Developing a framework for housing models to age in place

Abstract

The global population is ageing at a rapid pace, accordingly many countries implement ageing in place policies to prevent unmanageable growth of costs of institutionalised care settings. Like many other countries, the Dutch government also shifted towards ageing in place policies to reduce the costs of institutionalised care settings. Ageing in place is aimed at allowing the elderly to live independently and stay part of the community. Therefore, policies and services are increasingly aimed at supporting the elderly in ‘place’, where ‘place’ consists of the dwelling and its surrounding environment. However, the current ‘place’ may not always be the best option for the elderly to receive care and support in order to age in place. The playing field of housing and care has made a significant transition since the decentralisation of the General Act on Exceptional Medical Expenses. Due to the changes in national policy and legislation, the binary perspective on housing for the elderly, in the conventional market or traditional institutions, has been expanded to include a potential spectrum of housing models to age in place. By disconnecting supportive functions, such as housing, care and welfare, from the traditional institutions, a new playing field has arisen for housing models to age in place between the traditional family home and the traditional institutions. Furthermore, public and individual responsibilities have shifted. The municipality has been given the responsibility to develop a strategy on ageing in place and the elderly have become responsible for choosing a 'suitable' place to age. However, municipalities, elderly and other stakeholders have their own perspective on the definition of a suitable ‘place’ to age, therefore municipalities, elderly and stakeholders have their ‘own language’ with regard to housing models to age in place. This leads to a so-called ‘dialogue of the deaf’ during the process of development and realisation of housing models to age in place. The new playing field of housing and care grants the opportunity to develop new supportive ‘places’. In order to provide supportive ‘place’ for the elderly, municipalities are able to proactively facilitate stakeholders in the development and realisation of housing models to age in place. This study offers an instrument that supports the coordination task of Dutch municipalities in order to develop and realise housing models to age in place.The basic functioning of the framework is as follows. The combination of the residential object and the variables in the inter- and external dimension reflect what a housing model to age in place entails. Within each variable, several options or combination of options are available to define the variable, where the prerequisites can be predefined options that need to be included in the model when developing a new housing model to age in place. The diverse variables are able to ‘build’ a variety of housing models within the new spectrum of ageing in place, therefore the variables are labelled as building blocks. Based on this study, three applications of the framework have been defined in order to support the coordination task of Dutch municipalities in order to develop and realise housing models to age in place.The first application of the framework is focussed on structurally collecting data on preferences of the elderly on local scale in relation to housing models to age in place. The framework can be used as a tool to gather data of the preferences of the elderly in relation to housing models to age in place. Findings based on the data collected on the preferences of the elderly in relation to housing models to age in place can be used to define prerequisites, which can be taken into account when developing a housing model to age in place. By exposing the demand for housing models to age in place through the use of the framework, the municipality is provided with data that can be used for both housing and ageing in place policy. The second application of the framework is aimed at creating a frame of reference for municipalities on housing models to age in place. Currently, the new spectrum of ageing in place is mostly unexplored and therefore municipalities have an incomplete frame of reference on housing models to age in place within their municipality borders. Therefore, the framework can be used to enhance the frame of reference on housing models to age in place by analysing existing housing models within municipality borders. The framework offers a ‘template’ for municipalities to structurally organise information on existing housing models to age in place.The final application of the framework focuses on the guidance of stakeholders in relation to the discussion on what a supportive ‘place’ is for the elderly. The framework provides a starting point for ‘shared language’ on housing models to age in place in order to guide the dialogue between stakeholders involved with the development of housing models to age in place. The framework can be used as a guidance in order to break the ‘dialogue of the deaf’ that frequently occurs between stakeholders during the development of housing models to age in place. This application of the framework can be compared to a structured interview with the same questions asked in the same order each interview. In this case, the same building blocks are discussed in the same order each consultation round between stakeholders. Through repeating the process the occurrence of the ‘dialogue of the deaf’ will decrease. The research presents several recommendations. One of the recommendations is focused on bridging the domains of different stakeholders. It became apparent that stakeholders within the playing field of housing and care think too ‘compartmentalised’. While the framework offers an instrument to bridge the domains, it still requires a cultural change to bridge the domains. This means that the stakeholders have to show ‘entrepreneurship and guts’ to successfully develop new housing models to age in place. The municipality will have to take a proactive and facilitating role in order to stimulate stakeholders to ‘look over their own fence’.