Summary
« The adaptation of housing to the challenge of demographic change : a field for future work »
The adaptation of housing to meet with the challenge of demographic change is a response to two concerns expressed by families when talking about their own situation or the situation of those who are dear to them, namely housing and ageing. These two areas, that are at the crossroads of several challenges and are accompanied by a statistical tool, are of an equal degree of complexity.
A SILENT REVOLUTION
It is a simple fact the French population is ageing under the dual effect of the on-going decline in fertility since the 19th century and the fall in the mortality rate. Life expectancy has increased by three months per year over the last 20 years.
In 2030, 20 million French people will be aged over 60 and 15 million will be aged under 20. The most spectacular progression will be seen amongst those aged over 75 (x 3) and those aged over 85 (x 4).
This tendency can also be observed in the European Union: 17% of its population (which is the oldest in the world) is aged over 65 (21.7% aged over 60 in 2004). Italy, Germany and Greece have the highest rates of senior citizens.
The Community institutions have integrated demographic challenge within their policies, considering it in terms of measures to accompany the ageing process rather than measures to tackle the issues raised by old age. It is addressed notably through the eight stages of healthy ageing. Publications and a forum have been organised in 1999, 2005, 2006, and 2009, whilst a consultation process has been launched for 2012, the European year for active ageing. The political authorities have also turned their minds to the issue of ageing: “Municipalities and Regions of Europe”, held in Malmo in April 2009 and the European Council of Ministers for Social Affairs in June 2009.
More importantly, from 2050/60 onwards, the number of members of the active population (15-64) per person aged over 65 will fall from 4 to 2. A consequence of this change will be an increase of almost 5 percentage points of GDP in the public spending related to ageing (pensions, healthcare, home care services).
Of perhaps even greater significance is the fact that the period of a person’s life spent without infirmity will also increase. Thus, the average age at which people fall into a state of dependency is estimated to be 85. There is a real silent revolution underway and this marks the end of the three ages of life. Following youth (education and training) and adulthood (working life), retirement is no longer limited to the equation according to which old age = illness = infirmity = dependency, rather it opens up to new individual, community and family times.
A progressive differentiation may be established across the 20 or 30 years of life that follow retirement: 60-75, the age of active pensioners, 75-85, the age when a whole series of small infirmities begin to appear, although these people are still relatively autonomous, and those aged over 85 who are beginning to have to face up to dependency. The ageing process no longer corresponds to a homogenous public, we can now see the progressive nature of ageing, including issues related to housing conditions.
That is why it is absolutely essential that a distinction be drawn between the provision of support and accompanying measures during the ageing process and prevention on the one hand, and the traditional, social and health-based approach to ageing which, in terms of social protection, is classified as being a risk.
It is in the field of the provision of accompanying measures and support that there is the greatest room for manoeuvre at the lowest cost. In 2009, the additional cost to the public purse of the admission of an elderly person into a retirement home is €180, not including care-related costs.
A variety of operational, innovative and reproducible paths have already been introduced, but thus far this has only been done in a fragmented manner, whereas a widespread response is required.
Ninety percent of those questioned in polls say that they would like to live for as long as possible in their own homes and this has been confirmed in a series of surveys and studies (Ipsos, Opinion Way, Giesbert & ass.). With the assistance and support of its practitioners, housing policy must lead the way by addressing the needs of the elderly population, on the basis of the knowledge that 74% of retired persons are homeowners (out of a total of 58% of the population of France), 9 out of 10 people up to the age of 85 still live at home and that only one quarter of those aged over 85 live in an institution.
HOUSING AND LIVING SPACES THAT NEED TO BE RECONSIDERED
It is only possible to age and to “grow old comfortably” and in all safety if the fluidity between the three spaces of life that constitute housing (the pubic space, the collective or shared space, the private or homes space) is well organised and is accompanied by solidarity and cohesion between networks and local services.
There is therefore a need to introduce a transversal, coordinated approach to public policies, notably between the health and social policies (which require both public approval and contribution) and the housing policy (which is responsible for the adaptation of living spaces to generational needs).
As the traditional frontiers of the cycles of life are becoming more blurred, how can housing be adapted, as the living spaces that form the focal point of the lives of the active elderly, so that they become a comfortable space with safe facilities that are financially affordable and that accompany people in their old age?
The housing policy is expected to provide a response in several areas :
- Adaptation of housing: newly built housing represents 1% of the renewal of the housing stock per year… in 2008, only 28% of the housing stock was less than 25 years old. Three quarters of retired households have lived in their current homes for at least 12 years. This means that they are not particularly mobile. Almost 80% of the population are city dwellers and this tendency is confirmed amongst the elderly.
Thus, the challenge of adapting housing to meet current demographic changes must take place within the existing housing stock, in the heart of our towns and, with a greater degree of complexity, in the old urban centres. For all of these reasons, new housing, which is designed from the very outset to be adapted to the needs of people of all ages, providing shared comfort of use (design for all), represents the targeted response to the emerging needs. - Responding to the economic fragility of the elderly: the end of a happy parenthesis: the symmetry between the increase in life expectancy and the increase in resources has now been broken: in 2005, the standard of living of retired persons was 10% lower than that of the active members of the population.
Projections confirm this gap both in France and in the other EU Member States.
Indeed, we now see generations of people approaching the age of retirement who have not been permanently employed. The rate of financial effort related to housing increases from retirement age onwards. It is more visible amongst tenants (including those in the social housing sector), but home ownership (75% of retired persons) is no longer a defence against poverty. The Abbé Pierre Foundation has highlighted the fact that the vast majority of owners live below the poverty threshold.
The capacity of the elderly to contribute to the adaptation of their home therefore becomes a pressing question, even if it only refers to their ability to cover the costs that remain once public aid has been taken into account.
This means that all avenues must be explored: annuity-based mortgages, micro-credits, part financing of care services… - Preventing fragility-related risks: ageing is not an illness, but it does expose those who suffer from a range of small scale sensory impairments (hearing, sight-related) to certain risks and these risks are further exacerbated by the fact that the environment in which they live (public highways or housing) has not been adapted to their needs.
The accidents that happen in the everyday lives of people aged over 65 (80% represented by falls), of which 62% occur at home, cause almost 10,000 deaths a year and also cause disabilities that compromise a person’s ability to live at home.
In 2008, the “life time homes” plan (cf. annex) was introduced in Great Britain. The adaptation of housing is at the heart of the policy designed to prevent risks related to ageing due to the public cost of the consequences of accidents that occur in everyday life.
A flexible and empirical (or non-standardised) approach to adaptation at an accessible cost can make it possible to ensure that a greater number of elderly persons are able to spend longer in their homes, enjoying a comfortable standard of living at an affordable cost (including from an energy point of view). Prevention is also part of housing policy. - Coordinating the actors: from old age to ageing: this is the consequence of the previous point. All of the practitioners confirm that the levels of adaptation may be different (a staircase is not totally unacceptable) as long as the principles of prevention are taken into account. In order to achieve this, all of the actors, rather than just those from the health, medical and social sectors, must be also be represented within the bodies in which consultation and dialogue takes place.
- Developing jobs related to the new needs: community care services are ranked second in order of importance by the elderly (IPSOS survey), coming second only to the adaptation of housing.
Today, 1.9 million people already work in the home care/community services sector, which is a sector with a huge growth potential.
The opening up of new employment possibilities, increasing the level of qualifications and professionalization are all objectives that are supported by locally elected representatives and the economic actors (notably local building companies). This singular activity, which is at the crossroads of social and employment policies, in which the client and the provider interact within a relationship based on trust, would be further enhanced by developments of this type.
DRAWING INSPIRATION FROM SUCCESFUL EXPERIENCES
A whole range of measures that are both innovative and may be reproduced are already operational for this in-between generation of people who, “whilst they are not as young as they used to be, nor are they really very old!”
It is the responsibility of public housing policies to further develop, underpin, to organise and to base their efforts on these various avenues that have already been opened up by the various economic actors in the industry in order to ensure the provision of a new and adapted supply of housing, both in terms of new constructions and renovated buildings.
Areas of convergence
Economic actors in the industry are designing adapted housing that provides comfort of shared usage (design for all) so as to enable people to grow old comfortably in their own homes, regardless of whether they are private companies or social housing associations (for affordable housing). In doing so, they take the same elements into account.
- A favourable environment: The adaption of the territory in which people live is as essential as the adaption of housing. Geographers, sociologists, (Icade, MSA), doctors (Broca hospital), authorities (General Council of the Rhône region) have all observed, with or without the assistance of a GPS system, the journeys made and the places frequented by the elderly. Shops and community services, accessible public transport, town centres (together with the presence of a church in rural areas) and urban neighbourhoods with good facilities all influence these preferences. These methods, which are all easy to reproduce, make it possible to identify the places in which it is most useful to build new housing.
- The “target groups”: through a pragmatic analysis of age-related capacities and incapacities, carried out by a multi-disciplinary team, the technical specifications can be defined in the earliest possible stage of the process; we refer here to the specifications of a form of housing and an environment that is both adapted and has the potential to evolve (housing located close to a residential centre for the elderly). Professor Tubiana reminds us that the 10 million elderly persons who are able to move without any difficulty over a flat terrain only require a safe ramp or a bath support rail: they are not handicapped.
- The levels of adaptation: these are established on the basis of the needs of the “target groups” and may be described as follows: healthy, safe and affordable housing, accessible housing, housing for people of all ages (design for all – CRIDEV) and housing that is adaptable and lends itself to future changes. All of the equipment or facilities listed during the hearings (see annex) are common to the actors in the private sector and to the social housing associations and are available for an additional cost ranging from €2,500 to €8,000.
- New technologies: looking beyond the generational and cultural reticence which, in any case, will slowly fade, and the elitist image related to their cost, the fact is that ICT in the home (formerly known as home automation) will have to play an important part in the process of growing old comfortably in one’s own home. However, it will only be possible to reduce related costs and, as a consequence, to grant wider access to these technologies at an affordable price, if support is provided for the development of this economic sector.
Other areas of convergence also exist in which the market and the social economy are able to propose joint or even partnership-based solutions: property developers who divide up pieces of property and entrust their usage to social housing associations who rent them out as adapted housing under the PLS/PLUS scheme, which is a housing design for all initiative that has been developed in Saint Etienne and was presented at the Design biennial event in 2006 and has since been fully rented out. The integration of design for all concept, in the sense of shared comfort, within the innovation policy of SMEs, is the subject of a working document drafted by the European Commission. In May 2009, the Minister for Housing launched the PUCA programme based on the concept of “housing design for everyone”.
Adapt or move?
Adapt or move: any evaluation of this question must consider both the social cost and the social benefit.
As well as the fact that the elderly do not wish to move out of their home, any effort to encourage them into a specific form of housing implies the existence of a provision of adapted and affordable housing, which is not yet the case, particularly in deprived areas.
Many existing forms of housing do lend themselves to the type of adaption work that is required in order to ensure that the people who live in them are able to age in comfort. The real challenge is to determine the needs through the networks of community groups or professionals (Familles Rurales, MSA, PACT…), to diagnose a given situation (from small jobs to re-fitting work), to seek out funding (Anah – retirement funds,), to entrust the work to competent professionals (Capeb certified…).
The conditions under which the adaption work can take place:
- Raising the awareness of the elderly, their family and friends, of public opinion, of the locally elected representatives and of the field practitioners, of the importance of ensuring that housing guarantees both comfort and safety: non-slippery flooring, showers with entry-level drainage, electric blinds, lit pathways, audible and visual doorbells… ;
- Display the adaptation work in a real-life situation in a home (show home) in order to provide a concrete example of the possibilities that exist and, above all, to overcome the reticence that is often rooted in a person’s belief that the adaptation work will make their home look like a hospital.
The wide-scale adaptation of the private housing stock is made difficult by the multiplicity of actors (particularly of joint-owners) and the absence of operational and decision-making discussion partners. The support of the local authorities is essential through the provision of detection tools and incentives to improve housing (thematic General Interest Programmes, etc.).
The adaptation of the social housing stock: Social housing associations, which have internal technical skills and property evaluation instruments, undertake their own diagnosis of the situation, establish programmes for rehabilitation or adaptation works, monitor the changes that take place amongst their tenants, with whom they have continuous links. In the absence of partnerships, the social housing associations have introduced (integrated or shared) services and, in some cases, a housing for the elderly label.
Any new supply of housing through newly built facilities or the adaptation of the existing stock in order to respond to the challenges of the ageing process must also be achieved through the adaptation of the territories in which people live.
The question of ageing is raised and taken into account during the establishment of town planning documents, but it is only rarely given concrete expression through these documents. It is interesting to note the processes of consultation and dialogue that have been truly followed up: the PLH (Local Habitat Plan) in Nancy or Longwy, the PDU (Urban Mobility plan in Grenoble, or the SCoT (Territorial Coherence Scheme) in Dunkerque, the city of Le Havre…
The authorities have a role in bringing together all of the stakeholders in order to formalise, through town planning documents, a policy that addresses the issue of the ageing of the territories of life themselves, accompanied by appropriate evaluation tools.
Organising services and networks
In order to support the possible adaptation of the built environment and spaces, there is first of all a need to address the issue of the organisation of services and of local community networks through:
- ICT, with the European (ageing comfortably in the information society, 2007) or French programmes, the SIGAAL project – Intergenerational services for the provision of homecare assistance to the elderly (CSTB – Scientific and Technical Building Centre, Icade, CHU in Nice, Agevillage…), the IDA project (Archipel Habitat in Nantes) ;
- Integrated services as part of the global housing service provision, mostly provided by the social housing associations: Valophis (Val de Marne) which has put together a guide for community carers, the creation of approved structures (Espacil in Rennes, Floralys in the North), targeted events (Territoire Habitat in Belfort) ;
- Services provided on a partnership basis, and/or the mobilisation of the authorities, such as the “blue housing” project in Nantes, the property developers or builders of individual houses with the ASSAD – Home Care Association or the ADMR – Home services Association;
- The mobilisation of informal networks: the family, neighbours (networks of “good neighbours” and “companions”) resource persons (creation of groups of acquaintances, notably around the warden).
Does solidarity between the generations represent an alternative?
Mobilised through several, notably community-based, initiatives, shared housing makes it possible to reconcile the mutual interests of two low-income generations who provide one another with mutual support and services. The Boutin legislation has made shared housing a possibility for tenants of social housing. However, this provision requires a legal security.
Many Planned inter-generational housing projects have already been introduced by social housing associations (Chambéry, Longwy…) that are members of the USH in France or of Cecodhas in the European Union. Cooperation with the authorities is frequent.
However, the extremely well developed, structured and contract-based projects established by the city of Alicante in Spain, which combines the rehabilitation of the neighbourhoods and housing that were unfit for habitation, with the joint interests of the elderly and of the young people who, by signing a contract, commit themselves to providing services to the people who live in their residential building or neighbourhood, provides a well-defined framework that could be reproduced in France.
For the most fragile members of society, solidarity between the generations takes into account the housing needs of the elderly migrants, by combining the adaptation of the built environment and the social project. The ADOMA system is a direct result of this approach.
This large-scale movement is now also taking the form of housing that is shared by the elderly, the first examples of which may now be seen.
THIRTY TWO PRAGMATIC PROPOSALS
With a view to adapting housing in order to meet with the challenges of growing old, the report has drawn up 32 proposals for the attention of the public authorities, with a European outlook in mind. These proposals, that would have no budgetary effect and are outside the field of dependency, lie in different areas: the legal and administrative framework, financing, training, intervention rules and communication. They are designed to bring together both human and technical aspects.
The further development of the attention paid simultaneously to the concerns of the elderly and of those who are close to them and to the technical and affordable solutions, through a committed housing policy, is central to the development of this vast project that is at the heart of the calm, albeit inescapable, evolution of our lifestyles: how and where do we wish to grow old?
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