Every day, we see stories of people, places, systems and services that inspire us. The PPS Dispatch is our way to capture, share and amplify some of the incredible things happening within our communities. This connects to the core of all our work, which is focused on moving towards more resilient SYSTEMS, COMMUNITIES, PLACES and SERVICES.
PPS x PWC collaboration
For this edition, we have partnered with Kiersten over at Public Works Collaborative. PWC is a collaborative working to advance public health, i.e. the well-being of people and places where we live, learn, work, and play. We are regular collaborators with the good people of PWC, and one theme we have been exploring together is ‘aging in place.’ So in this issue we will share some of our exploration into that topic and how it connects to opportunities for more resilient systems, communities, places and services.
Why aging in place?
We're getting older. In the last 200 years, life expectancy has doubled. [Source] By 2050, 1 in 6 people will be 65 or older. That’s 16% of the global population. [Source] Meanwhile, the number of babies being born is decreasing. [Source] According to the United Nations, "Population aging is poised to become one of the most significant social transformations of the twenty-first century, with implications for nearly all sectors of society." [Source] The need to critically and creatively reflect on population aging is particularly acute in the U.S. Today, as the median age inches toward 40, the U.S. population is older than it ever has been. [Source] In 10 years, older Americans are expected to outnumber children for the first time in history. [Source] By 2050, the number of Americans 65 and older is projected to increase by 47% and reach 82 million. [Source] These global trends will have physical, social, economic, and environmental impacts on society and how we age. In response, the United Nations declared 2021–2030 the Decade of Healthy Aging.
Aging in place: resilient systems
As populations age, the need for long-term care will increase. [Source] It's hard to imagine how these needs will be met, given many healthcare systems struggle to adequately care for people today. In Canada, Medicare is buckling. [Source] In Iran, thousands of healthcare providers are emigrating. [Source] In the U.S., hospitals are closing urgent care centers and pausing essential services to survive. [Source] And this is just the tip of the iceberg. Yet there are signals that suggest healthcare systems as we know them today could look, feel, and operate in radically different ways tomorrow.
What are systems that support a more equitable world for the aging population AND consider the care work needed to support them?
Bogotá transformed its care system
Bogotá’s Care System aims to reshape the public services and infrastructure of Colombia’s capital to enable the equitable distribution of unpaid domestic care work across genders, and to give women more time and autonomy over their lives [Source]. The goal is to transform society and the cultural and behavioural norms—for both men and women—that have resulted in entrenched societal inequalities in the city. You can watch an interview with Diana Rodríguez Franco, Secretary of Women’s Affairs for the city of Bogotá here to learn more about the key elements of the Care System, and the iterative approach to policy design and implementation that underpins the System.
The real importance of projects such as the Care System lies in the fact that they can inspire other local governments to make structural changes that truly benefit citizens. "Bogotá is demonstrating the importance of taking risks, testing these initiatives, and working as a team among diverse entities for positive change."
Care Policy Scorecard
Measuring impact is an integral yet often overlooked part of the design process. The goal is not to prove that a design – be it a policy, service, or system – works but to improve its capacity to catalyze the desired changes. The Oxfam scorecard is designed to empower advocates to track progress on policies that aim to recognize, reduce, redistribute, and represent unpaid care work and adequately reward paid care work. Then, communicate to policymakers what's working, what's not working, and why. [Source]
"The scorecard... allows you to carry out an assessment of the care public policy environment in your country to understand where there is positive progress, and where there are gaps and room for improvement." [Source]
Aging in place: resilient places
Where we age impacts how we age. [Source] Social determinants of health (SDH) account for 30-55% of health outcomes. And contribute to longstanding inequities in health and well-being. [Source] The built environment is one of the primary social determinants of health. [Source] It is particularly important in the context of aging given older adults tend to spend more time at home than other age groups. [Source] Yet home means different things to different people. [Source] Following are two signals that speak to the evolution of the built environment as a physical, social, and psychological determinant of health that impacts aging.
How might the built environment support the needs of the aging population, especially in the context of aging in place?
Design Guidelines for Age-friendly Built Environments
If given the choice, many people say they'd prefer to grow old at home. Aging in place can prolong independence, autonomy, and social connection. [Source] Yet many homes are not designed to do so. They lack the physical, social, and psychological infrastructure to support the diverse needs of our elders. In large part, because there's a lack of diversity in architectural design and planning. And co-creation is not widely embraced within the profession. [Source] To fill part of the gap, Victoria University Professors Dr. Hing-Wah Chau and Dr. Elmira Jamei published a comprehensive list of design standards and guidelines for age-friendly housing and buildings (as well as public spaces and transportation). [Source]
"The aim is to foster active ageing by optimising opportunities for older adults to maximise their independent living ability and participate in their communities to enhance their quality of life and wellbeing. An age-friendly built environment is inclusive, accessible, respects individual needs and addresses the wide range of capacities across the course of life... [To this end] Government and local councils should be more proactive." [Source]
Fake Bus Stops at Benrath's Senior Center
One of the most physically simple yet psychologically sensitive adaptations to the built environment we've seen was designed by The Benrath's Senior Center in Dusseldorf, Germany. It's a fake bus stop. [Source] Why would a senior center install a bus stop where buses never stop? Many residents have Alzheimer's Disease or dementia. And wander off. They become disoriented and want to go home (even though they are home). [Source] This is a dangerous scenario. Half of those who wander and are not found within twenty-four hours are found dead. [Source] To avoid sedating residents or locking them in their rooms, the staff persuaded the transit authority to install one of the city's bus stops in front of the center. The result? Residents have a physical destination that also serves as a psychologically safe space for staff to soothe them back inside. For the full story, check out Lulu Miller's conversation with Benrath's Richard Neureither and Regine Hauch on RadioLab. [Source]
"The bus stop has changed how the staff approaches all residents—the staff has become more amenable to their patients’ insistences, and more readily make allowances for a patient’s perceived reality. The bus stop was so successful that soon other senior centers in the city installed their own faux stops..." [Source]
Aging in place: resilient communities
Social isolation and loneliness are widespread. And the impact on public health and well-being is significant. For older people, social isolation and loneliness increase the risks of cardiovascular disease, stroke, diabetes, depression, and dementia. [Source] In response, WHO has called on government agencies around the globe to make addressing this issue a priority. And are actively seeking effective interventions that can scale. [Source]
How might we leverage community to combat social isolation and loneliness among older people?
Friendship & Fancy Footwork
The Bodacious Belles are a North Carolina-based chapter of the Sweet Potato Queens, a network of more than 6,500 women’s groups that offer each other “a balance of amusement and mutual support.” [Source] The Bodacious Belles—ranging in age from 57 to 92—perform at local events, participate in year-round social events, and form lasting bonds. But these amazing ladies aren’t just about dancing, karaoke, and movie nights. Many are widows and they provide a critical support network for their members who are coping with loss and grief. [Source] Through it all, the Belles demonstrate how celebration and connection can be an antidote to isolation.
"The positive feelings that come with seeking community... produce positive effects on the body. “What these good hormones do is slow down our molecular aging,” Dr. Hou said, because they help cells function better. “It’s like nutrition for us.'" [Source]
University-based Senior Living
Life-long learning can have many benefits. [Source] It can improve individuals' self-esteem, communication, and sense of purpose as well as promote emotional resilience, well-being, and mental health. [Source] It's not surprising, therefore, that many senior living communities try to offer residents a variety of learning opportunities, from crafting to cardio classes. In 2000, the founders of Lasell Village in Massachusetts decided to take this to the next level. And embrace lifelong learning as a "way of being." To support this mission, the village is integrated into the physical and social fabric of Lasell University. And each resident must commit to a goal-oriented program of education. [Source] The model is so popular with seniors that Lasell Village has a waitlist of 300 households. [Source] And University Retirement Communities are popping up all over the U.S. [Source]
"The college setting, the selection of courses, and interacting with students of all ages keeps me young at heart and mind.” Paul, Lasell Village Resident [Source]
Aging in place: resilient services
Our health depends on the well-being of the people caring for us. However, healthcare workers worldwide are in the midst of a crisis. This crisis has many facets. It's part labor crisis, part mental health crisis, part education crisis, part gender equality crisis, and part financial crisis. [Source, Source, Source] This reality is resulting in a global shortage of healthcare workers. [Source] There's not "the right number of people with the right skills in the right place at the right time, to provide the right services to the right people." [Source] This will become increasingly problematic under the pressures of population aging. However, crises often catalyze innovation. In addition to disrupting standard operating procedures, crises unite people. And empower them to see and do things differently. [Source] These signals suggest the healthcare workforce crisis is no exception.
How might we place a thriving health workforce AND the aging population they are serving at the center of public health policy?
Action Plan for a Thriving Health Workforce
Burnout among U.S. healthcare workers reached "crisis levels" before the pandemic. [Source] Covid amplified the effects. "Exhausted, helpless, and heartbroken" are the three words that the U.S. Surgeon General Dr. Vivek Murthy most frequently hears when talking with healthcare workers today. [Source] In response, the Surgeon General declared health worker burnout one of the most public health issues of our time. [Source] And made addressing it 1 of 6 priorities for his administration. [Source] This Advisory translates insights into actions that can unfold at various scales, offers examples, and calls attention to its limitations. "This Advisory contains steps that different stakeholders can take together to address health worker burnout. It calls for change in the systems, structures, and cultures that shape health care. Given the nature and complexity of the challenges outlined, this Advisory is not intended to be comprehensive in its recommendations." [Source]
"When health workers look ahead, they should see a future where their dedication isn’t taken for granted, and where their health, safety, and well-being is as much a priority as the well-being of the people and communities in their care." [Source]
Aged Care Legislation
After four years of research into aged care across Australia, the government determined the entire system needed an overhaul. And recommended a new Aged Care Act that 'places older people at the center of all aspects of aged care.' [Source, Source] Changing rules changes behavior. [Source] What’s particularly intriguing about Australia's new Aged Care Act is how they're designing it. The government is co-creating the legislation with older adults, their families, care teams, and advocates like the Aged Care Council of Elders. [Source] Co-creating with the stakeholders for whom a policy, system, or service is being designed has many advantages.
"Much has been said during our inquiry about the need to ‘place people at the centre’ of all aspects of aged care. To achieve this, we are convinced that a new Act is needed. The new Act must focus on the safety, health and wellbeing of older people and put their needs and preferences first." [Source]
P.P.S. / post postscript
Watch this film from the Ageing in Place research project, led by Professor Tine Buffel, Dr Patty Doran and Dr Sophie Yarker, which explores how cities can adapt to meet the needs of a growing and increasingly diverse ageing population to become more age-friendly. As part of the Ageing in Place project, older people from multiple cities including Akita, Bilbao, Brno, Brussels, Manchester, Oslo, and Québec were asked what ‘age-friendly’ meant to them.
The simultaneity of demographic change and deepening urbanisation means that cities must move quickly to plan for ageing populations and provide the services and infrastructure their residents need. This is especially important given that most people will ‘age in place’ or remain living in their home and community rather than move into residential care.
Thanks for following along,
Lena with Process/Practice Studio + Kiersten with Public Works Collaborative