Population ageing has been a focus of research since the 1960s (Michael et al. 2006), and it has become a domain of international discussions, debates and research throughout a myriad of disciplines including housing, urban planning and real estate (Buffel and Phillipson 2016, van Bronswijk 2015, Kort 2017). Kazak et al. (2017) described how the ageing population has a profound impact on the real estate market, which is transforming in terms of availability of retirement accommodation for older people including accessibility, adaptability, and the availability of single-floor dwellings. Older people usually have a strong connection with the environment they understand and know well (van Hoof et al. 2016), enabling them to spend the latter years of their life in a familiar setting, which, in turn, influences their self-confidence, independence and the potential to successfully age in place. Older people are encouraged to continue living in their homes a familiar environment to them, instead of moving to an institutional care facility, and this is referred to as “ageing-in-place” (van Hoof 2010). This can be supported by creating a functional and spatial structure of cities that are friendly to older people (van Hoof et al. 2018, van Hoof and Kazak 2018). In the domain of environmental design, a series of home modifications can be identified. The most frequently encountered measures in and around the home are adaptations to improve the accessibility of the home (i.e., removal of barriers such as thresholds, installation of stair lifts in multi-storey homes, and the replacement of bath tubs by walk-in showers,). Separately from these expensive measures and adaptations, simple handgrips can improve the accessibility, safety and mobility of older people (van Hoof et al. 2010, van Hoof et al. 2013). A further concern that should be considered within the living environment is the lack of storage space for wheeled walkers and mobility scooters (including a place to charge batteries) whilst living in an apartment block with limited space to manoeuvre on corridors (Kazak et al. 2017). However, with increasing demands for care, it is not always possible to remain living in one’s own home and moving into a residential or nursing facility is the only remaining option; whereby, specialist and/or nursing care can be accessed and provided in these living environments (van Hoof et al. 2009). Policy principles within long-term care aim to provide a home from home environment for their residents (Moise et al. 2004). Several specialised housing models have been developed in order to facilitate this person-centred care approach, as more traditional institutional settings often do not match with the new holistic and therapeutic goals (Verbeek 2017). Radical alterations have been made in comparison with traditional nursing homes, implementing changes in the organisational, physical and social environment of settings (Verbeek et al. 2009, van Hoof et al. 2009). For example, smaller groups of older people (six to seven persons) form a household, with nursing staff having integrated tasks, including assistance with activities of daily living, preparing meals, organising activities and doing household chores together with residents. Daily life is mainly determined by residents and nursing staff, and the physical environment resembles an archetypal house. With this distinct increase and popular notion of the role real estate plays in ageing-in-place and living well in old age, there is also a shifting focus regarding participation, activation, and helping each other. Home modifications and the home environment itself have a profound influence on the care provided and received at home. In short, the fewer barriers there are at home, the easier and less onerous responsibilities placed on the family carer(s) (Duijnstee 1992). Family carers themselves need such environmental interventions that support care, and a sense of community and belonging. Enabling one to age-in-place and to successfully age requires more than a simple occupational therapeutic approach of environmental interventions. It requires innovative new housing encompassing suitable technology arrangements that can facilitate and enable older adults to live comfortably into old age, preferably with others and offer family members (i.e., children, grandchildren and spouse). Furthermore, interconnecting technology into such environments can offer family members the option and opportunity to monitor their loved one remotely whilst all actors know there are additional safety barriers in place. This chapter discusses and provides innovative examples from a Dutch social housing association and their practices, which illustrates a new approach to environmental design that focuses more on building new communities in conjunction with the building itself, as opposed to the occupational therapeutic approaches and environmental support. First, we take a closer look at why we care for each other, which is the basis of the participation society, in which we must look after people who are near to us. This should ideally be at the basis of new housing arrangements -in which people are stimulated to meet, engage, survey and care- that social housing associations are developing, retrofitting and developing.
The nursing home is often a final stage in the living career of older persons, but the question remains whether it is a true home or merely a place where care is provided for the residents. This study investigates the sense of home and its constituent factors among both permanent and temporary residents of nursing homes in The Netherlands. A qualitative research design was chosen for the study, which consisted of in-depth interviews using a topic list that was developed through literature review and a focus group session. Autonomy and safety and security are the basic aspects for a sense of home. These aspects refer to the relationships and actions of nursing home residents and the environment in which people live. The research findings show that developing a sense of home encompasses much more than just being surrounded by personal belongings and having a private room with certain facilities. Subjective components of relationships and (inter)actions are as important as the physical component of living and housing. Only when a right balance is achieved between all factors, a true sense of home, albeit away from the familiar home someone spent most of his/her life, can be developed. Understanding these perspectives and needs can contribute to a better design and retrofitting process of future nursing homes.
Background: The purpose of this study was to investigate the cost-effectiveness and budget impact of the Boston University Approach to Psychiatric Rehabilitation (BPR) compared to an active control condition (ACC) to increase the social participation (in competitive employment, unpaid work, education, and meaningful daily activities) of individuals with severe mental illnesses (SMIs). ACC can be described as treatment as usual but with an active component, namely the explicit assignment of providing support with rehabilitation goals in the area of social participation. Method: In a randomized clinical trial with 188 individuals with SMIs, BPR (n = 98) was compared to ACC (n=90). Costs were assessed with the Treatment Inventory of Costs in Patients with psychiatric disorders (TIC-P). Outcome measures for the cost-effectiveness analysis were incremental cost per Quality Adjusted Life Year (QALY) and incremental cost per proportional change in social participation. Budget Impact was investigated using four implementation scenarios and two costing variants. Results: Total costs per participant at 12-month follow-up were e 12,886 in BPR and e 12,012 in ACC, a non-significant difference. There were no differences with regard to social participation or QALYs. Therefore, BPR was not cost-effective compared to ACC. Types of expenditure with the highest costs were in order of magnitude: supported and sheltered housing, inpatient care, outpatient care, and organized activities. Estimated budget impact of wide BPR implementation ranged from cost savings to e190 million, depending on assumptions regarding uptake. There were no differences between the two costing variants meaning that from a health insurer perspective, there would be no additional costs if BPR was implemented on a wider scale in mental health care institutions. Conclusions: This was the first study to investigate BPR cost-effectiveness and budget impact. The results showed that BPR was not cost-effective compared to ACC. When interpreting the results, one must keep in mind that the cost-effectiveness of BPR was investigated in the area of social participation, while BPR was designed to offer support in all rehabilitation areas. Therefore, more studies are needed before definite conclusions can be drawn on the cost-effectiveness of the method as a whole.
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