TITLE Aspects considering new and current forms of housing for elderly. Housing options and modifications to maintain independence and to promote health. KEYWORDS Aging in Place / home modification / assisted living Dependent / independent / phases and changes / housing options / modifications / tendencies / Multigenerational household / relocating-options / integrated living / self-determined life / Precautionary model and preventive strategies BEGINNING 1) Introduction - What is housing? Everyone does it and nearly everyone would assume to know what it is about – housing. … Where from in the topic? Example of a young couple with the awareness of the aging topic. Wanted a design offer for a single family house, lot division for sister (ecology), house is to be modifiable into two units (aging) Parents: Discussion about a new built shared home with friends (downsizing) because current house is too large and the garden causes a lot of work and takes a lot of time. Significance? This two personal stories, of whom possibly everyone could tell similar ones, imply several aspects. …roughly circumscribe them Several questions arise out of the housing diagram I created and its content will be the guideline through the paper. The notions and options I try to describe and as well how public health can address its content. …show and describe diagram Housing is understood within the overall goal of wellbeing, which is influenced by the social environment and from the person itself. Healthy Aging / Aging in Place / WHO / What is housing? The understanding of health by the World Health Organization (WHO) is described as ´a state of complete physical, mental and social well-being, and not merely the absence of disease or handicap` (WHO, 1948) Within this scheme, the components of body functions and structure, as well as activity and participation, are interrelated and the environmental and personal factors have an interfacing role in theses dynamics (WHO 2001). This is obviously a positivistic thinking already to be found in 1948 and looking at the 2001 expressions we can clearly find the role of the person itself, influencing his well being. What do I cover and what not? ??? MIDDLE How does it fit in the topic of aging and how can public health apply on it? How and where can it be implicated? 1. What is the incidence/prevalence of risk factors or health issues? 2. Does the risk factor/problem have a consequence to the health status of the individual? 3. What are the underlying mechanisms that affect behaviour? 4. Can we have a positive effect – intervene -? 5. Can we take it to scale? 2) Housing options (Folts & Muir, Robinson & Moen) a. Current forms of housing Describe examples from the texts (Active marketing of housing to a target group vs. supportive housing Granny Flats, Home Sharing, Share a Home, Intergenerational Housing, LORCs , age-restricted luxury rental apartments, life-care-communities (LCCs), care retirement communities (CCRCs), cohousing) What are the new forms of housing and wherein lay their qualities and differences? What group of elderly is addressed in each new form of housing? b. architectural examples 1) Vienna, Austria: BKK3 | www.bkk-3.com | www.sargfabrik.at 2) Frastanz, Austria: intergenerational housing in the countryside/suburban area i. Where to position in point a? ii. What effect when implemented in US? 1. mobility question (also see in Frank & Engelke, 2001) 2. stimulating/maintaining physical environment (personal barrier, environmental barriers, Sallis and Owen 1990 3. solutions: community minibus taxi, retired persons work as taxidrivers,… 3) Why do people want to age and maintain living in their own home? Evidence and reasons for it. Is there evidence that maintaining to live at home independent is a main goal of Public health? (it is a main goal of older adults) Is living at home the preferred housing style for elderly and what are its reasons? (ages) Decision on how to live are described in a four category model of: background characteristics, housing history, social integration, and health. Older peoples expectations about future housing vary by several factors (Robison & Moen). Economic question Already in 1979 Chappel & Penning were addressing that the trend to deinstitutionalizing the elderly should not mainly depend solely on the economic burden. Their results showed the advantages of the trend for elderly people. They suppose alternative services such as home care programs as a reaction of that trend. Their main findings support a multidimensional approach to the study of the elderly. As they say, the overall well being of a person is influenced of the health, socioeconomic status, nationality and social interaction and the weighted importance of one of these depends on the specific environmental setting. ´Elderly housing facilities, even those that appear inflexible, are not simple monolithic structures. They are sites, plans, and amenities but they are much more. They also consist of ideas, emotions, perceptions, and most important, people (Folts & Muir, 2002) What are the requirements to live at home? 4) Advantages while living at home (easily get assistance the need from family and people who live with them, money saving, Being active and socially connected and engaged, Dependent / independent Two different views on independency. What means independent living? (they are able to live in their home with little or no assistance from others) What is a self-determined life? Mobility Independence means that the older adult is able to live in their home with little or no assistance from others. “But it is the impairment which creates dependency or is it in fact the social consequences, the context in which impairment is experienced, which undermines autonomy and creates ´dependent people`? (Morris 1994) 5) Possible changes / phase a. In medical care needs b. In functional abilities c. In available support and changes in cognitive abilities d. Independent to dependent (Morris) e. Impairment vs. disability at home i. Three distinct types of moves during later life (Litwak and Longino 1987) 1. move for amenities 2. moderate disability ii. move in the face of major, chronic disability f. trend away from expecting children as caregiver / blended families / i. creates the need to plan for alternate housing and community based LTC 6) Modifications and technology a. Before needy b. While needy c. Maintain – safety – stimulate What can be changed / repaired in private homes to increase safety? 7) What is done from public health a. Who gets help and what kind of b. Frail people c. Different financial situation d. How can Public Health address this i. Strengthen social setting (community programs) ii. Maintain Mobility = geographical radius that is available for a person further out the home (a specific US goal, argued out of the comparative example between to shown project) iii. Develop acceptance for alternative housing forms (Robison & Moen) iv. Develop programs throughout every age to build acceptance / awareness / vision Life course formulations 1. e.g. Intentions and behaviour diverge when people gain more information or when unforeseen circumstances aris between the time of their stated intentions and the time when their behaviour is assessed. (Juster 1997, Manski 1990) 2. day nursery: breakfast – goal: experience of frsh food, start of socializing kindergarten: food: how does it smell and taste and where does it come from school: sport: awareness of one own needs and experience benefits of sport; e.g. Götzis, Austria: school program, certificate for social work during the school year if offered within a collaboration of the public schools and the city 3. lifestyle interventions, structured interventions (Dunn, Anderson 1998) 4. transition programs 8) Tendencies and notions from an architects view Lack of venture in clients, developers. Demanding clients and architects. Need for a deep knowledge beyond ones general area of expertise. Most new forms arise from private initiatives. (e.g. architectural example from Vienna) There is a need to have a broader discussion including different experts and case studies. Corburn 2007: “The precautionary principle is an analytic and decision-making framework that seeks to reduce or eliminate pathogenic exposures, to ecosystems ahd humans,…,setting environmental and public health performance goals with impacted stakeholders, and collaboratively reviewing prevention scenarios,…” “By requiring action in the face of uncertainty, the precautionary principle also demands that alternative courses of action be explored, often redirecting environmental health science and policy from describing problems to identifying solutions.” Mollica 2003: Overall goal is to deliver the most appropriate service to a person and this is the least restrictive environment. This goal is influenced of many interests of different player included such as Payers, Providers, Policy Makers and Housing managers. “Collaboration, though more complex, is important if we are to meet the preferences of beneficiaries o remain where they are and to prevent the need to develop additional settings to serve people.” Example: New York: Arakawa + Gins | www.reversibledestiny.org/home.php Bioscleave House (Lifespan-Extending Villa) East Hampton, New York | Size: 2,700 sq ft. | Construction: 2000-2008 …Describe project and main goals which lead directly to the conclusion 9) END a. Conclusion New forms of housing can not only be invented from developers and planners, from researchers monitoring the elder population with its needs and possibilities. Public Health programmes have to create the acceptance, awareness and visions in every person throughout the life time for possible specific changes in older ages. One goal lies in the potential quality of a widespread experience created and developed in each person life- time. It is the responsibility of every individual to take care of oneself and its health and through that have a positive impact on society. Personal health is a value which is ~contributed to the society within ones biological conditions~. MIX OF PHRASES: Balsam: Population becomes more diverse and consumers begin to demand more comprehensive care responsive to their personal needs…supports for individuals who wish to enhance their own health. Kutza: Early identification of treatable chronic diseases and home safety reviews to reduce the incidence of falls are two examples of how a modest community investment can reap large health care cost savings in the future. Evidence to live at home: Live alone because of blended families. Security. Because of “blended families”, as a fact of the changes due to the growing participation of women in the labour force, and the high incidence of divorce and remarriage. (look at national academy of Aging) Problem: Most state Medicaid programs provide reimbursement only for the most “medicalized” services and do not include chore services. Frank & Engelke, 2001: “Public policy interventions designed to improve regional mobility, traffic congestion, and air quality could simultaneously generate significant public health benefits through increasing levels of moderate physical activity.” Corburn 2007: “Planners will also need to critically question the adequacy of existing norms and institutions that help determine how practicioners use or abuse power, respond to or even resist market forces, work to empower some groups and disempower others, promote multiparty decision making, or simply rationalize decisions already made.” Mollica 2003: Relation between high rates of nursing home beds and hence less money for HCBS programs (p.167). QUESTIONS TO ANSWER AND IMPLEMENT IN THE TEXT What are the advantages for public health when elderly live in their familiar settings as long as possible? (informal care, assistance and social support) What systems do support one to live at home? How long is it arguable to live at home? What are there barriers for elderly to think of new possible forms of housing? Are new forms of housing well accepted? (market driven) To differentiate: maintain to live at home vs. relocation into a new housing form privately organized housing vs. institutional housing stages: independent – supportive – care new influences: blended families – kinship – technology trends according to personal financial background (low – middle – high income) LITERATURE REVIEW http://online.sagepub.com Environment and Behaviour/Journals of Gerontology/The Gerontologist/Research on Aging/Environment and Behaviour/Urban Affairs Review/Journal of Planning Education and Research … READ … UNREAD 1 st round: … Chappell & Penning_The Trend away from Institutionalization_ 1979.pdf … Robison & Moen_A Life-Course Perspective on Housing Expectations and Shifts in Late Midlife_ 2000.pdf … Folts&Muir_Housing for Older Adults_New Lessons from the Past_ 2002.pdf … Biegel_Integrational Partnership_ 2002.pdf … Morris Jenny_Community care or independent living_ 1994.pdf … Imamoglu_Assisted Living as a new Place Schema_A comparison with homes and nursing homes_ 2007.pdf … Oswald Frank_Relationship Between Housing and Healthy Aging_ 2007.pdf 2 nd round: …Pynoos and Nishita_The Cost of Financing of Home Modifications in the United States_ 2003.pdf …Krusih & Anemaet_Fall Risk Assesment & Prevention in Home Care_ 208.pdf …Corburn_Reconnecting with Our Roots_American Urban Planning and Public Health in the Twenty- first Century_2007.pdf …Mollica_Coordinating Services Across the Continuum of Health, Housing, and Supportive Services_2003 …Frank & Engelke_The Built Environment and Human Acitivity Patterns_Exploring the Impact of Urban Form on Public Health_2001.pdf …Irivine_A review of major influences on current public health policy in developed countries in the second half of the 20th century_2006.pdf …Krieger_Using Community Based Participatory Research to Address Social determinants of Health_2002.pdf …Malizia_Planning and Public Health_Research Options for an Emerging Field_2006.pdf …http://whqlibdoc.who.int/hist/official_records/constitution.pdf (accessed 12 october2008) 3 rd round: ?? Modifications, technology, Point 7 skipped: Serow_Economic Consequences of Retiree Concentrations_ 2003.pdf Rabig_Radical Redesign of Nursing Homes_ 2006.pdf Rural Retirement Migration_2008.pdf . TITLE Aspects considering new and current forms of housing for elderly. Housing options and modifications to maintain independence and to promote. cohousing) What are the new forms of housing and wherein lay their qualities and differences? What group of elderly is addressed in each new form of housing?