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Aging and residential situations: an international perspective

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Mais de Consorci Universitat Internacional Menéndez Pelayo Barcelona (CUIMPB) - Centre Ernest Lluch

Aging and residential situations: an international perspective

  1. 1. 1 1. Thank you. I am very glad to be here, it is always an honour to be invited. I think I am here as I am a housing researcher and have been working on issues around residential mobility, housing choice and options and affordability for many years and for the last 15 years or so with older people in focus. I am pleased to be able to share some of the results of this research and present you with some ideas of a line of thought to better cater for older people’s needs. I am currently an Associate Professor in the Department of Human Geography at Stockholm University in Sweden and one of the coordinators of a working group on Housing and living conditions of ageing populations within the European Network for Housing Research. This working group meets every year in a European country at an annual conference where the latest research findings are presented providing us with an update on issues of importance in different countries. Today I will talk about older people’s housing, their thoughts about housing and their housing options. 2. I will begin with some quotes from our research work. This is a quote from a telephone conversation I had with a woman whose mother had received a survey from us within a research project we conducted. She was quite agitated as she experienced a severe lack of suitable housing for older people who wanted to move out of their single family homes – housing that cater for their needs but housing that is also affordable. Obviously, there is an experienced need for such housing. 3. A couple of other quotations from interviews with older people that we conducted some years ago within a research project. The quotations illustrate the difference between older people and a complex the situation. In this first quote the man and the wife of the household are not quite in agreement of their future housing career, when interviewed the lived in a single family home in a small village in the Swedish countryside with no grocery stores or other shopping and service facilities nearby. 4. This other quotation shows perhaps the opposite, an elderly couple have prepared for old age by moving to a small town statistically considered to be the best place to grow old in Sweden and where everything is within walking distance… When considering the housing situation of older people – we will have to consider very different housing situations as well as different individual and household abilities and preferences. 5. This figure shows the development of the ageing population in Sweden and it resembles that in many other European countries. The older population grows in proportion as well as in numbers and in particular the number and proportion of the very old will increase in the years to come. Added to this we have geographical differences to take into account – there are quite dramatic differences between rural and city areas where the rural areas have a much higher proportion of older people than the cities, the population older than 80 years in some
  2. 2. 2 Swedish municipalities will in five years reach 12% and most of these are located in the more remote areas of the country. Thus, the concern about being able to provide welfare for an ageing population may be general but will have different effect on different geographical areas. 6. There is in many countries today a general concern about the growing expenses of an ageing society and how to provide welfare to its older population. Perhaps by looking at older people’s housing situation and by making sure that older people are adequately housed the burden on the welfare state and welfare expenses might ease. In addition, if people are well housed, the quality of life of older people may be improved. However, we also know that in many countries there is a lack of adequate housing – housing that caters for the needs of an ageing population and we know that in some countries in particular some older people are poorly housed and have little options to change their situation. 7. Studies from several countries show that the vast majority of older people want to age in place, that is in a dwelling or place where they have lived for a long time. This comes as no surprise as the reasons they provide is that they feel at home where they are, they might have lived there for very long time, they know their whereabouts, they might have built the house in which they live themselves and are thus emotionally attached with a lot of memories connected to the current dwelling, they know their neighbours and in general feel at home in the area and find no particular reason to move. And this is important to remember, that the vast majority of older people manage well in old age without any additional support from society. We also know that older people in general have low residential mobility rates. The highest mobility rates are found in Northern Europe and can to some extent be explained by the housing market structure as these countries have a larger rental housing market and where rented housing is not necessarily considered inferior to ownership. As it is easier to move between rental dwellings this increases mobility rates. However, compared to other age groups older people are stayers rather than movers and ageing in place is overall the most preferred option. Ageing in place is also the most preferred housing policy option as this is the least expensive housing choice for the welfare state. Welfare expenses on older people that remain in a dwelling in the ordinary housing market are considerably lower than those who live in any kind of supported housing. In the Nordic countries older people in assisted living facilities pay according to income but the costs are practically always subsidised. 8. Even though most older people do prefer to stay where they are, certain factors trigger residential mobility whereas others do not. If the household remains stable and does not change the probability of moving is low – the same is true for those who own their house. However, to become single for whatever reason, by the loss of a partner or a divorce, or to reach very old age instead increases the probability to move.
  3. 3. 3 To change housing in old change also depends on the availability of alternative housing – if nothing better can be found in the housing market there is no reason to move. However, if there is a choice of housing that better fits the wants or needs of older people the willingness to move increases. We have, in the Nordic countries, been able to observe increased mobility rates among the young old, those around the age of retirement, compared to older cohorts when they were the same age. 9. As you are all aware the number as well as the proportion of older people is increasing in most European countries, after Japan’s 27%, the European countries follow swift with 18–21 percent of the population being 65 years old or older. In addition the very old, those above the age of 80 are increasing their proportion and it is among the very old most of the expenses for the welfare state exists – until then older people are often very independent. With a larger proportion of very old people we might need to reconsider the Ageing in place policy depending on how we interpret this. Ageing in place is sometimes used to describe older people’s possibility to remain in a home where they have lived for a long time – sometimes receiving assistance to do so through home care and home modifications such as stairlifts, ramps, railings etc. In the Nordic countries home adaptations when deemed as needed, are paid by the municipality. For some years the interpretation of Ageing in place, at least in some countries, has been to age in the ordinary housing market but not necessarily in the home where you have lived for a long time. Instead, the older individuals are supposed to, on their own accord, move to more adequate, often more modern, housing where they to a larger extent can maintain independence in old age. The willingness and possibilities to do so and the choices made the vary between different groups of older people depending on age, income, financial assets, education, family structure and choice of life-style. With higher ages not only the physical support will be enough – we also have to consider the social aspect of the housing situation – from many countries loneliness among older people is reported, and here the housing situation can be a key issue. As partners and close friends pass away and close family members are perhaps further away this is an issue that needs to be taken into consideration. Similarly, when we ask older people if they want to stay in their current dwelling or move to another – the quick response is usually that the want to stay – as you know what you have got but not what you can get – however, when we instead ask questions about how the current housing situation fits with their current needs we might well get another story such as; they have difficulties climbing the stairs to the entrance, they have difficulties maintaining the house and the garden or do the house cleaning, they need a walking aid but there is no room to move about with one or if they are bedridden for most of the day they might not be able to see anything from the windows etc – such answers in turn show us that the actual dwelling might not be the most appropriate place in which to grow old.
  4. 4. 4 10. Looking at the housing situation on one occasion in Sweden we can see that different age cohorts live in different types of housing. Most importantly there is a big difference between the older age groups and the younger where in particular the oldest age groups to a considerably larger extent live in municipal and private rented housing as well as in tenant cooperatives – these are practically all apartments – indicating that the very old tend to be found in smaller dwellings. This is a cross-sectional picture and does not show mobility over time but based on other studies we know that this is what happens – with age older people tend to move towards smaller dwellings, dwellings that most often are easier to maintain. 11.As I said earlier most older people choose to remain where they are without specifically thinking about moving – in particular if no changes are taking place as regard household structure and health. However, among those that do move (in Sweden we talk about a mobility rates of 25% over a period of 5 years) they make different choices depending on the housing market structure, that is what type of housing is available. Some housing types, like senior housing and extra care housing to some extent have developed in response to the lack of adequate housing in the housing market and the reduction of places in assisted living facilities (equivalent to nursing homes but legally different). They might move to any other dwelling – perhaps back to a family home or a second home or just to another dwelling, sometimes an apartment that better caters for specific needs (such as an apartment with an elevator or a one storey house with no stairs to be climbed or a smaller dwelling needing less maintenance), but not necessarily, sometimes just to something different. T hey may move to housing specifically designated to older people such as senior housing – apartments often constructed as lifelong housing for household above a specific age, usually 55, 60 or 65 – that is accessible housing, often with room for social gatherings within the house, a guest apartment and possibly access to a hostess or other services (house and window cleaning, laundry, catering etc on demand. This type of housing can be municipal rental, tenant cooperatives or sometimes run be a group of people having formed their own senior housing complex. Senior housing varies in standard from rather ordinary housing with only basic qualities in addition to the age limit to rather exclusive housing with winter gardens and high levels of services. A variety of senior housing is that with a more pronounced cooperative orientation – that is people in the house may cook together some days of the week and have different tasks within the housing cooperative – this is most often written in the housing contract in order to make sure that people wish to have a closer connection to the neighbours. Cooperative housing is of course also available as housing for people of all ages. Another option is Extra care housing which has developed during the last 10 or so years in Sweden. It is a type of housing in the ordinary housing market where older people rent their apartment from a housing company but in the house there is a host or hostess during office hours, responsible for social activities and support. They also have rooms for common
  5. 5. 5 activities where people may eat together, have coffee, play games and organise other activities. The host/hostess is financed either by the housing company or the municipality and the tenants pay ordinary rents. Assisted living facilities are in Sweden the equivalent of nursing homes in some other countries and is housing with 24-hour care and admittance to such housing is through a needs based system for which Social Services are responsible. In Sweden the number of places in such facilities have decreased by almost 25% since the beginning of the 1990s with a slight increase in the last year or so. The consequence is that people that are admitted to such housing are much more frail today as only those most in need are provided a place. A large proportion of those living there suffer from some kind of dementia or other disabilities making it impossible for them to live independent. The decrease in the number of places in assisted living facilities resulted in people ageing in place which was made possible by home care and subsequently medical care being provided in their homes. Another type of housing is a housing complex with apartments for older people but also for young people, most often students. As stipulated in the housing contract the residents are supposed to help an older person with some household tasks or to provide them with company for a minimum amount of time each week. In some countries staying with your children in old age is more common than in others – in the Nordic countries this is very unusual and definitely nothing that older people wish to do. Different varieties of these type of housing exist or are being tried out in different countries. social aspect of the housing situation – from many countries loneliness among older people is reported, and here the housing situation can be a key issue. As partners and close friends pass away and close family members are perhaps further away this is an issue that needs to be taken into consideration. 12. To keep in mind when discussing older people’s housing choice is that many have limited knowledge about the housing market since they have not been active for a long time. Even if there are good housing options suitable for older people, studies have shown that they might not be aware of them. There is also an affordability problem, that is housing options may be available but can be considered to costly in particular to low income groups – and we know that often older women are among the most vulnerable – women the outlive their husbands but are left with a minimum income as for the generation that now constitute the elderly – most women have not been active full-time in the labour market and as a result have a very low income from pension. Similarly, recently arrived old immigrants may lack resources as they have not spent much time in the Swedish labour market and are left with a very low pension limiting their housing possibilities. However older people on low income in Sweden can obtain a housing allowance and a housing supplement on top of their pension but housing costs may still be excessive – in particular in new production.
  6. 6. 6 To provide information to older people about housing options may trigger older people to find housing adequate to their needs, studies have shown positive results from such information initiatives performed by municipalities or housing companies. 13. In Sweden, and the other Nordic countries for that matter, the dominating housing policy is ageing in place – that is to allow as many older people to age in place with the assistance of home care and medical care. The possible dilemmas of the ageing in place policy is that more people are very old, above the age of 80 and this proportion is growing in the years to come. In the cities as we have seen, different housing alternatives develop as a result of an increased demand – but housing markets in small municipalities, in particular in areas that have suffered from population loss for many years have limited possibilities to offer modern and accessible housing to its population as no housing companies are prepared to invest in housing in de-populating areas, at least not without government support. These areas are also the ones that contain the largest share of older people. 14. In order to satisfy the housing needs of an ageing population there are a few things we can think about. We need to adjust the housing supply – that is the type of housing on offer - according to demographic development and in relation to where and how older people are already housing as we know this will influence their choice of housing – there is also need to offer a choice of housing types to cater for the different needs and preference of older people. - and according to the affordability and what older people are able and prepared to pay in relation to their current housing situation. We need to identify and make use of different actors such as housing companies and different organisations in order to create good housing to all older people and provide information on possibilities and housing choice. 15. We should do this in order to - Make older people feel secure about finding a good place to live in old age - Understand the responsibility older people themselves are prepared to take on, regarding their housing situation - Create housing that is sustainable over time