A home for life? Developing lifetime neighbourhoods to support ageing well in place

aerial view architecture autumn cars

Photo by Pixabay on Pexels.com

The UK population is ageing. A 2019 report from AgeUK using data from the ONS highlighted that there are nearly 12 million (11,989,322) people aged 65 and above in the UK of which: 5.4 million people are aged 75+, 1.6 million are aged 85+, over 500,000 people are 90+ (579,776) and 14,430 are centenarians. By 2030, one in five people in the UK (21.8%) will be aged 65 or over, 6.8% will be aged 75+ and 3.2% will be aged 85+.

Allowing people to live well in old age in their own homes is something which housebuilders and planners are giving increasing thought to, both from a wellbeing perspective for residents, and a financial perspective for services, including the NHS and social care. The creation of “lifetime neighbourhoods” – spaces where people can live well from birth to retirement – brings together a number of elements: providing easy access to services; creating physical spaces which are suitable for people with disabilities and mobility issues to navigate; and allowing people to maintain those social and community ties which are associated with wellbeing, which can sometimes be lost with forced moves to residential care or a prolonged stay in hospital.

Homes for life

Building homes that are suitable for an ageing population is an important first step in creating lifetime neighbourhoods. However, planners and developers are starting to realise that one size doesn’t necessarily fit all when it comes to housing for older people. As with the general population, older people are not a homogenous group, and while some may need the support provided by extra care or sheltered housing projects, or may need single-storey open plan living to accommodate mobility aids or telecare packages, others simply want to live in a space which enables them to live comfortably in a community which suits their needs in terms of location and availability of services.

Designing and building a range of different housing types, which includes single-storey homes, extra care and sheltered housing, as well as stock which is suitable for people looking to downsize, is a key part of the development of effective lifetime neighbourhoods. This can free up larger family homes for people with children to move into and ensure that people are not kept unnecessarily in hospital because housing cannot be adapted to meet changing needs. A 2014 Age UK report showed that the scarcity of suitable and affordable retirement housing is a barrier to downsizing, highlighting that retirement housing makes up just 5-6% of all older people’s housing. Now groups like the Housing Made for Everyone coalition (HoME) are calling on the government to make all new homes accessible and adaptable as standard to help meet growing need in the future.

Social infrastructure such as libraries, community centres, local shops and good transport links are also a key aspect to planning effective lifetime neighbourhoods, as is ensuring accessibility of services such as GP appointments. Effective infrastructure planning can help enable the whole community, not just older people to feel connected to their local area, both physically and socially which can really help to support the idea of lifetime neighbourhoods and enable people to live well regardless of age.

Preventing loneliness and isolation in older age

Preventing loneliness and isolation in old age by creating spaces which facilitate engagement and encourage people to have positive social interactions is important to ensure that everyone within the community feels respected, involved and appreciated. However, the challenges are different depending on the nature of the community in question. In rural areas, social isolation can be compounded by a lack of appropriate transport infrastructure or the removal of key services at a local level in favour of “hubs” which are often located in towns and cities; in urban areas, loneliness can be exacerbated by the chaotic, hostile or intimidating environment that living in a densely populated area can have, a flip side to the benefits of density.

Ambition for ageing is a programme which aims to discover what works in reducing social isolation by taking an asset based approach to creating age friendly communities. Asset based approaches seek to identify the strengths and the abilities of people and communities, rather than their deficits. The asset based approach to creating age friendly neighbourhoods also seeks to use the experiences and  attributes that all members of the community have to help make the community better. To create effective age friendly neighbourhoods older people need to have opportunities to participate and feel that they are making a positive contribution.

A space for all ages

While much of the research and literature on lifetime neighbourhoods focuses on older people, it is also important to ensure that spaces meet the needs of all groups in the community, including children and young people and people with disabilities. Creating places which balance the needs of all groups within the community is an important consideration for planners.

The physical environment can be as important as the built environment and infrastructure development when it comes to developing lifetime neighbourhoods. Spaces which make use of natural and green infrastructure with lots of green and open public spaces have been shown to help improve mental health and wellbeing, as well as encouraging people of all ages to be more active. A number of design factors such as good paving, effective street lighting and easy access to seating and public toilets make neighbourhoods accessible to older people and people with impairments. Poor design can ‘disable’ people in their immediate environment and act as a barrier to participation in local activities.

adult affection baby child

Photo by Pixabay on Pexels.com

Final thoughts

For lifetime neighbourhoods to be successful, it is necessary that there is access to a range of appropriate housing options. In addition, the planning of public, open and green spaces, availability of transport links and local community infrastructure like libraries, police stations and local shops are all vitally important to ensure communities can thrive.

It is clear that while there is demand for more suitable housing for people in older age, the location and type of housing being built must also meet the needs and expectations of older residents, including good connections to local infrastructure, and safe accommodation. Projects which bring a range of ages together can be effective in strengthening community cohesion, can help challenge stereotypes and can reduce feelings of loneliness and isolation. Collectively these different elements feed into the creation of lifetime neighbourhoods which can support people to live well into retirement and beyond.


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Working longer – the reality ‘behind the headlines’

Senior businessman in office working on laptop

By Heather Cameron

With no shortage of headlines highlighting the record employment rate in the UK, and the increasing number of older workers widely reported, it may seem that the outlook for the ageing workforce is a rosy one. But do these headlines hide the reality?

Recent analysis from Age UK argues that the headline employment rate doesn’t tell the whole story about working longer, “making it an insufficient – and even misleading – tool for public policy decision-making”.

The statistics

The most recent official figures show that the employment rate (the proportion of people aged from 16 to 64 who are in work) is the joint highest since comparable records began in 1971, at 74.8%, while the unemployment rate is the joint lowest since 1975.

Data also shows that the employment rate for people aged 65 and over has indeed increased since the 2008 recession. It is currently at 10.4%, up from 7.3% in 2008.

Age UK has also recognised the increase in employment rates for older people, noting that, in fact, the older the age group, the greater the increase in employment. However, the average number of hours worked has declined since the recession, indicating a more complex and perhaps less reassuring situation than the one portrayed in the media.

The biggest drop was for 50-54 year old men, whose average hours declined by 29%. For men aged 60-64, the average number of hours declined by 8 hours (over 22%), while women aged 50-54 experienced a fall of 18%.

The only age group not to see a decline was women aged 60-64, which is likely to be as a result of the raising of the State Pension age.

Choice or necessity?

The change in the State Pension age was justified on the grounds that it gave people more choice and more scope to continue working if they wished to.

A recent CIPD survey found that the most common reason for wanting to work past 65 is that employees believe it will help keep them mentally fit, followed by wanting to be able to earn a sufficient income to continue to do the things they enjoy.

As Age UK suggests, it may be that the reduction in working hours is a good sign if it is due to older workers choosing to wind down their hours, maybe to enable them to juggle other responsibilities such as caring for their grandchildren, while still earning a wage.

However, the research suggests it may be less through choice and more as a result of the changing labour market such as increasing underemployment (working less hours than they would choose to) or increasing insecure working practices driven by the rise in self-employment and the ‘gig economy’.

As it is likely working fewer hours will mean less income, this could be a cause for concern since it will be more difficult for older workers to maintain their standard of living until they meet the State Pension age and for them to save enough for retirement.

Another issue highlighted by the CIPD, is that most employees don’t believe their organisations are prepared to meet the needs of the over 65s, suggesting that there is a need for employers to also review their practices in terms of managing older workers.

Final thoughts

It is clear that while, for some, choosing to work beyond the traditional retirement age will be a lifestyle choice, for many it will be a necessity. Any substantial reduction in working hours for these older workers could consequently pose a real issue.

It would therefore make sense for policy makers to heed the warning from Age UK not to rely on the headline rate of employment for older workers, and rather look beyond it to the reality of many struggling to get and keep the secure, well paid jobs they want and need.


If you enjoyed reading this, you may be interested in reading our previous post on the pros and cons of the gig economy.

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Assistive digital technology and older people: technology “bricolage” in dementia care

A key focus of social care teams today is helping people to grow old at home, safely, with dignity and with appropriate levels of care if needed, without breaking the budget. Increasingly, local authorities are looking to advances in technology to facilitate this “growing old in place”.

Telecare packages and assistive technologies are often the preferred way for care teams to deliver social care in a home setting. And in situations where care is required around the clock (for example, support for people with dementia and other life limiting degenerative diseases), families and carers are adapting everyday technology and integrating it into their care-giving in order to supplement the telecare provided by local authorities.

Notruf und Hilfe für Rentner und Kranke

 

Bricolage in dementia and elderly care

Bricolage means adapting an object to allow it to carry out a function which was not necessarily its original intended function. Relatives who care for loved ones with dementia, often adapt everyday objects to help them with their day-to-day caring. They find new, innovative and often non-conventional ways to use technology in diverse ways.

dementia post it

One example from dementia care was a man who bought a chicken ornament with a sensor which “crowed” whenever anyone walked past it. He placed it beside the front door so that if his wife, who suffered from dementia, walked up to the door to go out, he would hear and be able to go to her.

Other examples of technology being adapted include: setting alarms and reminders on mobile devices to remind people to take medication, or using webcams to act as personal CCTV so familly carers can monitor loved ones when they go out, or go into the next room.

These examples show that objects don’t have to be digital in order to be effective. The rise in capability of digital technologies and the relative decrease in cost, however, means it is often quicker and easier for families to invest in additional technologies themselves, rather than waiting for an assessment and an allocation of additional technology from their council.

Image by Buddi

Image by Buddi

Ethical challenges

Although there may be practical motivations, some charities have expressed concern about the ethics of some of the practices regarding adaptation of digital technology to form part of an assistive care package. While they recognise the strain of caring is significant for many people, rigging up a webcam in each room to allow you to “monitor” a loved one, or attaching a GPS tracking bracelet, for example, while often done with the best of intentions, could be interpreted as a breach of human rights.

Active assistive technology (technology which requires an active call for assistance) rather than passive technology (which is constantly monitoring) may be a better way of using technology ethically. It may also be used as an additional stimulant or interactive tool to allow patients to communicate. Apps and interactive devices, such as tablet computers, can inform a carer or loved one that someone had been using the app (providing a type of reassurance and monitoring) and the activities the app promotes might also be a visual stimulant and a communicative tool. The Dementia Citizens project has adopted this method and aims to help people with dementia and those who care for them, using apps on smartphones and tablets.

Dementia Citizens from Nesta UK on Vimeo.

Final thoughts

If we are mindful of the ethical challenges of integrating more technology into care, it might be possible for families and carers to work with social care and assistive technology development teams to adapt the tools available in a more empowering way. It might also mean that the onus is not on carers and their loved ones to build what they can from the standardised telecare provided by local authorities.

Bricolage in assistive care has, for many families, become the norm without them realising it. By adapting and supplementing assistive technology, like telecare packages, with non-assistive technologies or adapted additional digital technologies, families and carers can create a bespoke and personalised care package.

In future, understanding the extent to which families and carers adapt the technology given to them, could help creat more flexible care packages which can be more easily adapted to suit individual needs.

Telecare in the UK: lessons from Barcelona

By Rebecca Jackson

Telecare is technology to help people live independently, usually in their own homes, for longer. Usually delivered as part of a package of care, telecare devices can include things like: bed sensors, to detect if someone is out of bed at an unusual time; fall sensors; medication reminders; and alerts on screens or over loudspeakers. Such devices have led telecare to be heralded as a new dawn in patient-centred, independent living.  However, despite initiatives  to drive its application forward, not everyone in the UK is convinced about the benefits of telecare.

Practitioners and carers are sceptical about the potential of replacing traditional care with digital models to save money and the impact that this could have on standards of care. In addition, many patients themselves are uncertain about the use of telecare and digital health solutions, with many who have telecare systems within their homes choosing to continue to interact with primary and home care services in the same way as before. Much of the academic and expert-led research and evaluation of telecare programmes in the UK by organisations such as the Nuffield Trust and the Kings Fund has found little to no improvement in service, reduction in cost or reduction in workload for care teams in areas where telecare has been deployed.

While telecare in the UK appears to have stalled, elsewhere digital health solutions are not only successfully integrated into traditional care models, but are having a positive impact on the people in receipt of care, and reducing the burden of work on care providers.

Lessons from Barcelona

In Spain, the law has guaranteed access to telecare since 2006. Economic austerity has led to individual local authorities in Spain being given control over their budgets and therefore their provision of telecare. The approach in Barcelona has been highlighted as an example of best practice in telecare.

The system there – a cooperative venture between an independent provider and the local authority – sees carers take a proactive approach to telecare. The system does not just monitor and provide assistance in times of distress, but proactively engages with service users at regular intervals to help carers provide reassurance and build relationships.

As well as the emergency measures, such as fall sensors (typically the primary use of telecare in the UK), calls are made to check up on service users, provide reassurance, deliver general public health information and to mark important occasions, like birthdays. This can help to reduce feelings of isolation and loneliness, which in turn can lead to better general health and wellbeing.

Calls can also be made to highlight important information, such  as weather warnings; safety alerts and local events which the service users may wish to attend. These calls are backed up by visits from the care team, who work for the telecare provider. These visits supplement visits from municipal care and social workers and the two teams communicate and share information via digital platforms.

Digital healthcare as an enabler

The case of Barcelona shows us how digital healthcare solutions, and more specifically telecare, can be used as an enabler – a tool to allow the local authority to pursue a joined up and preventative approach to healthcare which has positive benefits for recipients.

Such approaches could also have a significant impact on the UK’s 3.8 million unpaid carers. Telecare has the potential to reduce some of the burden and stress of caring for a relative, which in turn can have positive effects on the health of the person in receipt of care. It can also  form an effective part of reablement programmes – supporting people as they leave hospital or return to independent living.

However the approach to delivering telecare in Britain is as much about culture as it is about the technological infrastructure. Using telecare as part of a preventative, person-centred approach should produce better outcomes. In this sense, implementation of telecare in the UK still lags behind other countries. Key lessons could also be learnt from programmes in Norway and the Netherlands in relation to telecare in dementia settings.

Generally, the targeting of telecare services also differs – in the UK it tends to be aimed at elderly people with complex and diverse needs, while in Norway and the Netherlands the focus has shifted to those suffering from chronic illnesses.

Local solutions

In the UK, some local authorities have been experimenting with digital healthcare, although local authority budget cuts have meant that in many cases these have been cut back to focus delivery on the most vulnerable clients.

The lessons in digital healthcare that Britain can learn from places like Barcelona could be key to the successful roll out of digital healthcare solutions in the future. The Barcelona example highlights the enabling role that telecare can play in joining up health and social care and promoting a more preventative approach to healthcare.

Opportunities to develop telecare strategies and deliver them in partnership, as in the Barcelona model, show that it cannot be delivered in isolation, or be used as a replacement for existing carer-led services. Instead telecare has the potential to be a supporting tool to ensure effective care outcomes. It could also help care services in Britain to tackle the increasing demand of an ageing population.


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