One Day Baby, We’ll be Old.
And then we might need support from others. Hopefully, we’ll still be in charge of our own life. But maybe we won’t be able to do all things on our own anymore. Or we’ll want to be in a new living environment that makes us feel more sheltered than a regular home. If family aren’t close or available to help all the time, we can get institutional support…
“Assisted living” until recently was pretty much the only option — providing professional support in return for a fee. But new models are emerging: one of them is community-oriented housing.
Community-oriented housing seeks to create a living environment that stimulates interaction between residents. The goals are to promote self-activation and create mutual support. In contrast to “assisted living” which has a strong service component, community-oriented housing is characterized by the following traits:
1. Meeting place & open events: The facilities are designed as meeting places for many different people rather than living places for older people only. There is a considerable number of events open to the public, which are meant to attract people from the surrounding neighborhood.
2. “External” offers: Many activities taking place within the facility are convened in cooperation with partners from “outside”, for example with associations or church-based organizations.
3. Responsibiliy & influence: Residents usually do not simply participate in activities offered by the facility but co-design and run those themselves. They also engage constantly in shaping the facility and activities taking place. Professionals only assist in making this happen, if at all.
The model as such sounds great. But does it also produce positive social impact? And if so, in which areas? To find out, my research team conducted interviews with 260 people, 110 living in community-oriented housing and 150 from “assisted living”.
To corroborate findings this was repeated after a year. Answers were then coded and analyzed to detect differences in people’s social network, their mutual support, or participation in community activities. Other areas covered included: trust, or engagement in the facility, but also satisfaction and health status.
The results show that community-oriented housing is indeed superior to assisted living across these dimensions, with few exceptions:
People were for example 3 times more likely to receive a “high” degree of support in daily life from their neighbors. This support ranged from help in the household to sharing knowledge and experience. Residents in community-oriented housing also engaged about 3 hours more in performing communal activities, such as convening events. On average they also “fully trusted” two more neighbors than residents in assisted living.
The strongest difference was detected by measuring “network strength to neighbors”, assessed by an index incorporating (1) the number, (2) the frequency, and (3) the perceived importance and (4) intimacy of contacts to neighbors. The average score on community-oriented housing was more than 40% higher than in assisted living.
However, and this is important (!), this was not due to differences in the absolute strength of individuals’ network, but its relative distribution across residents. In other words, individuals in community-oriented housing didn’t have more or more intense contacts overall, but there were significantly fewer people that didn’t have any contacts at all as illustrated in this graph.
The graph shows that the slopes of the two curves displaying network strength in the two models are similar and that they are almost at level for the highest score on the index (here: 0.6). But the “peak” of the assisted living curve is located in the area of very low network strength (close to 0.0) and at a marked distance from the one of community-oriented housing.
Another statistic underscoring this difference is that the share of people in community-oriented housing receiving any daily support from neighbors at all lay at 73%, while it was as low as 40% in assisted living.
Here are some restrictions:
In contrast to the above, there were hardly any differences in the personal emotional support received from neighbors. Nor were there pronounced differences in the satisfaction of individuals or positive effects of community-oriented living on health status. When it comes to health the repetition after one year was almost certainly too short to detect any effects, even if these existed. And satisfaction did not seem a good indicator altogether. Several residents in both models stated they felt obliged to “be happy with what they had”, since their generation had been through hardships in the past.
The bottom line is: neighbors in community-based housing cannot replace a person’s best friends or family, but they still provide a high level of social interaction and support. Many of the detected differences were due to the fact that a significantly smaller proportion of persons were excluded from the community altogether. This “inclusive function” is of great importance against the background of individual isolation in old age and the negative consequences it can have.
Apart from this immediate learning, my study shows how important it is to have multi-facetted and detailed accounts of social impact, because: (a) single indicators (here: health status and satisfaction) might be inhibited in their capacity to show relevant positive effects, and (b) the cause of differences between alternative models may be hidden in the details.
For those interested, a more detailed version of the results is available here (in German).