Journal of Community & Applied Social Psychology J. Community Appl. Soc. Psychol., 24: 69–73 (2014) Published online in Wiley Online Library (wileyonlinelibrary.com) DOI: 10.1002/casp.2175
Integrated Service Areas: An Innovative Approach to Housing, Services and Supports for Older Persons Ageing in Place JEROEN SINGELENBERG1, HOLGER STOLARZ2 and MARY E. MCCALL3* 1
Steering Group on Experiments in Housing (SEV), Rotterdam, The Netherlands Kuratorium Deutsche Altershilfe e. V. (German Foundation for the Care of Older People), 50677 Cologne, Germany 3 Saint Mary’s College of California, 1928 Saint Mary’s Road, Moraga, CA 94556, USA 2
ABSTRACT As the number of older people increases, the need for housing and services grows. A unique project, started in northern Europe, provides a platform for sharing best practices, within appropriate cultural contexts, for supportive local housing for a range of needs. These Integrated Service Areas (ISAs) provide a range of co-located and locally integrated services in small communities. This paper presents preliminary research that points towards greater satisfaction, feelings of security and longer housing independence among those living in ISAs compared with other elders. We argue that ISAs represent a useful example of possible housing arrangement for older people and that similar projects in different cultures could be implemented in order to improve the quality of life and housing for older persons. Copyright © 2013 John Wiley & Sons, Ltd. Key words: Integrated Service Areas; supportive housing; collaborative planning; cultural context; web platform
Research around the world consistently indicates that older persons would prefer to live independently and in their own homes or own neighbourhoods as they age, often referred to as ‘ageing in place’ (American Association of Retired Persons, 1990; Ball et al., 2004; Gilleard, Hyde, & Higgs, 2007; Lawton & Nahemow, 1973; Vasunilashorn, Steinman, Liebig, & Pynoos, 2012). In addition, global research points to the relationship between social integration, activity, physical and mental health and longevity (Anme & McCall, 2011; Brink, 1990; Lawton, 1990). A challenge for all countries with ageing citizens is how to manage the relationship between the ‘bricks and mortar’ of housing stock and the social-psychological needs of dignity and independence for older persons in a
*Correspondence to: Mary E. McCall, Saint Mary’s College of California, 1928 Saint Mary’s Road, Moraga, CA 94556, USA. E-mail:
[email protected]
Copyright © 2013 John Wiley & Sons, Ltd.
Accepted 8 November 2013
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culturally appropriate way. Affordable, accessible and suitable housing options can allow older adults to age in place and remain in their community their entire lives, especially housing that is located close to community resources that provide opportunities for physical and mental activity and social interaction and engagement, which can contribute to longevity (Anme, Shinohara, Sugisawa & McCall, 2008; Anme & McCall, 2011). Given the increasing life expectancy in developed countries, coupled with the decreasing numbers of young people available to care for them, new and innovative ways to support elders are needed. In this paper, we present an international platform for sharing best practices in efforts to provide creative solutions to the needs of older persons. In 2009, a group of varied professionals from four European countries came together to share best practices for supporting older persons in their homes and communities. This collaborative project identified existing examples of what came to be called Integrated Service Areas (ISAs). These projects seek to provide resources to seniors in a manner that upholds their dignity and independence. These projects model collaboration including housing providers, social workers, care providers, architects, researchers and local officials who have come together to support older persons in their communities. These criteria were established by the initial group of professionals, on the basis of their agreement of what factors might contribute to helping elders maintain their independence in their communities. As international efforts (Brink, 1990) focus on how to address global ageing concerns, this model may serve as one exemplar of cooperative approaches to these needs and a model for how we can share best practices, even across different cultural contexts. The ISA network (www.isa-platform.eu) began in 2009 with representatives from Germany, the Netherlands, Switzerland and Denmark identifying various types of housing and service arrangements in their country. This group of architects, city planners, service providers and researchers looked for existing projects that met a series of criteria they developed. These criteria included housing that was clearly integrated into the local community, with systems of support that were multidisciplinary and coordinated across areas of support (i.e. physical health as well as social support services) and included the active participation of local citizens and local governments. They called these projects ‘Integrated Service Areas’ because they included provision of housing, social and physical support services and various levels of care. These ISAs focused on residential areas of towns or municipalities where all generations lived together. They identified two key implementation components, which were (1) full participation of local stakeholders and residents in shaping the types of housing and services and (2) cooperation between stakeholders, especially professionals and local governments. They also described four key provisional components. They were the following: (1) free or low barrier (e.g. reachable cabinets and accessible bathrooms) normal apartments with easily accessible public spaces; (2) varied levels of assistance provided by specialists as well as neighbours; (3) a variety of care options, emphasizing small-scale home care and other residential forms for senior citizens in need of varying levels of care; and (4) one or more social meeting places. These various implementation and provisional components are important to helping older people feel that they are a meaningful part of their community. For example, in the ISA in Eching, Germany, the senior housing building (including both independent and assisted living floors) has a first-floor cafe that is open to the community, as well as meeting and activity rooms that are open to all citizens of the town. There are intergenerational programmes there so that residents of the building can interact with others in the community. Another apartment building a few blocks away houses a low-barrier dementia unit on the first floor of the building, Copyright © 2013 John Wiley & Sons, Ltd.
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with age-integrated open apartments on the other three floors. This ISA was able to be created only through the cooperation of local government officials (especially the mayor) with local care providers. Funding streams came from both national and local funds and an integrated collaborative effort through funds for both bricks and mortar and for services on-site. Trial efforts with such residential area concepts are underway in several countries, with varied implementation and provisional strategies. This difference comes from different stakeholders and the extent and speed with which changes can be brought about. Some countries have already been able to gain many years of experiences in this field, whereas others are only at the starting point. Concrete solutions vary across locations, although the problem and approaches are global. The resulting information (www.isa-platform. edu) is to serve primarily as a source of inspiration for professionals and officials to implement such concepts in culturally appropriate ways. The goal is to continue to share expertise and experience so that similar planning efforts can take place in new projects. Examples from the initial four countries have been documented and published electronically. The group now includes participants from other countries (Sweden, USA and Japan, at the time of publication), and the website has information about each ISA. Partners from other countries are welcome to contribute. Platform participants meet once a year to inspect projects or exchange experiences. Some recent research points in the direction of the positive effects ISAs can have on participants. In the Netherlands, SEV is the national organization for innovation in housing. SEV was involved in the first ISAs in the early 1990s and started an ISA pilot programme in 2009–2011. Two evaluation programmes have been conducted and are posted on the website—with summaries in English and full studies in Dutch (Singelenberg, 2012 for English; de Kam et al., 2012 for Dutch). In the first of two studies, they initially evaluated the content and performances of identified ISAs and then provided feedback and advice for further development (Singelenberg, 2012). The first formal evaluations were conducted between 2010 and 2012 by an interdisciplinary team of researchers from several universities in the Netherlands (de Kam et al., 2012). Results (the details of which are in Dutch) revealed that ISA residents had greater confidence that an adequate basic level of services and care as well as adapted housing would be available when needed. Social contacts and active participation were more important for quality of life than physical impairments and chronic diseases, supporting the idea that a key element of well-being is the ability to offer help to other people, even when physical abilities are limited (de Kam et al., 2012; Singelenberg, 2012). This sense of meaningfulness is important for older people to continue to feel that they are an integral and important part of their community. In summary of the results of the studies, it was found that older people living in ISAs more frequently were satisfied with current housing and believed that there was no need to move in comparison with older people with the same frailty score in non-ISAs. Thus, it seems likely that they are living longer independently as a matter of choice and not because of a shortage of institutional capacity or availability. (Singelenberg, 2012). Older residents valued informal social contacts and activities more than those offered by social workers in purpose-built activity centres. The majority of respondents noted that they met people in the shopping area, in the medical centre, cafes or on the street but not in a formal activity centre. In fact, few had ever visited an activity centre, preferring self-directed activities in preference to standard programmes (Singelenberg, 2012). There is a clear reminder in these findings that when planning is done, preferences of citizens must be taken into account. Copyright © 2013 John Wiley & Sons, Ltd.
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The first meeting of an expanded ISA network occurred in May 2012 in Eching, Germany. Representatives from Sweden, Japan and the USA met with original ISA collaborators. They shared examples from their own countries of efforts at similar integrated service areas. For example, in the town of Tobishima, Japan (n = 5000), villagers have participated in an ongoing 20-year study of their health, social integration and longevity. The village centre, started over 20 years ago, was designed with the same basic criteria as European ISAs. Local officials, especially the mayor, worked with local residents to design, build and maintain this community centre, which provides both recreational and health services to all generations in the town. These long-term studies have demonstrated the relationship between various social interaction activities and longevity in a group of people older than 60 years of age (Anme, Shinohara, et al., 2008). The initial idea of having a community centre that serves all ages was particularly foreign to older Japanese people, until they could see, through their own involvement, what the opportunities and benefits could be for social interaction. This demonstrates the importance of understanding local cultures when planning how to meet citizen needs (Anme, McCall & Takayama, 2008). Thus, the implementation components of collaboration were demonstrated in both Eching and Tobishima and contributed to their success. We see similar examples of these types of community-based, intergenerational housing and service designs in other countries as well. In Sweden and in the USA, the concept of co-housing—both senior-only as well as intergenerational—has begun, and though they are relatively small at this point, they show promise for future housing design. These housing types, though, are not necessarily tied into local services and so, in some ways, are not entirely comparable with ISAs. However, they can become a small but influential nucleus for an ISA. Integrated Service Areas may well address the issue of social isolation among elders, which can be a major risk factor for functional difficulties in older persons. Sociability plays an important role in protecting people from the experience of psychological distress, enhances well-being and may prevent or slow physical decline. Posner (1995) points out that older people tend to make friendships predominantly with those within the same age cohort. Thus, it is important to provide specific opportunities for older persons to socialize with one another in meaningful ways. In the Tobishima studies, people who felt involved in their local community had greater longevity than those less involved (Anme et al., 2008). The variety of avenues for social integration means that we must think creatively about how to both implement and assess the outcomes of efforts to keep people connected to their communities. Perhaps the most difficult experiences in late life are that of isolation and loss of dignity and independence. The ISA concept was developed specifically to prevent these outcomes. The research presented here demonstrates the potential for ISAs to impact the quality and security of housing for older persons. This paper argues that the role of ISAs and the ISA platform can help national and local governments to create systems of cooperation in planning, implementation and evaluation of these housing, care and services projects, across the range of needs of older persons. With such intentional and collaborative planning, older persons can live lives of dignity, independence and worth, well integrated into their communities.
ACKNOWLEDGEMENT This article is dedicated to Jeroen Singelenberg, who inspired us all to work for the wellbeing of older persons and their communities. May he rest in peace. Copyright © 2013 John Wiley & Sons, Ltd.
J. Community Appl. Soc. Psychol., 24: 69–73 (2014) DOI: 10.1002/casp
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Copyright © 2013 John Wiley & Sons, Ltd.
J. Community Appl. Soc. Psychol., 24: 69–73 (2014) DOI: 10.1002/casp
