Nordic approaches to housing and ageing - Current concepts and future needs

Type of the Paper: Full Paper

Track title: inclusive design & health promotion, communal living

Nordic approaches to housing and ageing -
Current concepts and future needs
Ira Verma ¹*, Karin Høyland ² and Lisbeth Lindahl ³

¹ Aalto University, Department of Architecture; ira.verma@aalto.fi

² SINTEF Community; karin.hoyland@sintef.no

³ Göteborgsregionen, lisbeth.lindahl@goteborgsregionen.se

* The corresponding author.

Abstract: The Nordic countries have a reputation for having both universal welfare systems and high housing standards. However, the demographic development and ageing in place policies bring challenges to the present housing and care services for the older population. During the last decades, there has been a significant decrease in the coverage of care for older people. This is related to the increase of older people as well as challenges related to the availability of the workforce and raising care costs. This development is leading to increasing demand for various supportive housing solutions for seniors and older people. The objective of this paper is to provide a comparative overview of existing housing solutions for seniors and older people in Nordic countries. The objective of the comparative descriptive analyses is to point out the challenges and future possibilities for housing. This is illustrated by some new cases all of them showing solutions that enable older people to continue being a part of city life in their own neighbourhoods. They also show a variety of solutions that at the same time gives possibilities to live independently and live interdependent in different kind of co-housing and neighbourhoods. This paper highlights the need for a more systematic evaluation of housing solutions for older people across the Nordic countries, to be able to learn from each other and to be able to manage the impacts of the ageing society for the welfare system.

Keywords: housing design; older people; inclusion

1. Introduction

The demographic development is challenging the housing and care service structure for the older population. Since the 1990s in the Nordic countries, there has been a strong trend towards deinstitutionalization, which has led to radical transformations especially in Sweden and Denmark (Daatland, Høyland and Otnes, 2015). Due to the trend of deinstitutionalization, the share of older people living in residential care has decreased (Szebehely and Meagher, 2018; Socialstyrelsen, 2021a). In Finland, the number of residents has remained the same since 2014 (THL, 2021). This indicates that fewer older people have access to residential care. This trend contributes to an emerging need for alternative housing solutions, that are adapted to the different needs within the heterogeneous group of older persons. All Nordic countries have a high level of housing standards. However, many older people live in dwellings with a large number of environmental barriers and a socio-spatial environment that does not support their needs (Iwarsson et al. 2006). One way to solve these challenges is to make home modifications (Tanner, Tilse, and de Jonge, 2008). In the Nordic countries accessibility renovations with subsidized are widely in use but differ locally (Boverket, 2020, ARA, 2021). The dwellings may also be located in neighborhoods with poor access to services and social support (De Donder, Buffel, Dury, and De Witte, 2013; Ahrentzen, 2010; Cramm and Nieboer, 2013). As many older people live in housing or residential areas that don’t fit their needs, they may feel lonely or insecure (Berglund-Snodgrass and Nord, 2019), this may affect their ability to manage activities of daily living (ADL). In addition, there is a demand for housing solutions for older people wanting to live a self-contained life as an integrated member of a community (SOU, 2008:113, ME, 2020). The current policies in the Nordic countries have increased the number of older people living at home alone, which may affect the level of loneliness among older people. A Finnish study revealed that 36 % of older people in home care reported being alone always or more often than they wished (Alastalo et al., 2016). A Norwegian study shows that a good social network protects against loneliness and that this, in turn, contributes to better health (Veenstra et al, 2019). Moreover, a recent study in Sweden brought forward that living alone at an old age appears to negatively affect those who have the most disadvantaged social and functional status (Shaw et al., 2018). Therefore, the need for the development of a more communal way of living is raising.

The Nordic welfare model has reached international interest since the 1970s due to welfare services funded from general taxes. The Nordic universalism refers to the principle that the right to service is the same for all citizens, and services are publicly provided (Szebehely and Meagher, 2018). The housing services for older people have been funded by municipal income tax. The municipalities are responsible for ‘promoting’ and ‘facilitating’ housing development, that will accommodate the housing needs of the citizens (Berglund-Snodgrass et al., 2021). The health and social care services are distributed through needs assessment, and may vary locally (Vabø and Burau, 2011). Access to residential care (24/7) is based on needs assessment, and e.g., in Finland, the majority (80 %) of the residents living in residential care have memory disorders (MSAH, 2020). The situation is similar in other Nordic countries.

Today, in four of the Nordic countries, approximately twenty percent of the population is 65 years old and older (Norway 18 %, Denmark and Sweden 20 %, Finland 22 %). Iceland has a slightly younger population (14 % of the population is 65 years old and older). The population projections for the year 2050 show an important increase of the population cohort aged 80 years old and older, which is likely to need a supportive home environment. The share of the oldest age cohorts will be twice as many as in the year 2020 and represent up to 10 % of the population (Table 1.).

Table 1. Share of the population 80+, and the projection of 80+ for 2050, displayed for each Nordic country (Norden, 2020)

Therefore, there is a need to find new housing solutions that meet both current and future requirements of the older population and respond to their various needs and preferences. To evaluate the current housing solutions targeted to older people and to understand the potential for development, more studies are needed. This article contributes further knowledge on housing alternatives for seniors and older people in Nordic countries. In this article seniors refer to persons 55+ and older people persons in the age cohort 80 years old and older. The paper describes some new concepts of housing for seniors and older people with a few illustrative examples, that have emerged and expanded during the last decades.

2. Background

The policy for Ageing in Place is implemented in all Nordic countries. Denmark became a pioneer country in 1987 due to the Housing for the Elderly Act (Ældreboligloven), which focused on the improvement of the quality of life of older people, allowing them to live at home. The care system was transformed from an institutional long-term care model to a care model with a wide range of home care services, home adaptations, and health care solutions. The objective was to strengthen the continuity in care, self-determination, and independence of older people (Gottschalk, 1995). Since then, this transformation has been taking place in all other Nordic countries. Denmark was a pioneer in the field of co-housing (bofællesskab) especially in co-housing for the elderly (Durett, 2005). Similar co-housing projects are also found in Finland, Sweden, and Norway. It refers to a housing solution with shared common areas, where residents participate in daily tasks, social activity, and joint decision-making in a non-hierarchical process.

Research shows that the social environment provided by these co-housing solutions has great significance, especially for older people. Previous studies showed that residents in co-housing for older people in Denmark and Sweden reported that they were healthy, satisfied with their housing conditions, and warmly recommended the co-housing model to other older people (Choi, 2004). Moreover, Forbes (2002) argues that co-housing communities lead to closer social ties and greater participation, which in turn may contribute to happier and healthier aging. The benefits of communal housing for older people are mutual support, increased acceptance of aging, a sense of security, fewer worries, and less social isolation (Pedersen, 2015).

A recent study in Norway (2020) shows that the residents in private co-housing projects experience that the housing solution contributes to their quality of life through 1) increased self-efficacy (coping), the opportunity to manage themselves longer, 2) easy access to activities and an environment that inspires participation, 3) an experience of security/ safety, and 4) multiple social relations. The informants of the study lived in age-homogeneous co-housing and appreciate this, but many also see disadvantages with it and prefer possibilities to live together with people with different ages. Building relationships between generations has been found beneficial for both young and old. However, not all older people are interested e.g., to have common activities with children (Ukkonen-Mikkola, 2011, p. 153).

In all Nordic countries, the work on legislation for accessibility has increased considerably during the last decades. Universal design has become a standard in nearly all newly built housing projects and helps the elderly to live in their own independent home and get help at home. Therefore, a key question is whether we really need special housing for older people in the future? As the studies and public discussion show, we agree that accessibility is not enough. Older people should experience this last phase of life, living in housing that promotes the feeling of safety, residents’ activity, and participation in social life.

3. Aim and Methods

This article is based on collaborative work between the authors, who have conducted research within the field of housing for older people in different Nordic countries. It is based on long-term research work. The lack of an overview of the housing solutions in the Nordic countries was identified, and the need for this joint study came up in a collaborative research meeting of the Nordic network for research on housing for older people in Reykjavik 2017. The objective of this article is to describe emerging Nordic housing solutions for older people.

This research was carried out using the case study method (Yin, 1994). The study was conducted as follows: The first phase included a description of the different housing models that exist in the Nordic countries, policies, rules, and regulations related to housing services for the older population. The first phase aimed to discuss and define the similarities and differences of available housing services for older people in each country. In the second phase, the aim was to identify the current trends that could be discerned within the field of housing for seniors and older persons. This was done by descriptive analyses of recently built housing models. In third phase, we discussed and decided upon a categorization of the housing concepts and came up with three different main categories (see Results). Lastly, we decided to give illustrative examples of the results through a case study approach using the categorization developed in the third phase. The selection of cases was made by choosing those well known by authors, as they had previously conducted studies or study visits on site. Moreover, some evidence of user studies was available for the chosen cases.

3. Results

There are three broad categories of housing for older people in the Nordic countries: a) Special housing with 24-hour care distributed by needs assessment (Residential care, Sheltered housing), b) Housing with supportive services available (Extra Care Housing, Ordinary sheltered housing) and c) Housing targeted for the age cohort 55+ without supportive in-house services (Senior housing, Co-housing for seniors, Multi-generational housing). The first category is not discussed in this paper. The second category includes housing solutions for independent living, such as Ældre boliger in Denmark, Omsorg Pluss boliger in Norway, Tavallinen palveluasuminen in Finland, and Trygghetsbostäder in Sweden (Table 2.). These apartments provide the possibility for independent living with assistive technology, affordable meals, and personal support on request. In general, the personnel are available daily at working hours, organizing social activities with residents. The residents pay monthly fees for the apartment and may purchase services packages separately. Apartments are mostly for rent, and residents can get allowances, subsidies, or service vouchers for the living costs from the municipality. There are minimum regulations on the size of the apartments as well as accessibility.

Table 2. Housing with supportive services, Nordic models

The third category is referring to e.g. self-managed seniors and senior co-housing, where residents live independently and may give mutual assistance between seniors or between generations (Table 3.). The co-housing concept also supports community building, peer support, and social activities. The eligibility criteria for moving into senior housing is the resident’s age. There are no services in these buildings. However, residents may get home care services from the municipality. Senior housing has no particular regulations for construction. However, they are built taking accessibility into consideration. In senior co-housing, the residents may be the developers themselves and hence influence the design choices. Residents in co-housing also commit to a more communal way of living.

Table 3. Housing without in-house supportive services, Nordic models

These categories are not strictly defined and are overlapping. Further, we observed a trend showing an increased interest in mainstream housing with qualities that promote older persons’ independence e.g., housing with extra services (such as providing common spaces/activities, staff, or co-housing). The following examples illustrate such housing concepts.

3.1. Housing with supportive services

Trygghetsboende Bifrost is an Extra Care Housing owned by the municipal landlord Mölndalsbostäder. Mölndal is a municipality on the West coast of Sweden with 70 000 inhabitants. The housing was finalized in 2017 and comprises 66 fully equipped rental apartments (1,5 – 4 rooms, between 53-100 m²) for seniors (+65). All apartments have a large balcony which is partly glazed and partly open. On the ground floor, there is a lobby, a communal living room and large kitchen, a guest room, and a library. Outside of the lobby, there is a terrace (Figure 1), a greenhouse, and a boule plane. On the 9th floor, there is a gym, a room for small groups, a sauna, and a roof terrace with nice views of a meadow and the woods.

A hostess, in charge of activating the residents, is working in the Extra Care Housing on weekdays. The building has many communal areas for various activities. The residents create and participate in activities such as a walking group, book club, yoga, game evenings, coffee meetings, joint celebrations of holidays, etc. Moreover, bus stops outside of the entrance enhance the mobility of residents. A small grocery store as well as a residential care home offering lunch for a reasonable price, are located within walking distance from the premises.

Figure 1. Outdoor terrace at Trygghetsboende Bifrost (Photo, Lindahl)

Pastor Fangens vei 22, also called Seniorhuset, is a living and activity center for older people in Oslo. The aim is to build a community where residents care about each other. Residents rent independent apartments with assistive technology, wearable alarm, door monitoring, and fall detection, etc. that can be adjusted depending on the personal need for help. All residents have access to shared kitchen, living room, and fitness room. The house has 29 rental apartments on 4 floors (Figure 2). The apartments are bright one-bedroom apartments that all have a spacious balcony. Each floor also has a common living area. On the 2nd floor, there are 7 apartments for people with mild or moderate dementia.

The Seniorhuset offers activities for older people in the district and wants to become the meeting place for those living in the district. Outside the block there is a beautiful garden with a hen house, climbing wall, tables, and benches. A kindergarten is located in the immediate surroundings (Figure 3.). It provides a great activity for both young and old.

Figure 2. and 3. Pastor Fangens vei 22, and views outside (Photos, Høyland, Photo from employees used with permission)

The Seniorhuset has also two apartments for students, who work 30 hours a month as "co-residents". They participate in social activities together with the older residents in the shared used spaces. So far, the presence of students has been felt natural and the experience has been successful. The employees take responsibility for guiding the students on confidentiality, ethical guidelines, etc.

There are 2 permanent staff members in the house: a nurse manager and a public health consultant. Furthermore, home assistance is provided when needed. The home assistance focuses on daily coping, and the residents are able to continue to live the way they were used to but within a safer framework. It's just a more social form of housing. The manager emphasizes new ways of working, which are considered necessary for strengthening networks, and enhancing volunteering.

3.2. Multi-Generational housing

Generationernes Hus (Aarhus, Denmark) is a joint initiative within the municipality (Health and Care, Children and Adolescents and Social Affairs and Employment) and a public housing association (Brabrand Housing Association). The building contains 304 rental apartments: 100 apartments for older people living independently (43 m²), 100 apartments divided into seven group homes for 14-15 older persons with high care needs, 40 apartments for families (60 m² - 80 m²), youth housing for 40 persons (rooms 21 m² - 28 m²), and 24 apartments for people with a physical disability (39 m²). A kindergarten for children between 0 and 6 years old is also located in the building (for 150 to 190 children). In addition to the homes and institutional spaces, the building also contains a few common functions such as a fitness center, assembly kitchen, playground, conference hall, multi-purpose hall etc.

Generations Block is a new cross-generational housing development in Finland (Helsinki, Jätkäsaari area). It comprises 47 owner-occupied housing, 113 rental housing for seniors (+55), 102 apartments for students, and 20 apartments for people with disabilities. It is developed by three non-profit organizations: the Foundation for Student Housing (HOAS), Settlement Apartments (Setlementtiasunnot Oy), and Housing Foundation (Asuntosäätiö). It provides housing and shared spaces for its residents. A laundry room, and a gym, are in use by all residents. The people living in the neighbourhood can access the coffee shop at street level, and they can rent the common use spaces for meetings or events. All shared spaces are located on the ground level and open to the street or in the courtyard. The courtyard is designed for shared use. Moreover, the Settlement Apartments provide “Living Service Coordinators” who enhance the community building, provide information, and plan the activities and special events, such as excursions, and season festivities together with the residents.

3.3. Senior co-housing

Kotisatama is a communal senior housing realized by Helsinki city based on the initiative of the Active seniors’ association. It is located in the new urban area in Kalasatama. The owner-occupied apartments are subsidized by Helsinki City (Hitas). Hitas owner-occupied housing system is aimed at ensuring that housing prices are based on real production costs. The maximum prices of Hitas units are regulated. The proximity of the metro station, a shopping mall, and health care center enhance the independent coping and mobility of the seniors. The building was inaugurated in 2015. The nine-floor apartment building has 63 fully equipped apartments, from 38 m² studio apartments to 77 m² three-room apartments. There are over 500 m² common use spaces: dining room, library, hobby room, gym, sauna, a roof garden, etc. The age limit for residents is currently 48 +. The residents are distributed into 6 groups and sign an agreement to participate in preparing food, organizing common activities, and cleaning the shared premises.

Figure 4. and 5. The common dining room (photo Verma) and the communal kitchen (photo Høyland)

The residents call the building a “self-service house”. In the beginning in 2015, there were approximately 80 residents from 55 years to 80 years of age. According to Jolanki et al. (2017), the majority of residents reported a high level of wellbeing (94 %) and feeling part of the community (87 %). Due to the long period of planning and construction, the residents knew each other before moving to the building. The main goal of the residents was to maintain physical and social health, be active and integrated into the city life. Jolanki et al. (2017) found that a few residents experienced these duties and communal living too demanding. This will also be a challenge when the residents grow old together.

4. Discussion

The overall goal for age-friendly communities is that new mainstream housing developments and housing renovations would support older people to remain in their ordinary housing as long as possible. Age-friendly cities and communities promote older people’s inclusion and participation in community life, respecting older people’s decisions and lifestyle choices (WHO, 2015). Means (2007) argues that housing policies must seek to improve mainstream housing and enhance the development of a wide range of housing options with care in later life. He points out that many older people, especially those on low incomes, are vulnerable because they live in vulnerable housing situations (accessibility issues, affordability, etc.). People wish to maintain a normal life and to be integrated into society also at old age. The chosen cases show that communal housing solutions can be successful and support the social needs of older people. Architectural solutions create a platform for common activities. The geographical location and spatial organization of the housing for older people influence the opportunities for spontaneous and informal social contact with neighbors (Berglund-Snodgrass & Nord, 2019). Examples of this are housing solutions for older people in multigenerational neighborhoods (Høyland et al. 2020), service blocks (Verma et al, 2017), and Extra Care Housing (Lindahl, 2015, Lindahl, Andersson & Paulsson, 2018; Berglund-Snodgrass & Nord, 2019).

Older people are a heterogeneous group of people, who have diverse needs, lifestyles, and housing choices. Therefore, a variety of solutions that support daily living, social activities, and peer support are needed. Multigenerational housing solutions may help to avoid the spatial segregation of older people and increase their inclusion in the community. Ng et al. (2020) found that self-acceptance and interdependence are two factors that are most pertinent in old age and promote longevity. They suggest that interventions to support these should be added as factors of wellbeing and ageing health. Metze (2016, p. 192) suggests solutions where people are allowed to be old and increasingly frail, and still maintain their relational autonomy and individual preferences. She argues that solutions appealing to older people are empowering and focusing on reciprocity, peer-to-peer support, and solutions instead of problems.

The housing policy and urban planning are important strategic tools to enhance the inclusion of older people in the community. The major concepts related to multigenerational neighborhoods where older people can remain living in their own apartments are based on the Universal Design of the urban environment and renovation of existing housing for older people (Høyland et al., 2020, Verma, 2019).

In 2016, Denmark started to collect data and strengthen the knowledge base regarding the quality of life and housing conditions of the older people. This was carried out with 5 preliminary analyses. After that, Realdania organization formed an initiative called “Rooms and Communities for Seniors” to test and create new housing solutions through partnerships with senior co-housing communities (Realdania, 2022). The collaboration focused on promoting new frameworks for communities that strengthen the common venues to promote social relationships and inclusive, equal communities. Realdania sought to stimulate the market through partnerships with private investors and the general housing sector. They approached the main real estate developers in the country with the proposal of collaborating on the creation of senior community-based housing. In turn, Realdania committed to supporting the research and development for each of the projects, including the housing prototypes. This illustrates an interesting approach how to influence the housing market, other than only financial support or regulations.
In Finland, the Implementation of the housing development program for older people (Ministry of the Environment, 2020) emphasizes the accessibility renovations of existing apartment buildings, multigenerational and communal housing developments, and enforcement of age-friendly communities. The aim is to provide alternatives to 24 h residential care. The future challenge is to provide a safe and inclusive living environment also for older people with cognitive decline. In Norway, Universal Design is implemented as a national strategy and new apartments should be accessible to persons with mobility impairment. Moreover, the benefits of social participation are well-known. Despite that, there is a lack of political programs for supporting co-housing.

5. Conclusions

The objective of this comparative descriptive analysis is to point out the challenges and future possibilities for new housing strategies. The implementation of Universal Design in rules and legislation in housing construction is making many older people able to stay at home longer. Case studies show, however, that loneliness also is a growing challenge. Therefore, defining an age-friendly environment as a question of low thresholds or wheelchair accessibility is too narrow. It is an important challenge to find solutions that promote activity, participation, and a feeling of safety. These are important aspects from a health promotion perspective. As the number of people with memory decline is increasing, we also need to critically consider which is the best housing environment for them.

The cases chosen for the paper are illustrating some new concepts, all of them showing solutions that enable older people to continue being a part of city life in their own neighborhoods in different ways. They also show a variety of solutions, which reflects the diversity of people’s needs and wishes. However, we need further knowledge and comparative analyses on the effectiveness of various housing solutions on the wellbeing, health promotion, and coping of older people. This paper highlights the need for a Nordic program that supports innovation and a more systematic evaluation of housing solutions. We also propose spreading the good examples across the Nordic borders. The policies for housing and services for older people are an important tool to promote this development. Moreover, in the Nordic countries, where housing construction is highly regulated, we also need to allow more pilot projects and experiments in the housing sector. This would give us new knowledge on how to promote inclusive communities, and how we can meet implications of the demographic change for the Nordic welfare model. 

Contributor statement

Author 1: editing, writing, investigating
Author 2: writing. investigating
Author 3: writing, investigating

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