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How societies should rethink eldercare with multi-generational housing
Ageing Articles

How societies should rethink eldercare with multi-generational housing

Nurse and patient

The world is ageing fast. While living longer is in many ways a good trend worth celebrating, the rapid rates of some of the region’s fastest silvering societies can bring about profound social and economic implications that policy makers must address promptly.

The number and proportion of people in the world over 60 years is set to double from 0.96 billion (12.7%) in 2017 to 2.08 billion (21.3%) 2050, according to a report by the World Health Organisation. However, longer lives do not necessarily equate to more fulfilling lives, if the healthcare and welfare needs of the growing pool of seniors are not met.

Today, Japan is the only Asian nation among the top 10 counties with the largest share of persons aged 60 years and older. But by 2050, four other Asian countries – South Korea, Taiwan, Hong Kong and Singapore – are expected to find their places in the same super-aged league.

This requires a whole-of-society effort to address the long term challenges of an ageing population. So how should governments work with communities to cater to the elderly? Several experts including Dr Bill Thomas, a geriatrician from the United States, share insights at the Ageing Asia Innovation Forum held in Singapore on May 2018.

Age segregation hinders inclusivity

The places we live in can be made much friendlier to older people. Forum keynote speaker, Dr Thomas, proposed dismantling age segmentation as key to empowering the lives of seniors.

He is the founder of ‘The Eden Alternative’, an approach to elder care that was developed in the early 1990s.  Dr Thomas was then a medical director at a nursing home in the US, and he wanted to change the culture of care from a top-down institutional approach to one that is ground-up, where the senior is at the core.

Sharing how western societies embrace age segregation by keeping the elderly in institutional care or communities, he warned Asian countries not to go down the same path Europe and North America did.

“Do not segregate elders from the rest of society and condemn them and the rest of their lives in an old age archipelago,” he observed.

“Show me a society that flourished by taking its elders and removing them from their communities. If I look at human experience, people of different ages live together – that was how it was. It is a strange modern distortion that we take older people and segregate.”

Societies should instead focus on developing inclusive neighbourhoods and communities, nurturing belonging, and embracing digital tools that keep people connected.

Inter-generational housing

Intergen housing
Photo source: https://myminka.com

By 2050, the US will see a huge growth in seniors who are aged 60 and above. Their numbers will rise from 69.8 million (21.5%) in 2017 to 108.4 million (27.8%).

Dr Thomas’ latest innovation, MAGIC – multi-ability/multi-generational inclusive communities – is a new type of inter-generational housing concept that could address the needs of this group.  

By taking the idea of the traditional Japanese minka, meaning ‘house of the people’ further, he aims to build an inclusive community through affordable, modular housing platform. Minkas were used in the past to house a wide variety of people from farmers to village headmen, merchants and samurai.

Similarly, his new housing concept aims to accommodate different types of people. The modular building system is designed to be adaptable – everything from size and layout to interior and exterior finishes can be selected and combined flexibly.  The concept has been brought to life through a pilot project with University of Southern Indiana, where MAGIC has been implemented as a housing model for both students and the elderly, starting in 2018.  

Citing how such communities are the north star of ageing, he explained that they give the elderly a sense of belonging, help them find purpose, and encourage them to maintain strength for themselves and others.

“In America, young college students are put in dormitories, older people go into facilities,” he shared.

“I’m looking at a future that doesn’t segregate the people by their age and abilities, and when young people get to be around older people, and think that’s really cool and fun, because that’s how you build the bonds between the generations – it’s that contact that make relationships happen.”

One-stop eldercare

Other forum speakers also shared on how housing will be the focus of discussion as the greying population grows.

In a speech at the forum, Dr Amy Khor, Senior Minister of State for Heath in Singapore, cited how the city-state is pioneering new models to transform how the country cares and supports seniors to age in place within their communities.

One model is Kampung Admiralty, the first “retirement kampung” (village) where seniors can access a continuum of social and health services to support them as they age – from markets to clinics.

Kampung Admiralty impression
Photo: HDB An artist’s impression of the Kampung Admiralty pilot project. The integrated development includes intergenerational facilities such as child care, elderly day care, banking, and recreational facilities for all ages.

And similar to Dr Thomas’ idea, this housing concept is not exclusive to the elderly. Younger residents are also catered for, with a childcare centre, playground, and communal features like a roof-top garden, community farm and fish-rearing pond.

Soon, Singaporeans can look forward to more of such developments sprouting up around the country. “Both Ministries (Ministry of Health and Ministry of National Development) are studying the potential sites for such assisted living developments, within both private and public housing,” said Dr Khor.

Another eldercare option that is being explored is home or day care, where seniors can age-in-place while having their healthcare needs attended to while still living at home.

The government aims to grow the number of home care support from 7,500 places today to 10,000 places by 2020.

“Recognising that a lot of people want to stay home, there are also day care services where they can come to the centre during the day and be back home at night, and they don’t need to be here every day,” said Mdm Low Mui Lang, executive director of The Salvation Army Peacehaven Nursing Home.

Ageing-in-place

Over in Hong Kong, policy makers are grappling with the city’s ageing time bomb.

Dr Lam Ching-Choi, Member of the Executive Council of Hong Kong, shared that the government is helping people to age in place, but more needs to be done.

For instance, a 24/7 personal care emergency service is offered by the Senior Citizen Home Safety Association, which aims to provide a one-stop helpline for seniors from the comfort of their homes.

Despite such services, many seniors are enrolling themselves in nursing homes – when they do not have to. He believes the root of the problem lies in the lack of affordable and elderly-friendly housing that are connected with essential facilities.

“I have been fighting this battle for many years… A lot of these macro-ageing problems are housing problems,” Dr Lam said.

“By building a good kampung for the people, you will actually solve a majority of the ageing problems.”


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