Ageing-in-place is becoming increasingly popular as a concept. There’s a movement towards maintaining autonomy by staying in familiar surroundings, and a desire to stay home rather than enter residential care. The Australian Housing and Urban Research Institute (AHURi) found that older Australians are challenging the preconceived ideas of ageing, but especially where we can receive care. AHURi found in a sample of seven thousand older Australians aged 50 years and over, more than one third of respondents (36%) lived alone. That’s a 57% increase on previous generations. Out of all the respondents, only 7% lived in an extended household with family or others supplying day-to-day support. The survey also showed a clear resistance to the prospect of living with extended family in the future. And they reported that they “live alone and love it.”
This is an important shift that communities need to be proactive in meeting. Especially with the increase of people needing age-related support in Australia.
It’s not only the appetite for living in care environments that is pushing the necessity of ageing-in-place. The current crisis in Australian housing and issues related to supply and demand with aged care and palliative services has highlighted that need to get smarter about where people age and die.
Managing these kinds of constraints takes planning. It also means making the case for ageing-in-place with family, friends, and with community support. We have to plan to deliver an aged care experience people want. And that means explaining what’s involved in practical terms.
ExSitu has spoken about ageing-in-place before on a more individual level and provides an ageing-in-place checklist via questions.
This article tackles why we need to normalise ageing-in-place on a community level and challenges we face in making this happen on a larger scale
The case for promoting ageing-in-place to neighbourhoods
The benefits of ageing-in-place help both aged care providers and recipients alike. From an infrastructure perspective, it means:
Taking the pressure off aged care centre waiting lists and placements
This is especially helpful to regional and rural Australia where options are far more limited or where people are reluctant to enter care because of a lack of choice between providers not meeting cultural, personal or needs-based selection criteria.
Providing a much-needed alternative to dying in a medicalised environment
If somebody is dying outside palliative care or with an actionable at-home care plan, they risk not receiving tailored care that respects their dignity, as well as the potential for too much treatment or invasive procedures. They are also reducing the resources and beds available to other people seeking help, creating further on an already strained hospital system. The number of Baby Boomers exceeds the number of beds available to die at hospital level, making this a critical issue we have to address – and soon – in Australia.
Less drastic changes re: the makeup of neighbourhoods and the diversity within
This is true of towns and suburbs where there is a high percentage of older Australians. For example, regions like the Southern Highlands or suburbs like Windang in Wollongong, where the ageing population is to such a degree that more people need support than can offer it.
Promoting well-being for the entire neighbourhood
Designing for the well-being of older Australians means creating green, clean, and safe public spaces. It’s about providing level, well-maintained, and shaded walkways, opportunities for exercise, and easy access to shops, facilities, and public transport. These neighbourhoods benefit the wider community by promoting active and healthy lifestyles, reducing pollution, and creating attractive public spaces for everyone to enjoy.
Creating accessible neighbourhoods
If we can enhance the streets, architecture, transport and services to cater to older Australians with accessibility, cognitive and mobility considerations, we’re also creating the conditions to make people with disabilities and who are non-neurotypical to feel more welcome. We also solve movement constraints for wheelchairs that then lend themselves to families with prams, cyclists, and cater better to groups of people. If we consider the cognitive effects, we design lower stress, less confusing and more user-friendly infrastructure.
Promoting autonomy and increasing well-being on an individual level
Autonomy and choice aren’t only about giving a person what they want. It’s what occurs when we don’t. And when we don’t meet the individual needs of each person, we risk creating stress and cultivating the conditions for a degradation in mental health by fostering anxiety and depression. By failing to listen to and address the needs of older people, we not only increase the likelihood of support being rejected, but also create greater stress for service providers, carers, and loved ones. This can lead to reticence in disclosing changes in a person’s needs, as well as combative and undesirable behaviours, as older people may feel unheard and infantilised.
Transforming neighbourhood culture
In neighbourhoods that are connected and mobilised to age-in-place, the assumption can be made that they enjoy higher social currency and greater personal safety, stronger assistance networks, and socialising and connecting on a community level. By supporting people to age in place, we’re creating a network of social systems that promote people getting to know each other, sharing the domestic load, looking out for one another, pitching in to help, and coming together to learn about what their neighbour needs. The same culture can benefit single parents and parents of small or high needs children, people with disabilities, help with diversity and inclusion, and create social cohesion and belonging. This could also aid in advocating for infrastructure and systems, reduce crime, and raise neighbourhood house values, all of which benefit the wider community.
The barriers faced in scaling ageing-in-place
All cultural transformations face barriers and ageing-in-place is no different. The barriers include:
Housing affordability and supply
Australia is in a housing affordability and supply crisis. Without affordable, suitable places to downsize to, especially in proximity to well-known neighbourhoods and infrastructure, many ageing Australians are holding onto their homes and making do. This means houses are not selling to make way for new families – which means the much-needed injection of younger people to the neighbourhood to help support the ageing in the community is not happening.
Also, in the past, properties were not being built with disability and ageing in mind to accommodate older Australians. Because of this, older Australians may live in homes that increase the risk of falls, are difficult to keep clean and up-to-date, and lead to a feeling of low morale as autonomy is restricted and anxiety and depression because of that lack of independence is exacerbated.
By speaking up and not accepting it as the norm, we may make in the housing affordability crisis. We can also do something on a community level by:
- Going out of the way to introduce ourselves to our neighbours
- Embrace intergenerational living and live with family or people who need it
- Consider not only property from a value perspective, but as shelter and a basic human right
When we talk about beautifying neighbourhoods or creating shared spaces, many people shout about councils failing residents or mayors ignoring rate payers. But beautifying and changing neighbourhoods has a rich history in community-led action. In fact, you can count on the government to get involved once the people prove the benefits by demonstrating effectiveness and proving there is a demand for it.
Part of the issue with placemaking initiatives is the assumption that someone else is responsible. In reality, all good community initiatives require shared goals, community consultation, and incremental change undertaken by the communities it serves.
We’re taught to remain siloed, wait for change, and not to rock the boat. However, a healthy amount of advocacy and pushing for change requires us to come together, present the case for change, and make noise. Ageing-in-place is no different.
A lack of community
Finding, building or nurturing neighbourhoods into flourishing, connected communities is not as simple as holding events or having a consultation call out. It means get to know the community and what makes them tick. Sometimes, it means bringing people together when the pain points are such that change has to come because there is no other way.
It also means having a unique ability to create space for people to be heard while also managing the inevitable differences of opinions and knowledge that you may face. And that means understanding how to manage communities effectively towards a shared vision.
Plus, to keep us all safely ageing-in-place, Australia needs to deal with issues like crime and disaster preparedness, prevention, management and recovery. We also need to shift towards planning for accessibility on a home design and street design level. And we need to promote the softer skills that make up the shortfall within the built environments.
Part of that is challenging the individualistic, scarcity driven culture. Focusing solely on what one will obtain from participating in ageing-in-place means we don’t get the chance to offer what is necessary. We also risk monetising community-led care in such a way as to recreate the barriers to other forms of care and leave people behind.
A lack of family unity
Culturally, we have to challenge the idea that we’re islands, or that individual need trumps the benefits found in collaboration.
This includes issues related to:
- The strength and availability of family units to support the ageing process. Some people simply don’t have the sort of family that lends itself to eldercare through geography, attitude, hierarchy, culture or estrangement. We need to normalise talking about family issues in order to address them
- Normalising helping each other. Australia has a cynicism issue that sometimes leads people to dismiss help-oriented and community-led action. This cynicism invites an unfortunate assumption that to ask for help on a physical, emotional, financial or social level is to fail and/or to burden. This is despite the knowledge that helping others is beneficial to all parties
- A lack of consultation. Family structures, presumptions about personality, prejudice concerning age, gender, disability and race create a climate where decisions are made for others without consulting them. The result is the infantilisation of the parties, increased conflict and a lack of collaboration, as well as a lost opportunity to gain experience from each other. Choosing for people without their permission or involvement can lead to alienation and exclusion. If you damage the trust at the start, you can expect to see a lack of eagerness and hesitation to engage in the future
- Preventing burn out. Families that are actively supporting their older relatives are a wonderful thing. However, this care often falls on the shoulder of one person – the daughter of the ageing Australian. That often creates issues as this nominated carer is often parenting alongside their eldercare role. More needs to be done to encourage a wider family net – and to incorporate the neighbourhood and communities within communities (e.g. cultural, sexuality etc), and formalised supports into the mix
A lack of understanding of the ageing-in-place concept
While many of us want to stay at home for longer and wish to die in our own beds, we lack the knowledge to make it happen. The community remains enamoured with the concept without the tools, resources and ability to action it.
Awareness, education and tool-sharing are vital parts of ensuring that all older Australians are well-versed in the options available. And have a good understanding of what is involved in creating care plans that suit ageing-in-place and building those care plans before they are needed.
In our next blog, we’ll discuss what we can do as individuals and organisations to normalise and mobilise a movement towards ageing-in-place, now and in the future.