Joining the dots for ageing in place

A chart shows the four main features of Lifelong homes: Safety, Walkable community, Visitability, and Affordability.A research paper from Colorado State University brings together all the elements for successful ageing in place – universal design in housing, walkable and wheelable communities and a discussion on home and place, and what it means for residents. It shows how simply providing infrastructure is insufficient to support population ageing. While the situation is a little different in the US, the research supports Australian studies and the advocacy for universal design in housing. However, the recommendation for market incentives in terms of certification has not worked in Australia, save for the specialised homes specifically for people with disability. It is a similar situation in New Zealand. It has not produced mainstream uptake of accessible housing.

The tile of the report is, Colorado Lifelong Homes: A review of barriers and solutions for aging in place. 

Abstract: Colorado’s aging population is growing, yet our housing options are not evolving to support this population. The need for housing that accommodates older adults as they age is crucial to balancing demands on other services, such as assisted living facilities, and to support successful and healthy aging. Most homes in our state are not built using principles of universal design that support successful aging in place. The outcomes of community and industry engagement activities show that advocating for lifelong housing is a critical step to help advance age-friendly housing in the state of Colorado. This paper summarizes key research and industry trends related to lifelong homes, the barriers in the marketplace, and the key qualities of lifelong homes. Based on this research, we present a path forward for advancing affordable, healthy, and safe home options for our growing population of older adults in Colorado and beyond.

 

What evidence? I’ll stick to what I know

Basilica tower at Pisa, Italy. It shows the lean to the right compared to the Basilica building. A culturally-ingrained habit of confirmation bias might be one of the reasons we still don’t have universal design in mass market housing. “This is the way it’s been done in the past, and no one’s been sued, therefore we will stick to this”. This quote from a stakeholder in an article by The Fifth Estate might be why the house building industry is missing the big picture.  The article is based on research by Australian Housing and Urban Research Institute where they looked at the question of social housing being treated as infrastructure in the same way as transport. But should it be treated as infrastructure or continue to be treated as welfare? According to the article, the most popular form of evidence used was feedback from previous projects: which implies that the practitioners tended not to look outside of their comfort zone. That’s how confirmation bias begins especially when the building industry claims that research is too hard to understand.

The Fifth Estate Article is titled, Why the building industry and social housing are missing the big picture. The AHURI article is a Policy Evidence Summary, Understanding business case frameworks for social housing. It is based on the Final Report No. 312.  

The cost of not including UD in housing

new home construction site with timber on the ground.A New Zealand report on the value of including universal design in all new homes claims that it is more costly not to incorporate these features. It found that for $500 the design of most new builds could incorporate these user-friendly features. However, some designs could cost up to $8000, if they needed major changes, but costs could be avoided if the redesign was configured within the current footprint. The costings are for both materials and labour.

Their analysis was for the whole population because there are cost advantages for including UD features from the outset in all new homes. Today’s new house has a high likelihood of being occupied by a family that has disability or ageing present. This is in line with the landmark study by Smith, Rayer and Smith in 2008.

While this report does not quantify any cost savings to health budgets, it points out that there are savings to be made. For example, each fall at home has an average medical cost of more than $1000. Even if only 10% of falls were reduced, this would be a saving of $27m per year. These and other saved care costs further justify the requirement to have UD features in all new homes.

This is a very comprehensive report with cost calculations based on existing floor plans for new homes. They use the term User-Friendly in their reporting as this captures the concept that the features are beneficial for everyone.

The title of the 2011 study is Lifetime Housing – The value case. It was funded by Branz, the New Zealand building research body. It was referenced in the WHO Housing and Health Guidelines in the chapter on accessible housing. The WHO report claims it is 22% more cost efficient to include the features in all new builds.

Flexible housing offsets risk

Picture of a tall long skinny house with white lattice covering. It fits into a driveway.The current standard design ideas for homes goes back more than a century. It’s time for a rethink on home design to suit the way we live our lives now is the claim in an article by Kirsty Voltz in The Conversation. Home designs are not keeping up with societal changes that include affordability, size of homes, accessibility across the lifespan, and designing so that as lives change, the interior of the home can adapt to suit. The risks are in not recognising the need to change and adapt to current circumstances, lifestyles, societal changes and personal aspirations. The article contains links to other references and concludes, “Existing housing stock is designed around the numbers of bedrooms and bathrooms that appeal to the market and so fails to be responsive to what people need from housing in the 21st century.” This includes the need for an update to the National Construction Code for creating homes that provide at least a basic level of accessibility for all. The picture is of the 3 bedroom home that Kirsty Voltz designed to fit in the space of an obsolete driveway.

Designs for Quality of Life

Dr Phillippa Carnemolla is in the news for her work on home modifications and how it can improve the quality of life for older people and people with disability. In the UNSW Newsroom article, she says, “I want it to be much easier for people to have houses that they can live their entire lives in with autonomy and mobility and freedom.”  As an industrial designer, she has a passion for design and human rights.

Phillippa’s PhD study showed that “improving people’s home environments not only impacted the amount of care received in the home – it almost halved the amount of care – but it changed relationships.” She goes on to say, “Inclusive design is design that enables people to have that quality of life that we’re talking about – so to participate, to be as independent as possible, to be autonomous and to live in the world without having to ask permission.  It’s about how we include people in the research and design process so that they’re a participant in that decision making and that what we get in the end works for as many people as possible.”

Kitchen Drawers with easy grip handlesRead the full article by going to the UNSW Newsroom website. You can also read one of Phillippa’s conference papers.  She is currently working on a project providing supported accommodation for people at the highest level of need; people who require assistance to be available 24-hours a day.

Dr Carnemolla is a Director of Centre for Universal Design Australia.  

Relationship between housing and health

A yellow brick house with yellow steps to the front door set back under a red brick archway.By undertaking a systematic review of the literature, Janet Ige and colleagues in UK found there is a strong association between housing and health. However, it is not clear that there is a causal link and their article argues that more research needs to be done. The team found more than 7,000 studies on the topic, with 39 matching their criteria for analysis. Findings showed that housing refurbishment and modifications, provision of adequate heating, improvements to ventilation and water supply were associated with improved respiratory outcomes, quality of life and mental health. The title of the article is, The relationship between buildings and health: a systematic review, and this can be downloaded from the Journal of Public Health, or you can download the PDF directly. 

Abstract: Background – The built environment exerts one of the strongest directly measurable effects on physical and mental health, yet the evidence base underpinning the design of healthy urban planning is not fully developed.  

Method: This study provides a systematic review of quantitative studies assessing the impact of buildings on health. In total, 7127 studies were identified from a structured search of eight databases combined with manual searching for grey literature. Only quantitative studies conducted between January 2000 and November 2016 were eligible for inclusion. Studies were assessed using the quality assessment tool for quantitative studies.

Results: In total, 39 studies were included in this review. Findings showed consistently that housing refurbishment and modifications, provision of adequate heating, improvements to ventilation and water supply were associated with improved respiratory outcomes, quality of life and mental health. Prioritization of housing for vulnerable groups led to improved wellbeing. However, the quality of the underpinning evidence and lack of methodological rigour in most of the studies makes it difficult to draw causal links.

Conclusion: This review identified evidence to demonstrate the strong association between certain features of housing and wellbeing such as adequate heating and ventilation. Our findings highlight the need for strengthening of the evidence base in order for meaningful conclusions to be drawn.  

Home adaptations: Costs? or Savings?

A man kneels on the floor, he is laying floor tiles.Lesley Curtis and Jennifer Beecham argue that the expertise of occupational therapists can help save money in health budgets as well as improve the lives of people needing assistance at home. Their article is about home modifications and identifying the hidden savings in providing home adaptations. They explain their methods and argue that significant savings can be made if you tally all aspects into the calculations. The article is available from Sage Publications. You will need institutional access for a free read. The title is, A survey of local authorities and Home Improvement Agencies: Identifying the hidden costs of providing a home adaptations service.

Abstract: The Royal College of Occupational Therapists has launched a campaign to demonstrate that occupational therapists improve lives and save money for health and social care services. Occupational therapists play a major part in supporting older and disabled people to remain in their own homes through the provision of home adaptations. Among other benefits, studies have shown that home adaptations can reduce falls in the home and could therefore help reduce hospital admissions. However, to evidence savings, information on the full costs of supplying and fitting home adaptations are needed.

Method: Local authorities and Home Improvement Agencies were surveyed in 2014–2015 to obtain the information required to estimate these costs. Time inputs for staff involved in their provision have been collected and staff costs and total costs calculated for 18 commonly fitted adaptations. The process of obtaining publicly funded home adaptations is also discussed.

Findings: For major adaptations, the total mean cost was £16,647, ranging from £2474 to £36,681. Staffing costs absorbed up to 24% of the total mean cost. The total mean cost for minor adaptations was £451, with average staffing costs forming 76%.

Conclusion: Staff costs are an important consideration when estimating the costs of providing home adaptations.

Ageing better at home

Bathroom in an old house has been stripped and bare walls and old tiles remainBecause the majority of our homes are designed as if we are never going to grow old, most of us will need to modify our home as we age. That’s if you want to stay put, which is what most older people say is their preference. An easy to read and nicely presented report from Centre for Ageing Better in the UK gives an excellent overview of how home modification improves quality of life, mental health and overall independence. All good reasons for universally designing our homes from the start for the whole of our lives so modifications aren’t needed or are at least easier to do. Dwellings might be a “product” to property developers but for the rest of us a “home” is the pivot point for living our lives.

A great quote from a study participant to reflect upon, “You don’t get taught, at any point in your life, how to become an older person. It just sort of happens, you know…”. So waiting for consumers to ask for universal design isn’t going to work.

For a more academic take on a related issue of housing quality and health see a longitudinal study from UK.  

Housing: what theory and what research?

facade of an apartment building showing long balconiesThree academic articles come together for an intellectual tussle on housing theory and policy. David Clapham claims that there is a divide between researchers who focus on policy and those who focus on theory, and he asks where theory for housing research should come from and what it would look like. Hannu Ruonavaara, poses four positions about housing related theory: Is it possible to have one theory for all housing related research?; is it desirable to have one?; should we scrutinise housing as a special activity and experience?; and can we construct a theory about the relationships between the housing system and features of society?  Manuel Aalbers, who in his article, asks What kind of theory for what kind of housing research? responds to both academics. He discusses the pros and cons of their arguments. The point about housing research being largely for the audience of other housing researchers is well made. He believes it is more important to demonstrate the relevance of housing research to other social scientists. More importantly it needs to influence policy. Not light reading, but fascinating if you are a housing researcher or interested in housing policy. 

Downsizing? Baby Boomers defy predictions

Facade of a large two storey home commonly called a McMansionIt’s unlikely that baby boomers thought about their latter years when they bought their dream home. But they are having to think about it now. The renovation industry is due for a boom, particularly those versed in age-friendly universal design features. Housing experts predicted “the great senior sell-off”. But boomers aren’t selling – they are staying put as Bruce Judd and his team at UNSW found. They like what they’ve got, and they are comfortable in their neighbourhoods. So retirement village living is less likely to attract. 

Mimi Kirk in a CityLab article looked at new research from Harvard Joint Center for Housing Studies that discusses issues related to housing type, affordability and the different expectations of millennials and boomers. One other reason for boomers not selling is that millennials are not really interested in the style of homes of their parents and grandparents own. There goes the myth that boomers are (selfishly) holding onto homes that millennials could buy. Millennials are looking for smaller more affordable starter options. This also goes for boomers who want to downsize. Time for developers and builders to take note and to take up the challenge of all new homes by 2020 to be to the Livable Housing Design Guidelines.