• Industry: Healthcare
  • Type: Survey report
  • Date: 5/21/2013

Look beyond institutional boundaries towards the community 

Look beyond boundaries
As people age, most prefer to continue to live in familiar environments, which calls for accommodation that is suitable for those with declining physical or cognitive abilities. In some cases this can be achieved by adapting existing homes, but a more innovative alternative is the development of age-friendly urban and suburban communities.

Retirement villages are proving increasingly popular, supported by informal and professional health and social care providers. These may consist of resident-owned homes built around facilities that offer medical care, community services and entertainment, although such establishments tend to be more costly to create and run.

“It astonishes me how little training professionals receive around aging. Geriatric care modules in medical training are often quite minimal. There is a long term issue that we haven’t got to grips with yet, which is: how do you train the workforce so they can look beyond their specialism and help provide holistic care?”

Ruthe Isden, Public Services Program Manager, Age UK

A more cost-effective approach, pioneered by Beacon Hill Village in Boston, US,1,2 is to establish ‘virtual villages’ within existing urban or suburban communities, where elderly residents (and other volunteers) in a neighborhood are recruited to help one another with basic services such as transportation, home maintenance and health and wellness. Although many of these villages rely almost exclusively on volunteer help, some also include paid staff or contracted service providers.

Also in the US, Community Without Walls in New Jersey is a village that works with a local non-profit organization and relies mainly on informal volunteers. There is an annual fee of US$30 to join the community, with a charge of US$300 for a higher level of assistance. Other services are available for an additional cost.3

In 2012, Japan introduced a new Integrated Community-based Care System targeted at aging baby boomers. This concept aims to provide various support services, including welfare, healthcare, long term care and preventative measures within existing communities, accessible within 30 minutes. As a first step, there are 24-hour home visit services, which can be reimbursed under the national long term care insurance scheme. Senior housing developments now have safety monitoring and other services that are subsidized by the government.

Despite their many benefits, exclusive communities may also lead to ghettos that are socially isolated from the rest of society and future models probably need to be more integrated with existing infrastructure

“In my ideal world all nursing homes in the Netherlands would be closed today. A majority of the care could be delivered in a home care setting. The other part should be designed and delivered in small-scale homes. The alternatives should be as close to the ‘old life’ as possible and embedded in the community.”

Jos De Blok, Founder and Managing Director, Buurtzorg Nederland

Social versus medical models of care

Long term care is a unique hybrid of traditional medicine and social services and many practitioners are still seeking to find the best combination of the two. Doctors are trained to cure illnesses and heal injuries, with symptom relief a secondary priority, so they often fail to recognize and address emotional, spiritual and psychological suffering during the course of treatment. Many aggressive and expensive medical procedures and treatments are painful and demoralizing and, worse still, produce little improvement in chronic elderly patients experiencing the inevitable decline of old age. In contrast, social care professionals are primarily concerned with comfort, pain relief, dignity and the ability to function as a normal social individual. Consequently, the medical and social care sectors may not always work together in the best interests of the patient and elderly people can find themselves in hospital on multiple medications, when they would be better off in a nursing home – or even in their own homes – receiving more personalized, attentive care. Insufficient integration and coordination between health and social services providers exacerbates this dilemma, pushing up costs of care while compromising comfort and quality of life for recipients.

“We need to think more about combating social isolation and reducing dependency. This requires more customer-driven activities that can cater to a range of interests and abilities. I am talking about opportunities to develop and maintain a social life, integrating housing schemes into the local community, designing age-friendly environments, using restaurants and shops as venues for social interaction and ensuring access to extra care with support outside core hours of work, including the use of technologies. These are the virtues that good housing with care can deliver.”

Jeremy Porteus, Director, Housing Learning and Improvement Network, UK

Transforming care environments4

The Eden Alternative was founded in 1994 in the US and now has about 300 registered homes in the US, Canada, Europe and Australia. Its mission is to create elderly care environments that enhance the lives of both care recipients and caregivers, shifting care out of institutions and tailoring services to the unique needs, preferences and desires of recipients. This concept of person-centered care has been developed with certified trainers facilitating change by working closely with stakeholders that include non-profit, faith-based, or home health organizations, adult day services, hospices and independent living communities.

“The ability to deliver care to the home is hampered in the US by the almost obsessive belief that all healthcare must be done in a clinical setting.“

Eric Dishman, Intel Fellow and General Manager of Health Strategy and Solutions, Intel Corporation, US
One such partnership is with a non-profit foundation to promote wellbeing and a better quality of life for individuals with cognitive disabilities and the staff who support them. Intergenerational relationships with younger members of the community are also encouraged – including volunteers as young as 11 – to help change attitudes on aging and establish a fresh pool of younger carers. The Eden Alternative provides a wide range of training and teambuilding services, as well as caregiver certification and maintains a registry of trained, certified care providers that adhere to the organization’s standards and principles.

1The Village: A Growing Option for Aging in Place, AARP Public Policy Institute, March 2010
Accessed 23 October 2012.

2The “Village” Model: A Consumer-Driven Approach for Aging in Place, The Gerontologist, 25 August, 2011
Accessed 7 November 2012.

3It takes a village: Creatively aging in place, Davidson News, 15 February 2012
Accessed 7 November 2012.

4How We Serve, Eden Alternative
Accessed 8 November 2012.


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