘young old’ are paired with ‘old–old’. Younger seniors could be encouraged to provide psychological and physical support for older seniors. This is a basis for ‘befriending” schemes, such as Age Concern’s Accredited Visitors Service.

Further examples of intergenerational programmes come from the USA.

• Generations of Hope, in Illinois , represents an intergenerational approach designed to promote social capital and social inclusion. It fosters mutually beneficial social relationships between older adults and younger people who are experiencing personal and social challenges, such as substance abuse, domestic violence or homelessness.

• Communities for All Ages (CFAA) is also based on an intergenerational approach to community-building that involves residents of all ages, local organisations, policy makers and funders. Attempts to break through age-specific ‘silos’ include multi-generational neighbourhood learning and community centres, Farmers Markets and Arts Festivals.

However, the extent to which intergenerational programmes and structures such as these result in sustained social capital formation and social inclusion needs to be assessed. Other initiatives include intergenerational meeting places to facilitate social contact; programmes to encourage connection with neighbours; intergenerational and multi-ethnic community centres, library programmes, and cultural events. Such initiatives have been frequently identified as ways to encourage age-integrated neighbourhoods.

“Design for the young and you exclude the old; design for the old and you include the young.”

The notion of ‘a design for all ages’ has been closely associated with Universal Design, which is based on this belief . The approach can be extended from the design of houses, appliances, furniture and home utensils to neighbourhoods in which different generational groups meet, interact and negotiate shared use of their environment. This is another way to enhance social and emotional understanding between age groups, increase harmony, and promote sharing.

[3] www.generationsofhope.org

[4] http://www.communitiesforallages.org

[5] Biggs, S. and Carr, A. (2016) Age Friendliness, Childhood, and Dementia: Toward Generationally Intelligent Environments. In Moulaert, T. and Garon, S. (Editors) Age-Friendly Cities and Communities in International Comparison: Political Lessons, Scientific Avenues, and Democratic Issues. Springer International Publishing, Switzerland.

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NORCs- what are they and how can they be useful?

Judith Davey

07/04/17

I tell people that I live in a NORC, but it looks just like a high-rise apartment building. It might not strictly fit the definition of a NORC, but it is a good conversation-opener.

A naturally occurring retirement community, or NORC (rhymes with “fork”), is a term used to describe a community/neighbourhood/residential building or area that has a large proportion of older residents (over 60 or 65) but was not specifically planned or designed to meet the needs of seniors living independently. NORCs may develop in three different ways:

• Ageing in place: people moved into a community/neighbourhood/residential building or area when they were younger and stayed there as they aged (this is the case for several people where I live);
• Emigration: older people remain in place as younger residents move out (this would apply to many suburbs in New Zealand);
• Immigration: older people move into an area, attracted by features which appeal to them as part of retirement living (climate, scenery, local amenities). In New Zealand, the Kapiti Coast, Tauranga and parts of North Auckland would be examples.
Retirement villages do not fit the definition as they do not occur naturally.

NORCS just emerge over the years, but can be identified by census figures on age structure. Once identified, these areas are likely to develop age-friendly features consistent with the needs and aspirations of the residents. These could be hobby, sporting and other groups, based on interests. They could be support services for people who need them, whether commercial or linked to government-provided health and welfare services. They could be age-friendly features related to local planning – footpaths, road crossings, transport facilities. Now that the New Zealand government, through the Office for Seniors, is showing an interest in the global Age Friendly Cities and Communities movement, perhaps some local NORCS could become pilot areas for the AFCC approach.

An alternative and more formal definition of a NORC is found in the USA. The Naturally Occurring Retirement Community-Supportive Services Program (NORC-SSP) developed in 1985 in New York City. These NORCs are buildings or neighbourhoods that have been retro-fitted to provide services for older people. They are often a single residential estate or tower block. These NORCs provide health care management and prevention programmes; social care services; help with transport, education and recreation on-site or close by. Each NORC will provide a special range of services linked to the needs of their residents; they may have a special ethnic or cultural flavour. For example, Jewish Home in New York, has a 160+ year history of serving Jewish elders and now has partnerships with several NORC communities to provide health and social services to tenants in apartment buildings.

The first NORC programme in the USA was established in 1986 at Penn South Houses, a ten-building 2,800-unit moderate-income housing cooperative in New York City. Since then, the model has spread to more than 25 states across the country. In recent research NORC-SSPs have been found to contribute to social connections, community participation and service access, and have helped older people to age in place, when this has been their preference.

All American NORCs have the aim of promoting older people’s access to services and reducing social isolation. They are often partnerships between housing entities and their residents, health and social service providers, government agencies, philanthropic organisations, and other community organisations. NORC residents are usually an essential part of the programme, contributing to development, governance, and service provision as volunteers (along the line of the “age-friendly” philosophy). Clearly this approach would work best in areas of social or cooperative housing.
Other NORCS may take the form of membership-based “villages”, as I mentioned in a previous blog.

Some NORC-SSPs, at least in New York, have been able to advocate successfully for funding from state and local governments. But lack of, or insufficient, funding makes such developments vulnerable, and, outside New York, many NORC-SSPs have proved relatively unstable as funding opportunities change and/or are withdrawn.
There are obviously NORCs and NORCs and different views of their success. One comment- “Some of the best retirement communities occur naturally.” Another – “NORCs can take many forms, ranging from vibrant communities that encourage seniors to stay engaged to sad places where the elderly live in isolation, fearful that they’ll die alone.” What makes the difference? Perhaps having the array of services which best fits the local population is the key to success and sustainability.

Little seems to be known about NORCs in New Zealand along the lines of the overseas literature, but they certainly exist. Could they be the basis for age-friendly communities as promulgated by the World Health Organisation? What kind of organisation and funding would be suitable here? How could they contribute to the wellbeing of older people?

 


Bedney, B., Schimmel, D. and Goldberg, R. (2007). Rethinking aging in place: Exploring the impact of NORC supportive service programs on older adult participants. Paper presented at the Joint Conference of the American Society on Aging and the National Council on Aging, March 7–10, Chicago.
Bedney et al. 2007

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A Wider Range of Housing Choices needed for Older People- Examples from overseas

Judith Davey

24/3/17

Housing plays a variety of roles in the lives and wellbeing of older people. Inadequate living conditions lead to increased stress levels, social isolation, poor health and a higher risk of illness and injury.  Older people need to be able to exercise choices over their housing options and to seek out the types of housing which best suit their circumstances. But the range of choices in New Zealand is not very extensive.

Perhaps we need to consider new approaches. What about co-operative housing, shared housing, accessory units (“granny-flats”), co-housing and intergenerational housing?  Here are a few examples of innovative housing options, mostly from the USA, which I have recently come across in the literature.

Senior “co-housing” is a way for a group of people to get together and create a custom-designed neighbourhood and types of housing directly tailored to their needs and aspirations. Such developments typically have shared amenities such as a library, guest rooms, community gardens and recreational facilities, as well as individual living units. The model originated in Denmark and now co-housing for older people, or with a multi-generational focus, is found throughout Europe.

The first three senior co-housing communities in the USA opened in 2006[1]. In Glacier Circle, California, twelve friends who had known one another for thirty years built a townhouse-style community. Elderspirit, in Virginia, is a residential community formed around later-life spirituality. It has fourteen owner-occupied cottages, and fifteen rental apartments. Silver Sage is an upscale community of sixteen duplexes and attached homes in Colorado.

The Burbank Senior Artists’ Colony arose out of the collaborative efforts of a private developer, a non-profit arts programme and an affordable housing provider. It includes 147 rental apartments offering independent living (70% at market rate; 30% “affordable” rentals) in a creative, art-inspired environment. It has a theatre and art studios. Residents host arts events for their neighbourhood, present live entertainment and opportunities to work in the studios.

These examples fit the “village” model, where older people develop membership associations, often within an existing residential area, that provide supportive services and social activities.[2] Village members pay annual dues and receive access to services, such as weekly grocery shopping trips; referrals and discounts for outside services (e.g. home repairs); social and educational activities, and opportunities to participate in governance and peer support. It is a kind of “do-it-yourself” retirement village. Most of the New Zealand equivalents – retirement villages – are commercial enterprises with varying degrees of consumer input. Many are part of “chains”; others include individual private sector developments and villages in the charitable and religious sector, but the same comment will apply.

Providing affordable housing for low-income older renters in high-cost areas is the aim of Senior Housing Solutions (SHS), a non-profit group in California. The group purchases and remodels single family homes to provide affordable group rental housing. The design template for each house includes five private bedrooms, a shared kitchen and living space and landscaped front and back areas. By blending multiple funding programmes and rental income, SHS meets capital and operating expenses, and provides caseworker support.[3]

The Human Investment Project (HIP) Housing in California, is one of more than 100 home-share programmes in the United States that bring together home providers and home seekers through a “match-up” service. It can match homeowners – mostly older people – with home seekers who pay rent. It can also set up service exchanges that give home seekers a place to live for free in return for providing services to the homeowner.

The Homeshare Australia and New Zealand Alliance Inc. (HANZA) was established in 2006. Its web-site says that currently there are no active programmes in New Zealand but expressions of interest would be welcomed.[4] Presbyterian Support (Enliven) East Coast apparently has a scheme in Hawke’s Bay which is apparently proving a success with older home owners and younger homesharers.[5]

How could these models be used to expand housing choices for older people in New Zealand? Who could take the initiative? What are the prospects for partnership between public, private and voluntary sector organisations? Changes in the housing environment suggest that there is some urgency to address these questions. Will housing affordability become an increasing barrier to choice? The fall in home ownership will soon work through to affect the older age groups. Will current rental stock meet future requirements?

 

[1] From Kennedy, C. (2010) The City of 2050-An Age-Friendly, Vibrant, Intergenerational Community. Generations, 34,4, p.70-75.

[2] I will say more about such “NORCs” – Naturally Occuring Retirement Communities – in another blog.

[3] Abbeyfield is a New Zealand example of this type of housing.

[4] homeshare.org.au

[5] presbyterian.org.nz/node/3204/view

Posted in Housing and community environment | 2 Comments