They’ll carry me out of here in a box

A few days ago at the Institute we had a seminar from a researcher who had flown from Switzerland to present on “Coping with violence: Adolescents in eastern Congo and Burundi”. I have to say the topic was a surprise to me, for an Institute of Ageing. I am told it is relevant because the Institute takes a whole of life course view and is interested in earlier life stages because of their impact on older years. It is true that anyone interested in ageing inevitably gets drawn into thinking about the earlier life that shapes our final years. But I think I’ll keep my focus more narrowly at the 65+ end. If I have to consider all the years before I’ll need a lot more than a month here!

I’ve been looking at housing choice and issues around keeping older adults engaged in their communities. One of the keys seems to be this thing called “ageing in place”. The desire to stay your own home till you die.

There are a lot of different definitions but most people seem to think of it as something like “the ability to live in one’s own home and community safely, independently, and comfortably, regardless of age, income or ability level”[1] . Older adults certainly seem to prefer this. An American survey showed 90% of people over 65 wanted to stay in their current residences as long as possible.[2] New Zealand government policies favour ageing in place, and it is viewed as a less costly option for taxpayers than moving people into forms of residential care.

However ageing in place has its challenges. With the over 85 age group being the fastest growing, this will mean many more older adults with disabilities or frailty needing to be supported in their own homes.  Maintaining a home can be an increasing burden for older people and they can tend to under-invest in and defer repairs and maintenance, often on the grounds of cost[3]. It can contribute to loneliness, especially if a partner dies, family lives elsewhere, a driving license is relinquished and so on. There is also the quality of New Zealand’s housing stock and whether we can be sure our older population has safe and warm homes to meet their needs.

There are a number of features that can help age-proof homes

1. Flat entranceways to the home, without any steps to cause problems for wheelchairs or a tripping hazard
2. Being able to live on one level if you become unable to negotiate stairs (so that would include a bathroom on the ground floor)
3. Switches and power outlets at an accessible height, that is not so high that you can’t reach them from a wheelchair and not so low that you need to get down on hands and knees to use them
4. Extra-wide doorways and halls that let wheelchairs and walkers through
5. Lever-style door and tap handles that are easy for hands with poor grip strength

Even if we can adapt a family home to cater to our needs as we age, is that the best place for us to live, especially if many of the rooms are no longer needed? It’s not helpful to the community as a whole if larger homes are under-occupied.

One scheme that is about to be tried here in Oxford, but has been going for many decades in the USA, is a home share scheme where older owners are matched with a lodger paying a much reduced rent in return for helping around the house. Oxford is the very least affordable city to live in the UK, even worse than London, and it has a large population of students looking for cheap accommodation – so all the ingredients are there. To get good outcomes the matching has to be done well and there needs to be good support to establish the agreement and to help with any problems. But there are plenty of positive stories from USA examples, with some matches lasting decades.

Of course, some want to downsize to smaller and more manageable accommodation as they age. But if they are attached to a particular community it may be hard to find something suitable and it seems the older we get, the harder it becomes to make that move. We are often deeply attached to a home/garden of many years and some people fear leaving behind familiar surroundings may exacerbate any memory issues. Plus there is the cost of moving. And where will the family stay when they visit?

Lots of thought is going into tackling all these housing issues and giving older adults more choices – whether it is the ability to retro-fit an existing property or find a suitable alternative. Can communities be built with a better mix of housing types, can we have village type developments that allow people to downsize in the same area, walkable neighbourhoods with basic services available at a local hub? Changing planning rules to make it easier for families to add granny flats is an option that would help some, others are looking at adapting large homes to make 2 or 3 elder flats with the owner occupying one.

And the community is coming up with its own grass-roots solutions. Moving Buddies is a voluntary group that helps older adults that want to shift get through the exhausting process, not leaving them till they are safely settled in new accommodation. Another community-led approach to ageing in place is the setting up of networks, often with support from local councils, but mostly run by older adults.

An Australian network example is the Waverton Hub in Sydney. This group was set up in 2012 to help members age in place successfully. Now it has about 300 members and to build networks it runs activities like yoga, art classes, games days, walking groups and regular get-togethers. They also share info, recommend reliable local tradespeople and services and see themselves as a model that other communities can replicate.

Their website tells the story of a woman, Moira, who was 88 and living in a nursing home. She was told she had just weeks to live and her great desire then was to return to her home in Waverton to die. So a friend, also over 80, installed equipment that would allow her to return home and recruited a group of neighbours to come in three times a day to care for Moira. She died peacefully in her home two years later just after celebrating her 90^th birthday. The Hub sees that as the essence of their model, supporting each other to age in place.

As the numbers of older adults rises, the number of creative responses to ageing in place is bound to grow. And one of things I hope we’ll see is far more choice around housing options, so there is something to fit every preference and income. But we’ve got a lot of work to do to make this happen.