Nordic housing and ageing in place

How long can older people stay put in their homes? The answer rests on two things: home design and easy access to support services. Retaining a sense of connection to community is another important element which is why the quest to stay put is so strong. And of course, staying put also reduces the stress on the welfare budget. But are there alternative models of housing that can support older people in their later years? Three Nordic housing researchers found some.

A town nestling on the edge of a fjord with houses reaching up the hill. Nordic housing.

Older people aren’t all the same. One thing they do share in common – they want to maintain their autonomy and preferences.

Nordic countries have a reputation for providing strong social and welfare supports for their citizens. But population ageing is stretching the limits of these policies. The researchers reviewed the current situation in Nordic countries to identify issues and potential solutions. Using case studies they show how older people can live independently and inter-dependently.

The application of universal design across Nordic housing is enabling people to stay home longer. However, the case studies showed that loneliness is a growing challenge. Consequently, defining an age-friendly environment is much more than a step-free entry.

The challenge is to find solutions that promote activity, participation and a feeling of safety. Consequently, we need a joined up approach to housing and neighbourhood design. That is, apply universal design to everything. Then it will be good for everyone.

The way housing and urban environments are designed influences opportunities for informal social contact. Good examples are usually in designated specific older age communities. So the knowledge is there, it’s just assumed it’s only needed for older people.

Older people aren’t all the same

Too often it’s assumed that older people all need the same things. They don’t – they are as diverse as the general population. They have different lifestyles and want different housing choices. The one thing they share in common is wanting to maintain autonomy and preferences, especially as they become more frail.

The title of the article is Nordic approaches to housing and ageing – Current concepts and future needs. The article is relatively easy to read with case studies that show a variety of solutions, some of which are communal. The solutions enable older people to continue being part of their neighbourhood in different ways.

From the abstract

The Nordic countries have a reputation for having both universal welfare systems and high housing standards. However, the demographic development and ageing in place policies bring challenges to the present housing and care services for the older population. During the last decades, there has been a significant decrease in the coverage of care for older people. This is related to the increase of older people as well as challenges related to the availability of the workforce and raising care costs.

The objective of the comparative descriptive analyses is to point out the challenges and future possibilities for housing. This is illustrated by some new cases all of them showing solutions that enable older people to continue being a part of city life in their own neighbourhoods. They also show a variety of solutions that at the same time gives possibilities to live independently and live interdependent in different kind of co-housing and neighbourhoods.

A liveability framework for housing

A group of researchers in Queensland have developed a liveability framework for social and affordable housing. They interviewed key stakeholders from industry and government who make decisions about housing and housing policy. But will it work? With significant industry resistance to regulation changes, it will take more than an academic exercise to improve matters.

Building scaffolding representing a framework for a building.

Researchers tested the elements of the draft framework by interviewing stakeholders. They claim the framework has the potential to drive the adoption of better outcomes for whole of life solutions.

The five elements of the draft framework are:

  • Liveability – place based and community focused
  • Accessibility – person centres and community focused
  • Social, environmental and economic value – building the value equation
  • Regulatory and policy environment
  • Improving adoption

The case study used for testing the framework was based on an existing medium density development with access to transport and services. Twelve representatives from community housing, state government, advocates and industry associations were participants in the study.

The title of the paper is, Creating Liveable and Accessible Social and Affordable Higher Density Housing: the case of Green Square, Brisbane.

The social and affordable housing sector is a very small percentage of housing in Australia. The key issue is to gain adoption in stand-alone homes in master-planned sites which is 70% of all housing.

Upcoming changes to the NCC

The accessibility aspect of housing should be solved with the 2022 edition of the National Construction Code. This edition includes the key elements of the Silver level of the Livable Housing Design Guidelines. The housing industry continues to resist the adoption of these changes.

Editor’s comment: The framework is specific to social and affordable higher density housing, but offers nothing new to the this field of work. Similar frameworks attempt the same thing – trying to find a way to encourage implementation. Frameworks are clearly not the answer. This is a policy issue and not a design issue. Good designers are able to design out the problems, including cost, or at least design around them.

From the abstract

Ensuring liveability and accessibility in medium to high density urban housing and precincts is critical to maximise investment and minimise future risks to our community. This research investigates and develops our understanding of liveable and accessible social and affordable housing, with a focus on medium- and high-density urban precincts. The paper presents the findings of a case study undertaken in the Green Square Close precinct in Fortitude Valley, Brisbane.

Findings are derived from a literature review and in-depth interviews with key stakeholders from the housing industry and government. The results inform a liveability framework for social and affordable medium to high density housing utilising five key elements.

These elements include; 1) Liveability – place-based and community focused, 2) Accessibility – person centred and community focused, 3) Value equation – cost benefit, 4) Regulatory and policy environment and 5) Adoption and overcoming barriers.

The liveability framework also establishes sub-elements across these five elements to improve understanding of whole of life needs. The development of a liveability framework for social and affordable medium and high-density housing presents opportunities for decision making in the co-creation of, and investment in this critically needed housing.

Inclusive energy efficient home renovations

A case study from the Netherlands describes an inclusive process for designing energy-efficient home renovations. A neighbourhood of 280 apartments is the subject of the study. With a mix of homeowners, renters and social housing tenants, it was essential to involve residents in the renovation process.

Several tall apartment buildings situated next to a canal.  Energy efficient home renovations.

Involving residents in major renovations is essential for bringing together the technical and social aspects of design.

The principles of civic and energy justice underpinned the approach to the project. Given that the resulting designs will largely be the same for every home, they need to be inclusive and considerate of ongoing energy costs for everyone. That means an inclusive design process is required.

Participatory action research

Expert stakeholders and six residents were interviewed and 50 residents were observed and interviewed during a tour of the demonstration apartment. Mutual learning was a key part of the iterative process involving prototypes.

Attention was paid to diversity, accessibility of research materials and interview materials were both verbal and visual. Technical design features were part of the results, but values emerged from the process. These values were health, sustainability, property value, cost of living and comfort.

The paper goes into more detail on the findings and the process. As part of the process, researchers developed a renovation guide to help residents understand what the proposed changes mean for them. They acknowledged time constraints which meant residents did not have time to experience the apartment. Rather, they only had time to view it.

Recommendations

Recommendations for improving the process include:

  • Location. Any sessions should be in the neighbourhood and in an accessible venue.
  • Time. Different meeting and interview times will suit different people.
  • Invitations. The guide acts as an invitation but might not work for everyone.
  • Language. Dutch is a second language for some people so a session in English might be necessary.
  • Other options. Apart from meetings, phone and email should be available. Not everyone feels comfortable in a group.

The lessons from the paper could be applied in housing situations such as social housing and co-housing. It also adds to the literature on inclusive design and co-design, and participatory action research.

The title of the article is, Values arising from participatory inclusive design in a complex process. There are diagrams to illustrate the complexity of designing an entire home and it’s technical systems, indoor climate, the lives and values of residents, and connection to systems and services.

From the abstract

This paper addresses inclusive design in a situation of complexity and how to improve it. The focus is on the inclusive design of a complex process and its tools, which is increasingly an issue in systemic design challenges. The current situation of climate change means we need to work on sustainability and inclusion at the same time.

The paper presents a case study of an energetic renovation process and the stakeholders’ activities and views in it. In a research-through-design process, the paper traces the possibilities to intervene in the process with communication tools to increase inclusivity of both process and outcomes.

Energy efficiency and universal design

Are energy efficiency and universal design incompatible? Potentially. Energy efficiency has an engineering approach and universal design has a sociological approach. This is what makes them incompatible according to researchers in Belgium. Energy efficiency is a measurable product whereas universal design is a process. So how can they both be addressed in home renovations?  This was the topic of a conference paper in 2016.

Thinking has moved on and we now talk about sustainability from both perspectives and the importance of having both. However, this paper brings the concepts into the same conversation and highlights areas of potential conflict. The paper has some interesting and explanatory graphs and comparisons that are worth a look especially for academics and theorists. 

Roof of a house covered in solar panels

The title of the paper is, Energy Efficiency and Universal Design in Home Renovations – A Comparative Review

Housing options in later age

Long term care, nursing homes, and residential care are names for care in a facility dedicated to supporting older adults. But how many people desire this option? Usually it is a place of last resort because staying put is no longer an option. But can we do better than this?

Residential aged care, not to be confused with retirement villages, is usually a last resort rather than a choice. We all need better housing options in later life.

Front Cover of the report. Staying put in later age. Housing options in later age.

A report from Canada looks at the issues of long term care, ageing in place with a brief mention universal design. The 14 page document takes a Canadian perspective of international solutions and options which are all specialist solutions.

The first recommendation is to encourage alternatives to long term care. The alternative recommendation is to develop housing and care models that incorporate universal design features into new builds. The second recommendation focuses on support services.

The report discusses seven different types of housing, five of which are based on segregation by age. Here is a brief overview:

Current housing options

Independent Living /Active Lifestyle Accommodation is for adults requiring minimal assistance. They are either detached homes or suites within apartment buildings. These solutions are best when offered within the existing neighbourhood.

Assistive Living / Supportive Housing is designed to provide safe and accessible homes for people requiring personal care and housekeeping services.

Retirement Living homes are usually privately owned and suit older adults with higher incomes.

Co-housing consists of private dwellings with kitchens, bathrooms, bedrooms and shared common areas such as gardens and walkways. This model is not exclusively for older adults and offers connectedness as well as privacy.

Naturally Occurring Retirement Communities (NORCs) develop overtime due to older adults remaining in their own homes as they age. This model is aimed at helping older adults to live as independently as possible. The concept of NORCs originated in the US.

Villages are member-based, grassroots organizations developed and governed by older adults in the US. Villages provide free and discounted services and staff and volunteers coordinate activities. This model helps reduce the risk of social isolation. Faith based organisations or private companies own villages in Australia.

Intergenerational housing is the fastest growing housing arrangement in Canada. A diverse range of individuals of different ages live together and share life experiences and skills. Multigenerational housing encourages older adults to remain engaged in the community.

The title of the report is Housing & Care Models to Support Older Adults to Remain in Their Communities. The report concludes with additional resources and references.

In Australia…

More people will have the choice to stay in their current home as more dwellings are built to the Livable Housing Design Standard mandated in the National Construction Code. However, only Queensland, ACT and Victoria have adopted the Standard in their building codes as of May 2024. Other states aim to adopt later in 2024 or 2025. However, NSW and WA have made a policy decision not to adopt the Standard.

Including people with intellectual disability in co-design

Picture of a large family looking jubilant outside their housePeople with intellectual disability are often left out when it comes to design. Whether it’s built or digital environments, services or products, this group is often overlooked. However, with co-design methods, people with intellectual disability could and should be included. But, this is still a new idea and there is very little literature or case studies on working with this group.  The literature review found the following gaps in knowledge:
    • General lack of literature on co-designing with people with an intellectual disability
    • No specific literature encapsulating the co-design process, in the context of intellectual disability, and housing
    • No frameworks or benchmarks on co-design with people with disability
    • Lack of evaluation of the design outcomes of co-design process
    • Lack of research that can assist parents plan for their ageing children. 
Housing design for people with physical disabilities has evolved over time but is not easily adapted to suit people with intellectual disability. There is an obvious need to consider people with both intellectual and physical disability.  The title of the article is, Co-designing in Australia housing for people with intellectual disability: an integrative literature review“. You can download the web version or the PDF version

Intellectual disability and social inclusion

people walking down a wide pedestrian zone. Intellectual disability and social inclusion.Local government authorities are exactly that – local. They are the tier of government closest to the everyday lives of people. Local neighbourhoods are where people feel either socially included or not. People with intellectual disability are much more likely to feel socially excluded. A research project undertaken by the University of Technology (UTS) took a novel approach to the issue. To begin, they recruited researchers with intellectual disability to participate in all aspects of designing and carrying out the research. This was a key step for informing the research process. The purpose of the study was to understand the experiences of people with intellectual disability in their local community.  They found that people with intellectual disability have valuable information to share. However, their voices are unheard and consequently their needs not understood. The discussion starter was the question, “What would you do if you were boss of your local council?” The answers were that they want their council to:
      • Provide accessible information in a range of formats about what is happening in the community and how to participate.
      • Provide someone to speak to – or even better, face to face contact.
      • Employ people with intellectual disability.
      • Help them access better transport and find ways to make them feel safer and more welcome. 
      • Improve public toilets and offer quiet spaces at noisy, busy events. 

A framework for change

The researchers adopted the framework the WHO Age Friendly Cities program. which is pitched to community life at the local level. This is a good framework for councils to use with people with intellectual disability as well as older people.
WHO age friendly logo of 8 petals showing the 8 domains of life.
WHO 8 Domains Framework
Participants wanted to know what is available and how to get around the community. They also wanted respectful interactions with others in the community and said familiar faces and places were important. These findings have some important information for councils and their social policy. Grouping people with intellectual disability under the generic term “people with disability” risks leaving them out. Councils should adapt communication and engagement strategies to suit people with intellectual disability.  The title of the article is, Opportunities to support social inclusion for people with intellectual disability at a local level. Published in the Design for All India Newsletter. It is based on a published study, If I Was the Boss of My Local Government: Perspectives of People with Intellectual Disabilities on Improving Inclusion. The author is Dr Phillippa Carnemolla who is also a CUDA board member. This is a comprehensive article with recommendations for local government. 

Downsizing? But where to?

A row of flat front row homes in blue and white. Downsizing? But where to?The idea of downsizing is appealing to empty-nesters. But where can they go?  The biggest barrier to downsizing is finding a suitable home in the right location. Many empty nesters just want a smaller home and yard. Governments have a vested interest in older Australians having a home in which it is safe to grow old. It’s cost effective for everyone.

Sometimes it isn’t the home they want to downsize – it’s the garden maintenance. ‘Empty’ bedrooms do not necessarily mean that a home is under-utilised.  This is a crude measure because spare bedrooms are needed as guest and hobby rooms. Spending time at home means the home has to do more. A home too small limits options.

An expanse of green lawn in a suburban back yard.The Conversation discusses these issues and has links to well-researched reports. The title of the article is, Half of over-55s are open to downsizing – if only they find homes that suit them.

A similar article was published earlier in The Conversation titled, Lack of housing choice frustrates would-be downsizers.

When it comes to house size, Bruce Judd and colleagues from UNSW found that retirees generally want three bedrooms for flexibility of lifestyle. Some for visiting family and looking after grandchildren. Others need room for hobbies or a study. Some couples sleep separately for health reasons. Typically, retirees spend more time at home now that they are not working, so space becomes even more important.  

Baby Boomers defy predictions.

Facade of a large two storey home commonly called a McMansion Housing experts predicted “the great senior sell-off”. But baby boomers aren’t downsizing – they are staying put.

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. Millennials are generally uninterested in the style of their parents’ homes. So there goes the myth that boomers are (selfishly) holding onto homes that millennials could buy. 

Policy makers think that downsizing is largely about finances and homes being too large to suit ageing in place. But the evidence is something else. Research findings put to bed some of the myths younger policy makers have about older people and their ideas on housing.

“…high cost of new multi-storey apartments means that householders don’t necessarily have enough money from the sale of their larger family house to buy an apartment, particularly after stamp duty, bank and real estate agent fees, and moving costs are included.”  AHURI report, 2018.

Suitable housing in the future?

In the future, people living in Victoria, ACT, Queensland, NT and Tasmania will have the benefit of universal design features in new homes. However, the NSW, WA and SA governments have decided that this important change to the building code isn’t necessary. To keep up to date on the latest, follow the ANUHD website and join their network of supporters. The 2022 edition of the National Construction code will have the updated design features. 

 

Design with people with dementia

Front cover of the thesis. Design with people with dementia.It’s not often that people diagnosed with dementia get asked what works for them in terms of home design. People with dementia want to age in place in the same way as others. However, this requires integrated and diverse living solutions. The only way to do this is to design with people with dementia.

In a master’s thesis, Kembhavi explains the background to her research and the research objectives. Using a co-design process she identified three key concepts important to people with dementia: choice, integration, and service support. The process was not linear – many modifications and iterations were required to arrive at the final result.

To begin, the idea of aging in place was investigated. This inquiry created the first design challenge. That is, factors that make aging in place difficult. This resulted in the adoption of a user-centered design philosophy.  User-centred design focuses on the requirements and desires of users throughout the concept development process.

This paved the path for the second research topic: ‘how can people with dementia be involved in developing living solutions for themselves?’ 

Title of the thesis is, Integrated living environment for people with memory decline. Author Shreya Kembhavi, Aalto University. Helsinki city housing company housing was the context for the research.

This masters thesis covers a literature review, design methods, and an implementation strategy.  It includes case studies with images and explanatory graphics. The conclusion explains the background to the research, and how the research was done.

From the abstract

Giving people the ability to choose their way of life is an effective way of developing living alternatives for people with dementia. Residential services and spaces, engagement services and spaces, and support services and spaces must be addressed through service and space provision to enable aging in a place of choice. A strong network of these elements in the area could potentially allow a greater population to age in place.

By integrating the serviced housing with the housing for other user groups, the thesis proposes a strategy that incorporates serviced housing as a component of the standard housing stock. The serviced housing is built on the principles of residency, engagement, and support. As part of this approach, new services such as drop-in consultations for persons seeking advice, social spaces such as a cafés, and residential services such as a dementia hotel are proposed.

A branding strategy is advised to de-stigmatize and incorporate people with memory decline. This is an attempt to change an image associated with such spaces, into one that is inclusive and open to the community. The thesis with demonstration of the concept’s scaling and its benefits in the realm of living solutions for people with dementia.

Universal design in housing: is cost the real issue?

A spacious kitchen with white cabinetry. Is cost the real issue?
Image by Taylor’d Distinction

After twenty years of citizen advocacy for access features in new housing, the Australian Building Codes Board  commissioned a cost benefit analysis which informed the Building Ministers’ decision to say yes, let’s do it. But is cost the real issue? And are those costs real?

An article in The Fifth Estate discusses the way various facts and figures go unquestioned. Figures plucked from the air appear to carry more weight in NSW, SA and WA than actual evidence presented to the Building Ministers Meeting. Victoria, Queensland, Tasmania, ACT, and NT are ready to roll with the new features. However they have delayed adoption due to industry lobbying. That will leave mass market developers with different rules in different states. 

The title of the article is, States disagree on access features for new housing

The Guardian also has a good article with a similar message. 

But Gold is more cost effective

Front cover of the Accessible Housing report.
The Melbourne Disability Institute and Summer Foundation submitted a response to the Consultation RIS for accessible housing with the recommendation that, based on the independent assessments and research they commissioned, Governments adopt Option 2, that is to regulate to Livable Housing Gold Level in the National Construction Code, as the benefits clearly outweigh the costs.
The Melbourne Disability Institute critiques the final cost benefit analysis by the Australian Building Codes Board as being incomplete. It goes as far as saying the report “contains and inherent and under-acknowledged bias against building code reform”. It was prepared by Professors Andrew Dalton and Rob Carter.

The independent assessments and research are:

    • REVIEW OF THE ECONOMIC REPORT
      The review identified four key issues that individually have a large impact on the benefit-cost ratios reported. Taken together, they totally reverse the economic credentials of the regulation. 
    • Please note: The issues raised in the analysis are highly technical. The researchers provided more concise executive summary to improve accessibility. If you have particular questions, please contact md-i@unimelb.edu.au.
    • SURVEY OF PEOPLE WITH DISABILITY
      This extra data aligns with the advice from the Office of Best Practice Regulation to include qualitative analysis in all Regulatory Impact Statements, particularly when important elements cannot be quantified or monetised.
    • AUDIT OF ACCESSIBLE FEATURES
      This study found that many accessibility features are already incorporated into the most popular house designs being built in Australia, but not in a systematic way. It also demonstrates that accessible features are basic elements of good house design for the general population, and indicates that the likely cost of including further accessible features to be fully consistent with the accessibility standards in new builds is very low.
    • SUPPLEMENTARY REPORT
      MDI and the Summer Foundation prepared further information for the ABCB on 6 October 2020 to substantiate their position that that governments should adopt Option 2, which would set minimum mandatory standards for accessible housing at the Gold (LHDG) standard.

Home Truths: Dispelling Myths

Front cover showing an older woman wearing glasses and a headscarf. She is sitting in an armchair.Across the globe, advocates for universal design in housing find themselves faced with the same myths. And these myths prevail in spite of hard evidence. AgeUK and Habinteg have put together a fact sheet, Home Truths – rebutting the 10 myths about building accessible housing. They challenge the ideas that it is too costly, difficult or undesirable. And also why the solution is not in building more age-segregated developments. 

Note: In the UK, Part M4 (1) of the building code mandates some basic access features. There are two other sections; one is to include adaptability, and the other is to be wheelchair accessible. However, these are optional unless it is set down in the local government plan because there is a community need. Developers challenge these plans asserting that the local authority has failed to prove the need. This indicates that industry will continue to fight for what suits them rather than occupants of the home.  

 

The value of home modifications

A white Labrador dog sleeps behind the couch with a view to an alfresco with level access. Value of home modifications.Quantifying the value of home modifications is a tricky business. It depends on who is doing the valuing. Governments look immediately to costs and benefits while home occupants look at their quality of life. Research findings of cost benefits and improved quality of life have done little to change either policy or home design. So we have yet another research article. 

Jesse Abraham’s paper points to our ageing population and the lack of suitable housing for later life. It’s time for America’s existing housing to be made safe and accessible for ageing in place, says Abraham. The healthcare cost of falls is over $50 billion a year in the US. And that doesn’t count the quality of life costs to individuals and the inconvenience to families. 

Abraham looks at the current evidence and takes an economic approach to the issues. That means there are a few equations and tables in his paper. His key argument is that there are cost efficiencies for society and for the government to provide subsidies for home modifications. 

Abraham is curious that so few older people think about modifying their home in preparation for ageing. Usually it’s done as a reaction to a medical event and then done last minute. This is when the family is already coping with other healthcare needs. 

Australian research by Carnemolla and Bridge underpins much of the work in this paper. Abraham cites three of their papers using their map of the evidence. He acknowledges that there are other quantifiable benefits such as improvements in physical and mental wellbeing. 

A government incentive

The key point in the paper is that the cost of updating homes with accessibility features is a cost effective healthcare prevention. Given that older people are reluctant to take steps for their own wellbeing there is much to gain by providing a financial incentive. If governments were to pay half they would still be saving healthcare costs. 

Abraham says that this is a difficult argument to prosecute because there will be costs for those who may never benefit. Perhaps if he had taken a universal design perspective he would see that benefits go beyond older people.

The title of the article is, The Cost Efficiency of Home Modifications to Reduce Healthcare Costs. If you skip the technical bits, this is a relatively easy read. It has a lot of useful information on this topic and good references. 

OECD housing report: A crisis on the horizon

Brightly coloured graphic of little houses clustered togetherA new OECD working paper says there is a housing crisis on the horizon for people with disability and older people. Most jurisdictions in Australia are signing up to some basic universal design features in all new homes. But will it be enough?  In the UK, their home access regulations are being reviewed because they don’t go far enough. So partial access solutions are no solution, but for policy-makers it looks like they are doing something. 

Front cover of the OECD working paper on the housing crisis on the horizon.The OECD working paper says there is talk about housing for people with disability, but no real action. The shortage of suitable accessible housing is still lacking. And it will get worse. By 2050 more than one quarter of the population will be over 65 years – it’s 18% now. Major modifications will be needed if people are to age in place. 

Social housing is a help provided it is accessible, but it is not the best option for everyone or every family. Grants and loans for home modifications can help too. People with complex needs might need specialised accommodation. Briefly, the working paper suggests the following policy actions:

    • Finding out what people with disability need from their housing and what supports are available. An evidence base is important.
    • Developing tools to match available stock with people needing it.
    • Strengthening access standards for new residential construction.
    • Providing financial incentives such as loans and income-tested grants for upgrading existing stock. 
    • Ensuring people with disability benefit from increased accessible, affordable and social housing. 

The document concludes with ways that governments can improve housing support for people with disability. It also has examples from different countries. The title of the report is, A crisis on the horizon: Ensuring affordable, accessible housing for people with disabilitiesThe writing style makes this type of document relatively easy to read. 

Abstract

This paper discusses housing challenges facing people with disabilities in OECD and EU countries, and policy supports to make housing more affordable, accessible and adapted to their needs. It focuses on the adult population with disabilities living outside institutions, drawing on data from the European Union Survey of Income and Living Conditions (EU-SILC), household surveys, national population census and disability surveys, and country responses to the 2021 OECD Questionnaire on Affordable and Social Housing. The paper summarises housing outcomes; discusses policy supports to ensure that people with disabilities can be safely, affordably and independently housed; and outlines actions for policy makers.

A good reference document for people working in the housing policy space.