Supported Independent Living - Housing LIN
Supported Independent LivingCommunal and intergenerational living in the Netherlands and DenmarkSeptember 2019 Gita PrasadSupported Independent Living Communal and intergenerational living in the Netherlands and Denmark01
AcknowledgementsI would like to thank the following people fortheir support and generous time-giving, whoenabled my Churchill Fellowship to becomea reality:Hazel Ellard, Dr Sue Zeitlin, Debbie Morris andGrace Simmonds for their encouragementand supportMarijke, Marian and Bunel from the City ofAmsterdam GovernmentYvonne from De Hogeweyk, Weesp, NetherlandsGea, Peter, Mark and Sores from Humanitas,Deventer, NetherlandsMelanie and the residents from Saettedammen,DenmarkCopyright September 2019 by Gita Prasad. The moral right ofThe Housing Learning Improvement Networkthe author has been asserted.The Winston Churchill Memorial Trust and theLady Hind Trust for grant fundingThe views and opinions expressed in this report and its content are and, of course, to Rohan and Felix for theircontinued interest in my interests!those of the author and not of the Winston Churchill Memorial Trust,which has no responsibility or liability for any part of the report.Photograph on cover: Humanitas, Deventer, Netherlands(with permission).Above, statue of Winston Churchill with meat Churchill Park, CopenhagenSupported Independent Living Communal and intergenerational living in the Netherlands and Denmark02
04Executive Summary.06Background.11My Fellowship.11United Kingdom Context. 12Communal and Intergenerational Living . 15Findings.18Social Policy Context in Amsterdam. 19Humanitas, Saettedammen andDe Hogeweyk. 25Critical Success Factors of SupportedIndependent Living. 28Shared Ethos of Relational Careand Empathy. 29Under-occupation of Homesby Older People. 51Daily Rituals. 31Combatting Loneliness. 51Deliberate Interactions between Olderand Younger People.34Preventing Health DeteriorationAmong Communities. 51Organisation and Distributive Leadership. 37Designing Healthier Built Environments. 52Self-Management of Care.40Accessibility and the Market. 52Enabled Environments.41Appendix A.54Conclusions.44Record of Meetings.54Does Intergenerational Living Work?.45Appendix B. 55Benefits of Communal Living.46Bibliography. 55Wider Impact of Communal andIntergenerational Living. 47Recommendations.50Supported Independent Living Communal and intergenerational living in the Netherlands and Denmark03
TerminologyMany of the terms used in social care and housing were interchangeable from the UK to the Netherlands and Denmark, but to support this report it isuseful to have some explanation of the terms used.TermExplanationSocial careThe care required to support an individual whose capacity to fully look after themselves has reduced or changeddue to illness and disabilityResidential careThis is the provision of care, support and living within a dedicated facility. Accommodation, meals and living take placein one setting. The elements of personal care provided depends upon the need of the client and their assessed needHome or Domiciliary CarePersonal care and support with Activities of Daily Living are provided by Home Care Assistants who visit the clientat home or within a home-like setting (such as Sheltered Housing in the UK)Extra Care HousingThis is the overall term for housing, predominantly for older people, that supplies some care provision. Extra carehousing is also known as very sheltered housing, assisted living, or as housing with care.Co-housingCo-housing describes intentional communities in a place where there are shared functions within theaccommodation and/or shared amenities.CommuneA group of people living together sharing responsibilities and other features under an agreed ethos.Intergenerational communityInvolving many generations engaging around a place or function.NHS EnglandNational Health Service England is the overarching commissioning body mandated by the Department of Healthin England, responsible for commissioning health outcomesSupported Independent Living Communal and intergenerational living in the Netherlands and Denmark04
Supported Independent LivingCommunal and intergenerational living in the Netherlands and DenmarkSupported Independent Living Communal and intergenerational living in the Netherlands and Denmark05
Supported Independent LivingCommunal and intergenerational living in the Netherlands and DenmarkExecutive SummaryFindingsBackgroundThis Churchill Fellowship falls under the categoryof New Approaches to Social and AffordableHousing. The main focus of the enquiry is aboutthe needs and aspirations of older people, livingin communities, in later life. My fellowship took meto the Netherlands and Denmark and the mainthemes of this fellowship are intergenerational,communal and co-housing models.This study is particularly pertinent to the UnitedKingdom, as the challenge to support olderpeople in good quality housing that promotescare, wellbeing and alleviates loneliness hasbeen well documented by the government.The NHS’s recently published Long Term Planalso sets out how care models will bedesigned to meet communities’ needs,with local responses and infrastructureto support all of its residents. This has animplication for housing and accommodationto be part of that infrastructure, bringingtogether housing and health and socialcare commissioning.The normative values of communities andintergenerational living are the main focus ofthe study and learning was gained from theAmsterdam City Government, Humanitas andDe Hogeweyk in the Netherlands and from theintergenerational community, Saettedammen,in Denmark.Social Policy in the City of AmsterdamThe social policy context and assessment of needin the City of Amsterdam shows that the over-65population in the Netherlands is increasing andthat more people are living longer. The SocialSupport Act mandates care and support for theover 18s and the Health Insurance Act managesthe arrangements for care delivery. Clients are atthe heart of care principles in Amsterdam, whichleads the delivery of care to contracted care,personal budgets and community care provision.For older people’s housing, there are similar issuesto the UK regarding loneliness, under-occupancyand supporting later life choices. However, thereis also a strong message of self-responsibility andsupport to make those important choices.Supported Independent Living Communal and intergenerational living in the Netherlands and Denmark06
Humanitas, Saettedammen and De HogeweykHumanitas is a residential and nursing home in theNetherlands that provides accommodation andcare to 160 residents and there are also respiterooms. Six students live amongst the residents.Saettedammen, in Denmark, is a community ofintergenerational residents living within a cohousing environment. There are 70 people in thecommunity. De Hogeweyk, in the Netherlands, isa residential village which specialises in the careof 150 older people with dementia.Critical Success FactorsThe major part of my enquiry was to determinethe critical success factors of supported,independent living within a communal orintergenerational setting.The critical success factors I identified in Humanitas,Saettedammen and De Hogeweyk have createdthe key learning themes of this report.These are the following: Shared ethos of relational care and empathy Daily rituals Deliberate interactions between older andyounger people Organisation and distributed leadership Self-management of care Enabled environmentsConclusionsDoes Intergenerational Living Work?“ Yes this works. People arenormal human beings and thecombination of different peoplemakes a community.”Whilst the communal life could be allconsuming, this was also deemed to be apositive, as there was lots on offer and muchto give to the communal way of life.“Yes this works.People are normalhuman beings andthe combinationof different peoplemakes acommunity.Supported Independent Living Communal and intergenerational living in the Netherlands and Denmark”07
Benefits of Communal LivingThere were clear benefits for the sandwichedage groups – for parents of young children,having extra grandparents to supportchildcare was invaluable. There was alsosupport in Saettedammen for everyday tasks,like meal preparation and laundry and sensethat there was always someone who couldprovide a meal. In Humanitas, the studentI interviewed has gained maturity in hisperspective of older people.Wider Impact of Communal andIntergenerational Living“ The impact of Humanitas is thatit is creating the next generationof being a good neighbour. Thetake aways are about values.A ten minute chat is valuedand an arrangement is made.”Humanitas may be classified as an ongoingsocial experiment, but at the heart of thefacility is care, support and respect of olderpeople and adults of all ages. I was left witha sense that it’s the student residents who willgain invaluable and immeasurable benefitsinto their adulthood. In Saettedammen childrenand adults have the possibility to engagein decision making. Many children get theopportunity to speak in front of a gathering ofpeople and this develops more confidence andalso consideration for others.“The impact ofHumanitas is that itis creating the nextgeneration of beinga good neighbour.The take aways areabout values. A tenminute chat is valuedand an arrangementis made.Supported Independent Living Communal and intergenerational living in the Netherlands and Denmark”08
RecommendationsUnder-occupation of Homes by Older People– The UK housing market needs to cater for aheterogeneous older generation, who havecare needs or future care needs and who mayprefer some technological solutions to aiddaily living. The Amsterdam City approachof coaching people to support them to thinkabout future living decisions is also a positiveidea, which could be transferred to the UK fairlyeasily with the help of the voluntary sector.Combatting Loneliness - Combatting lonelinessby making communities more accessible and bymixing the desired cohorts inter-generationallyfor new building developments would preventcreating “ghettos” or segregated communities.Preventing Health Deterioration AmongCommunities - Reducing overtly clinicalmodels in care settings can help peopleto self-manage more and become lessinstitutionalised. The UK should also support thedevelopment of intentional intergenerationalcommunities in all of their many forms,as a response to the localised delivery ofcare. The UK should also learn from theCity of Amsterdam’s delivery of care model,incorporating a local delivery model with aTrusted Assessor.Designing Healthier Built Environments A continuation of the Health New Townsinitiative is recommended, with expansion intomany more sites.Accessibility and the Market - The voluntarysector has a large and significant part to playwith social connectedness and in encouragingolder people to access their rights. Theinnovation of De Hogeweyk and Humanitasshould be included as models of care whichsocial care, housing and the NHS can learn from.Supported Independent Living Communal and intergenerational living in the Netherlands and Denmark09
Supported Independent LivingCommunal and intergenerational living in the Netherlands and DenmarkSupported Independent Living Communal and intergenerational living in the Netherlands and Denmark10
Supported Independent LivingCommunal and intergenerational living in the Netherlands and DenmarkBackgroundMy FellowshipI applied for the Churchill Fellowship under thecategory of New Approaches to Social andAffordable Housing. My professional interest,as a commissioner of health, social care andas Co-Chair of the Housing LIN Steering Groupfor the East of England1 directed me to askquestions about the needs and aspirations ofolder people, living in communities, in later life.This initial enquiry soon took me to reviewintergenerational as well as communal orco-housing models. I had heard of Humanitasin the Netherlands and was intrigued aboutthe idea of young people living with olderpeople in a residential home. When I appliedfor the Fellowship, I had imagined staying at1 he Housing Learning and Improvement Network (LIN) bringsTtogether housing, health and social care professionals inEngland and Wales to exemplify innovative housing solutionsfor an ageing population. https://www.housinglin.org.uk/Humanitas, to get an immersive experience.I didn’t ever think this would be possible, butI got my wish thanks to the generosity ofHumanitas’ Wellbeing Coach, and it was a trulyinspirational and unforgettable experience!My research into co-housing led me to theDanish community called Saettedammen, somefifty miles north of Copenhagen. My aim wasto get in touch with and visit the community.Thanks to social media and a dedicatedwebsite, as well as the kindness of the residents,this was facilitated. I was again welcomed intoa close knit, but open and friendly communityand experienced what care, empathy andsupported independent living can mean.An enquiry into supported independence in later lifewould not be complete without reviewing dementiacare. The rising diagnosis rates of dementia andthe better identification of the needs of peoplewho have dementia led me to the communitycalled De Hogeweyk in the Netherlands. My visitwas a moving experience and, like the othercommunities, convinced me that there are, indeed,supportive models of care for independence inlater life to inspire the United Kingdom.As someone who works in the public sector, I wasalso interested in the role that social policy playsin relation to supported independent living. I wasvery lucky to spend some time with governmentalcolleagues from the City of Amsterdam and alsolearn about infrastructure organisations who supportolder people, such as AeldreSagen in Denmark.Supported Independent Living Communal and intergenerational living in the Netherlands and Denmark11
United Kingdom ContextHousing and AgeingThe International Longevity Centre (ILC) reportedin 20162 that in the UK there are over 16 millionpeople who own their own homes, living inunder-occupied housing, who are middle-agedand older people. Half of all older people withcare needs have not got housing adaptationsto support their needs and there are more olderpeople aged 65-74 who are living alone.The ILC reported the following statistics: Since 2005 there has been a significantincrease in the number of 45-64 year oldsliving alone (500,000) as well as the number of65-74 year olds living alone (300,000). The average household size was 2.9 people in1971. Today there are on average 2.3 peopleper household. Over 16 million people – mainly owneroccupied, middle aged and older households 2I nternational Longevity Centre, 2016, The state of thenation’s housing: An ILC-UK Factpacklive in under-occupied housing. Six million live inhouses with two or more excess bedrooms. The 50 to 64 age group has the highestnumber of people in under-occupied homes(4.5 million), while the 65-79 age group has thehighest proportion. Nearly 9 in 10 of the 65-79 age group live inunder-occupied housing – over 50% live inhomes with two or more excess bedrooms.Specialist retirement housing and independentliving schemes could support older peoplebetter and help to alleviate loneliness andpromote independence. Examples of retirementand independent living schemes in other partsof Europe are leading the way with innovativehousing schemes, whilst the UK can only meetthe specialist housing needs of 5% of over 65s.In 2008 Delivering Lifetime Homes, LifetimeNeighbourhoods: A National Strategy forHousing in an Ageing Society was publishedby the Department of Communities and LocalGovernment. It stated a need for a refreshedapproach to specialist housing and in meetingthe demands of older people, including creatingdesirable homes in amenable locations.This strategy also linked housing adaptationsand information and advice for older people andintegrated provision of housing, health and socialcare, all of which are highlighted in the UK’s CareAct 2014 as drivers to promote wellbeing.Supported Independent Living Communal and intergenerational living in the Netherlands and Denmark12
The current national trend of under-occupationof housing among older people who are unableto find alternative accommodation also addsto loneliness and social isolation. Older peoplewith lower incomes are also more likely toexperience fuel poverty and issues with coldhomes. The prevalence of winter deaths arelinked to cold homes which are not sufficientlyheated or insulated.The right accommodation can enable peopleto come together to undertake activities, aswell as retaining the privacy of having theirown home. The ability to form relationships,to connect to the community and experienceimproved wellbeing are also positives gained byliving within a community.LonelinessIn 2015 a systematic review and analysis byBrigham Young University (USA) investigatedwhether loneliness and social isolation wereliked to premature dying concluded that socialisolation increased the likelihood of prematuredeath. The risk factors associated with lonelinessand social isolation are comparable to otherssuch as smoking, obesity and alcohol misuse.According to Age UK, people over the age of 75are more likely to feel lonely and isolated in theirown homes. The risk of loneliness in older peopleincreases with age as local social networkscan become limited with reduced contact withfriends and family and fewer opportunities tocreate new social networks with advancingage. Poor health and long term illnesses andreduced mobility exacerbates reduced accessto community or social networks.Closed neighbourhood environments andlack of community infrastructure can also bea barrier to social interaction, increasing thelikelihood of loneliness. The latter includeshousing and accommodation which canenable (or disable) community and socialinteraction. Well-designed community-basedaccommodation for older people can promoteengagement with local communities and thisin turn can help to create opportunities toalleviate loneliness.Supported Independent Living Communal and intergenerational living in the Netherlands and Denmark13
NHS England’s Long Term PlanThe NHS launched the Long Term Plan inJanuary 2019, which articulates the strategicpriorities of the NHS and how to improveoutcomes of care. It
those of the author and not of the Winston Churchill Memorial Trust, which has no responsibility or liability for any part of the report. Photograph on cover: Humanitas, Deventer, Netherlands (with permission). Above, statue of Winston Churchill with me at Churchill Park, Copenhagen. Supported Independent Living Communal and intergenerational living in the Netherlands and Denmark 03 .
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