Description

New challenges arising from demographic change

In all European nations, the population will grow steadily older in the coming years.[1] In addition, longer life expectancy means that there is a greater proportion of people of an advanced old age. As the risk of becoming dependent on ongoing nursing care increases disproportionately with age, the level of care and support facilities for the elderly will change, both in terms of quantity and quality, to a degree that is generally still underestimated today.

Societal conditions are changing. In Germany, the greater proportion of all care for the elderly is undertaken by families, sometimes by friends and neighbours in conjunction with external services. In Europe, the level­ of support provided by families and relatives will change in the coming years as fewer children are being born[2] and because many have moved away from their home environment to find work, while the older, less mobile generation remains where they are. In addition, the proportion of women who work has risen, resulting in less capacity for informal assistance.

Projection of the old-age-dependency ratio (65 years and older) in Germany

Old-age dependency ratio

The old-age dependency ratio describes the ratio of people aged 60 years and older to 100 people aged between 20 and 59 years. Dataset: Germany overall (values prior to 1990 are mean values for GDR and BRD).

It is foreseeable that the cost of services for the elderly will escalate rapidly, caused by an increased demand for affordable care and support services coupled with unfavourable conditions. The aging of society in general­ will be accompanied by a parallel decline in the level of support provided by families, resulting in a contradiction for service providers: the number of elderly people dependent on help and services of various kinds will rise; at the same time the cost of these services will rise disproportionately as increasing demand leads to bottlenecks in supply and higher prices.

In the interests of the elderly and of the public sector, the changes described make it essential to develop new, innovative forms of living that foster self-organised arrangements and integrate forms of mutual assist­ance. In addition, it will be necessary to develop a variety of different offerings so that people with different needs can find an option appropriate to their requirements: the ability to remain independent for as long as possible and to make use of care and support only where absolutely necessary.

Forms of living for the elderly

The great majority of old people – in Germany over 90% of over 65-year-olds – live in private households. In Germany, of those in need of ongoing care, nearly a third live in nursing homes and around half are cared for by relatives. In addition to nursing homes, there are a number of professionally-run alternative forms of housing with combined care and support services.

Assisted living / serviced apartments

Assisted living or sheltered housing facilities with outpatient nursing and health care has existed for several years and increased since the introduction of long-term care insurance. The basic principle is that each person lives in “their own four walls” – whether as tenant or owner – and leads their everyday life more or less how they wish. The design and fittings are conceived with the needs of old people in mind, for example taking into account possible mobility restrictions, so that they can still live independently even when in need of ongoing care and assistance. This is complemented by a series of professional services (including nursing care) which can be taken advantage of as needed and are payable only when used. Ancillary services are provided in different combinations and extents and are usually covered by a service fee. The concept of sheltered housing / assisted living is provided in a whole variety of different constellations:

• Housing schemes employing external service providers including outpatient health care and nursing;

• Housing schemes with their own staff who provide outpatient care;

• Housing schemes with their own dedicated nursing facilities;

• Housing schemes alongside a nursing home.

Retirement homes and senior residences

Retirement homes and senior residences are privately financed, well-equipped housing schemes consisting predominantly of suites as well as small apartments. Care and support is provided at home; sometimes addi-tional inpatient care in a separate part of the complex is part of the comparably exclusive service.

Retirement homes and senior residences often have a hotel-like character with a café and/or restaurant. In most cases basic services are provided, such as lunch, cleaning services and general support services. Retirement homes and senior residences offer a series of more or less generous common areas. These can include an appropriately generous entrance lobby, a library, swimming pool, well-equipped common rooms such as a club room or fireside room, and a sun terrace. In addition, they offer recreational and cultural activities from readings to courses, visits to the theatre and even holidays, at additional cost depending on the activity. Residents typically enter into a contractual agreement covering overall board and lodgings.

Communal flats, co-housing and communities

In addition to self-organised communal housing projects, an increasing number of professionally-run housing projects with a communal arrangement are appearing on the market. In some communal projects, each resident has their own apartment and lives in close quarters with others, for example in a shared house or a community of neighbours. In communal flats, each resident has their own living area rather than a distinct apartment. Communal flats are often shared by older, less able-bodied people, for example as an alternative to a nursing home for people suffering from dementia.

Urban-scale alternatives: neighbourhoods for young and old

For the future, the development of existing and new urban quarters as inter-generational neighbourhoods for young and old and the funding of community housing projects will gain increasing importance. Without such innovative solutions, local municipalities will be faced with the negative consequences of demographic change, for example the ageing of entire neighbourhoods without the necessary supporting infrastructure or the increasing financial burden of care provisions for the elderly. A study undertaken in 2006 shows that the current and, even more so, the next generation of pensioners are willing to consider new forms of living.

Current discourse focuses on forms of living in old age that not only make use of paid services provided on the market but also integrate means of informal support. In Germany in particular, sustainable urban development policies are accorded increasing importance. A German government report on the urban environment[3] emphasises the importance of cities as a living environment for all generations.[4] Housing policy aims need to be aligned with those of urban development.[5] Following this initiative by the federal government, a series of municipalities throughout Germany have implemented new approaches to local neighbourhoods,[6] promoting urban developments that give residents the chance to continue living in their neighbourhood until they die. The urban quarters are organised in such a way that informal support structures complement professional care services.

To encourage the development of neighbourhoods as places for young and old alike, it is necessary to under­take both built projects as well as social initiatives. For new building projects as well as conversions of existing buildings, the following principles are relevant:

• New housing projects for old people or major alterations to existing structures should strive for flexible solutions that make it possible to use or convert normal apartments so that their inhabitants are able to receive nursing care at home (“from living to nursing”).

• As one cannot expect to cover the increasing demand for care and support through paid services alone, it is necessary to encourage and promote networks based on mutual assistance. It is important to mobilise the help old people can give to other old people: “younger pensioners” are a potentially valuable source of voluntary help and have sometimes ten to 20 years “time on their hands”. Mutual support will only come about with the help of a formal structure and staffing, such as a residents’ association.

• New housing projects should ensure that services are available in the vicinity. To avoid unnecessary costs, each individual scheme does not need to have its own expensive-to-run services. Urban quarters can be organised in such a way that a “common care centre” can provide affordable services and round-the-clock cover, which can be called upon by the entire neighbourhood.

• The integrative approach of multi-generational neighbourhoods represents a model for the future: combinations of different housing options together with an easily accessible living environment (following the principles of Universal Design). Neighbourhood housing should be arranged so that it encourages the exchange of services between young and old.

• Housing schemes for old people that are integrated into local neighbourhoods can represent a focal point from which additional services for members of the local community in need of care can be based. They can provide, for example, a midday meal for young and old alike as well as different forms of recreational activities.

Innovative urban quarters in Europe for families and old people

A series of European case studies[7] undertaken as part of the model project “innovative urban quarters for families and old people”[8] describe approaches from different countries which focus on the integration of young and old at the level of the neighbourhood.

In the Netherlands, so-called residential care zones (“Woonzorgzone”) have been initiated since the turn of the century. These are neighbourhoods, settlements, sometimes villages which offer optimal conditions for assisted living. The aim is that the residents can continue to live their own lives as they grow older and when they become less mobile. Since the realisation of the first residential care zones, the term and concept of this form of accommodation has changed. They are now termed residential serviced settlements or quarters (“Woonservicewijken”). In this revised concept, care and support services are no longer solely for senior citizens but for all inhabitants in the neighbourhood. An example of such a settlement is the Woonzorgzone Moerwijk in The Hague.[9]

In Denmark too, there is a long tradition of urban and housing policies aimed at social integration where old people can live in normal apartments. For this reason no dedicated housing schemes for old people have been built since 1987. The idea that older people live alongside younger people in their home neighbourhoods has been accorded high priority and is anchored in legislation. Housing for the elderly (which is accessible, equipped with alarm systems and so on) is eligible for grant funding and schemes are scattered throughout existing quarters.

In Germany, current initiatives are examining how lessons from the aforementioned model projects can be transferred. In Braunschweig a former tram depot in the city centre is being converted into a new housing quarter for young and old.[10] From the very beginning, a series of events, surveys and activities were employed to involve interested parties in a multi-phase competition. The end result encourages different generations to live together, and the architectural design of the scheme is planned so as to adapt to the changing structure of generations in the years to come.

The experiences of the model projects throughout Europe can serve to elaborate new directions for sustainable urban development. Urban qualities and housing tailored to the needs of the people can contribute towards strengthening communal living for all generations.

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Originally published in: Eckhard Feddersen, Insa Lüdtke, Living for the Elderly: A Design Manual, Birkhäuser, 2011.