Co-housing and aging-in-place for older adults
Authors: Marilyn Macdonald1,2, Lori Weeks1,3, Nadia Stec2
1. School of Nursing, Dalhousie University, Halifax, Nova Scotia, Canada
2. Aligning Health Needs for Transformative Change (AH-NET-C): A JBI Centre of Excellence, Dalhousie University, Halifax, Nova Scotia, Canada
3. School of Health Administration, Dalhousie University, Halifax, Nova Scotia, Canada
The population of older people is growing in both size and proportion globally. Demands for care are outpacing the supply of human health resources, including long-term care (LTC) homes. Co-housing is a potential solution that staves off the need for more involved care for aging populations. Such a solution would improve their quality of life by reducing social isolation and depressive symptoms while at the same time promoting mobility and daily life activities. The addition of co-housing to cities is an innovative, upstream planning option to creating healthier cities, allowing older people to extend the number of years they can live in their own home without formal support services.
The aging global population
By the year 2030, one in six people will be over 60 years of age, an increase from 1 billion in 2020 to 1.4 billion. Those over 80 years of age will be a group of 426 million people by 2050. In Canada, one in four Canadians will be over age 65 by 2031. In the United States, the population is currently older than it has ever been and the number of Americans over the age of 65 is predicted to increase to 82 million by 2050, making up 23% of the total population. With one of the highest life expectancies in the world, Sweden’s elderly population will also make up 23% of the total population by 2040.
The largest growth in older populations will occur in developing countries––they will hold two-thirds of the world's population in this age group by 2050. This includes much of Latin America, which contains many low- and middle-income countries. For example, the Andean region is expected to see a population growth to 22.4% by 2050 for older adults, from the current 12.42%. In the eastern part of the word, India will see its population shift as well, with those over the age of 65 doubling to over 20% of the total population by 2050.
In many cases, older populations across the globe face precarious financial security, and an important economic concern is the declining ratio of the workforce to pensioners. For example, over 40% of older people in India are in the poorest quintile, and almost 20% do not have an income, negatively affecting their quality of life and health care options. The process of aging also varies widely from person to person––many individuals in their eighties maintain physical and mental capacities of those decades younger, while others experience sharp declines in their health. This outcome is largely attributed to an individual’s physical and social environment, as it shapes their health behaviors.
The argument for co-housing
As people age, they prefer to stay in their own homes for as long as possible. This can be a challenge depending on the layout and location of their home, care needs, and affordability. People need a home that matches their personal needs. The World Health Organization considers LTC as services needed to mitigate physical decline, including health promotion, illness prevention or management, rehabilitation, assistive and end-of-life care. For many, LTC is an option that would assist them with daily living. However, the demand for LTC is rising quickly and all countries experience their own challenges. Moreover, the autonomy and socialization of individuals in LTC is lower. In Canada, there are just over 300,000 people living in LTC institutions while 77,448 are on a waiting list. As human health resources in LTC become more limited, it is necessary to provide other options to reduce the strain on the health care system and provide older adults with a better quality of life.
Co-housing is an intentional community design that originated in Denmark in the 1960s, eventually making its way to the United States and Canada in 1988 and 1996, respectively. Whether multigenerational or seniors-only, co-housing brings together people who are interested in design and development of planned communities of 20 to 40 people co-located with communal spaces. This design combines the independence of private living with advantages of shared amenities and a village-style support system, and this benefits older individuals as they can live autonomously for longer, pushing the need for institutional care further into the future. Residents mutually support each other to live independently, engage in social interaction, and experience the health benefits of belonging to a community. Other reported benefits of co-housing include contact with nature, autonomy, and the acceptance of aging.
Planning for healthier cities
In recent years, co-housing has become more widely accepted as a potential solution to social isolation and enhancing seniors’ quality of life. This is largely due to the social and support aspects of co-housing, including interaction with neighbors, shared meals, and independence. Being mobile and able to complete daily activities such as walking, feeding, bathing, dressing, and mental health are all key determinants of health-related quality of life. Seniors living in their own homes experience less depression and perform more of these tasks on their own compared with those living in LTC––so the benefits of co-housing are clear.
In a study on a Canadian co-housing community, the participants reported their quality of life to be very good in environmental, psychological, and physical aspects based on survey results. Most participants also stated that their quality of life was maintained or had improved since moving to a seniors’ co-housing facility. Thus, the attributes of these living facilities positively affect physical health and accessibility despite any decline in residents’ health.
In India, housing options for seniors are also experiencing growth based on the population shift, increased life expectancy, and the increasing prevalence of nuclear families due to younger generations moving away. Housing facilities are similar to those in Canada, including intergenerational housing that has parallels with co-housing for seniors.
Key takeaways
Co-housing is a potential upstream option that can be implemented across the globe to extend independence for older people and delay the demand for LTC. Not only would co-housing facilities reduce the strain on LTC and similar support options, but they would also provide residents with a sense of community and facilitate mobility and daily activities. While there are many benefits for older adults living in co-housing communities, public investment is needed to ensure that more older adults have access to this form of housing and to ensure that the cost is affordable.
In Canada, most co-housing communities are in British Columbia. The first co-housing community in the Atlantic region is now operational and includes older adults in a multigenerational community. With the depletion of finite, downstream human health services, co-housing would extend the number of years older individuals can live in their own homes with fewer formal health and support services.
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To link to this article - DOI: https://doi.org/10.70253/PRZR2214
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