Report on housing needs of seniors

Background

Seniors (those 65 years of age and over) are the fastest growing age group in Canada. In 2016, there were 5,935,635 seniors, who represented 16.9% of the total population in Canada and this percentage is expected to increase to 24% by 2036.

The 2016 Census reported that 93.2% of seniors lived in private dwellings (house, apartment or moveable dwelling) while 6.8% lived in collective dwellings, such as residences for senior citizens, long-term care (LTC) facilities or health care related facilities.

Approximately 25% of Canadian households are led by people over the age of 65 years, 75% of these households are owned and 25% rent accommodation. The largest proportion of these senior-led households are couples without children; the second largest group is single women. In 2016, 2.2 million Canadians lived in multigenerational housing, 349,350 of whom were aged 65 and over.

Housing moves by seniors can be characterized as either “lifestyle,” “planned,” or “crisis,” each of which is typically underpinned by a number of “push” (for example, death of a spouse) or “pull” factors (for example. a desire to be closer to children and grandchildren). Seniors are less likely to move than the general population. In 2016 only 5.5% of seniors 65 to 74 years old and 4.7% of those 75 years and older had moved compared to 13.0 % of the general population in the previous year. Seniors who are widows and those who are divorced or separated are more likely to move. Seniors who are renting their homes are twice as likely to move compared to seniors who are homeowners (14% versus 7% respectively).

Integrated housing need

Conclusion

The main findings of the report indicate:

1. there is a need to increase the supply of housing for seniors overall, with options that consider the range of health needs and income status of seniors
2. senior women are more likely to live alone and have low incomes, and therefore are more likely to live in core housing need
3. strategies should continue to be sought to incentivize builders, planners and purchasers to incorporate features of universal design for future adaptability and accessibility into new builds and renovations
4. strategies should continue to encourage and promote production of more diverse and affordable housing options, since the national and international evidence reviewed demonstrates that no one housing option is preferable to seniors and all of the options reviewed had positive benefits in sustaining the well-being of seniors
5. from the examples identified, the well-being of seniors can be improved through all levels of government encouraging and promoting inclusion of age-friendly principles into all future building and space design policy and planning. Overall, to implement Age-Friendly Communities, there needs to be adaptations and transformation among home design, neighborhood design, city planning, transportation, and health and home-care services

Considerations for further study that all levels of government can encourage, promote and/or increase:

1. mixed-use developments with housing located near services and amenities to reduce some of the accessibility and transportation barriers that currently exist
2. allow construction of smaller units such as accessory dwelling units for those wishing to down-size, reduce housing costs or house a live-in caregiver
3. develop housing suitable for intergenerational living
4. retrofitting of existing homes to improve accessibility
5. construction of affordable rental units especially in suburban settings; and
6. coordinate housing adaptations and community supportive services delivery to increases availability of supportive living options as a viable alternative to LTC
7. housing for Indigenous seniors

There is still a need for the creation of a robust knowledge exchange strategy to increase awareness of and access to evidence-informed best practices and models of housing options for seniors in Canada. In addition, further research is needed to understand what motivates seniors to consider various housing options and what deters them. Overall, addressing the core housing need and integrated housing needs of seniors will require adaptations and transformation with respect to home design, neighborhood design, city planning, transportation, and health and home-care services among all levels of government – in consultation with seniors and stakeholders.

Affordability

As noted previously, the affordability criterion for core housing need is defined by a shelter-cost-to-gross income ratio of less than 30%. While not directly related to core housing need, there are many extra costs that seniors may bear, especially those seniors with chronic health conditions and functional limitations requiring some assistance in usual daily activities. Out of pocket health expenses are higher for seniors and they are more likely to incur some costs for assistance in activities of daily living. This financial burden is augmented by the fact that generally retirement is associated with a reduction in disposal income and in non-durable consumption (MacDonald, Andrews and Brown 2008).

Appropriately designed, suitably located, and affordable rental housing represents an important housing option for seniors who are either unable to afford or are uninterested in personal home ownership. However, the supply of affordable, suitable and adequate rental housing in Canada has dwindled as the private sector has shifted focus, and as governments have reduced their investment in social housing. However, since 2010, there has been an increase in the number of rental unit starts as a percentage of all housing starts across Canada. In the last year for which annual data were available (2016), the number of rental unit starts across Canada was 36,574 or 20.2% of all starts according to CMHC’s 2017 Canadian Housing Observer. While there is no agreed upon optimal mix of housing and rental units, one widely held view is that the lack of supply of rental units is driving up the cost of existing units and driving down vacancy rates in many communities across the country (FCM 2014.)

The current short-term positive trend in the number of rental unit starts should, however, be viewed with caution for two reasons. First, the number of overall starts has been highly variable over the years, not necessarily reflecting the growth in the population of Canada or demand for housing of all types (see Figure4). Second, there is a great deal of variability in local housing markets. For example, in the Toronto CMA, the number of rental unit starts as a percentage of all starts was only 8.8%. In Vancouver the number of rental unit starts as a percentage of all starts was 27.4% and in the Montreal CMA, the number of rental unit starts as a percentage of all starts was 43.8% in 2018 (CMHC Starts and Completions Survey accessed January 2019).

Figure 4 - Text version

Total number of housing construction starts, rentals and rentals as a percentage of total housing construction starts from 1990 to 2016 based on data from the Canada Mortgage and Housing Corporation.

Year	Construction starts by intended market	Rentals	Rental as a percent of all construction starts
1990	150,620	32,201	21.4%
1991	130,094	30,495	23.4%
1992	140,162	27,197	19.4%
1993	129,988	18,193	14.0%
1994	127,346	11,698	9.2%
1995	89,526	7,998	8.9%
1996	101,804	6,643	6.5%
1997	123,221	7,559	6.1%
1998	116,793	6,531	5.6%
1999	127,103	9,276	7.3%
2000	131,052	10,155	7.7%
2001	142,280	14,681	10.3%
2002	179,124	18,841	10.5%
2003	191,911	19,939	10.4%
2004	204,389	20,343	10.0%
2005	193,471	17,210	8.9%
2006	195,024	18,518	9.5%
2007	193,744	18,605	9.6%
2008	187,368	18,265	9.7%
2009	130,369	16,237	12.5%
2010	166,175	19,735	11.9%
2011	174,351	20,721	11.9%
2012	193,563	21,990	11.4%
2013	170,134	24,267	14.3%
2014	171,843	25,308	14.7%
2015	181,597	35,136	19.3%
2016	180,647	36,574	20.2%

• Source: CMHC (2017) Canadian Housing Observer (downloaded 17 January 2019)

The combination of a rapidly expanding seniors’ population, limited investment in private purpose-built rental housing, and progressively declining government-funded social housing in most provinces from the mid-1990s until recently has resulted in long and growing wait lists for social housing and housing subsidies. In Ontario alone, the number of households waiting for rent-geared-to-income housing in 2015 was 171,360 and the seniors’ share of the wait list was 32%, up from 22% in 2003 (Monsebraaten, 2016). Ontario’s Housing Services Corporation (HSC) also estimates that one-quarter of all households on Ontario’s social housing wait lists are led by seniors, reaching as high as 50% in some communities (HSC, 2012).

Another indicator of the relationship between supply, demand and cost of rental housing for seniors can be found in Table 6, from the CMHC Seniors Housing Survey as reported in the Canadian Housing Observer (downloaded 17 January 2019). The table shows the number of standard spaces, the vacancy rate of standard spaces and the average rent for standard spaces (Table 6)^{Footnote 5}. In 2016, 179,676 rental units were defined as standard spaces by CMHC with Québec having almost double the number of standard spaces compared to Ontario, and Newfoundland having more standard spaces than any other province in Atlantic Canada. Ontario has the second highest vacancy rate of standard spaces while Québec has the third lowest vacancy rate of standard spaces and Newfoundland has the highest vacancy rate of standard spaces. While Ontario has the highest average rent for standard spaces, British Columbia has the second lowest average rent for standard space.

Table 6: The number, vacancy rate and average rent for standard spaces in Canada and the Provinces, 2018.

• Source: CMHC (2018) Canadian Housing Observer (downloaded 27 March 2019)

Collective dwellings intended for seniors, including seniors’ residences and LTC facilities, are an essential but costly component of the housing continuum, intended for older Canadians experiencing serious and often chronic limitations in health or mobility. Addressing the need for affordable housing that offers varying levels of support is one of the most pressing challenges facing governments today. The 2016 Census counted 455,690 seniors ages 65 and over or 6.8% of all seniors living in collective dwellings (the vast majority of which were health care and related facilities). Of this number, 163,300 lived in residences for senior citizens, 156,915 lived in nursing homes, 82,360 in facilities that were a mix of nursing home and residence for seniors and 12,955 lived in other forms of residential care facilities.

The proportion of seniors living in a collective dwelling has been declining in Canada over the last 30 years.

Suitability (including disabilities and mobility impairment)

As per the CMHC definition, suitability is determined based upon whether the dwelling had enough bedrooms according to the household’s size and composition. Using this definition, the incidence of suitability problems is relatively low for seniors, unless the senior is sharing a household other than as part of a couple (Table 1) where it rises up to 15.1%.

From the integrated housing needs perspective, even though many provinces allow certain rental housing stock to be designated specifically for older adults as “seniors’ housing”, there may be few if any requirements for seniors’ rental housing to be legitimately designated to accommodate seniors. As a result, a growing number of these apartment buildings or complexes are actually not meeting the physical needs of many older adults (particularly those older adults with some degree of physical impairment). A study of rental housing units built for seniors use within Nova Scotia in the last decade under an Affordable Housing Initiative noted the following concerns by seniors: lack of shared space for social interaction; absence of accessibility and adaptive feature; and issues of difficulties with transportation and accessing usual amenities (Leviten-Reid and Lake 2016).

Adequacy

CMHC housing adequacy is assessed based on the dwelling condition not being reported in need of major repairs. Solitary seniors living with offspring or other relatives or non-relatives were most likely to have higher reported adequacy issues (Table 1). Taking into account integrated housing needs, housing might also be considered inadequate if it requires major adaptations to meet the needs of seniors as disabilities increase with age (Figure 5, Tables 7, 8, 9). Table 7 also highlights how ageing increasingly becomes the explanation for activity limitations with age, while Tables 8 and 9 highlight that, regardless of the reasons for a person’s disability, as they age, they are more likely to find that their disability creates difficulties for them and that they need help (Table 9). Without informal and formal support (for example, homecare), and housing adaptations, older people with disabilities are among those who are most likely to want or will need to find alternative forms of housing.

Figure 5 - Text version

The frequency of disability expressed as a percentage of the total population of men and women in age groups.

Age group	Men	Women
15 to 24 years	4.5%	4.3%
25 to 44 years	6.0%	7.1%
45 to 64 years	15.2%	17.1%
65 to 74 years	25.0%	27.5%
75 years or older	39.8%	44.5%
Total	12.5%	14.9%

• Source: Statistics Canada (2013/2014). Canadian Community Health Survey

• Source: Statistics Canada (2013/2014) Canadian Community Health Survey

• Source: Statistics Canada (2013/2014) Canadian Community Health Survey.

Accessibility, adaptability, environmental sustainability and safety

Aging, disability and housing can also be linked to accessibility, adaptability, environmental sustainability and safety. One-quarter of Canadian seniors report they often have difficulty with one or more activities including hearing, seeing, communicating, walking, climbing stairs, bending, learning or other similar activities. A number of these functional limitations are potentially mitigated through environmental changes and adaptations (Hans-Werner et al 2009; Park, Han, Kim, & Dunkle, 2015).

Housing often lacks basic consideration of good environmental design (steps, ramps, railing, lighting, safety features, etc.) and location relative to the kinds of services that seniors commonly need. Seniors’ housing built between the 1960s and 1990s is now often unable to accommodate newer independence technologies such as motorized scooters and bulky electric wheelchairs that need to be plugged in.

Aging in place includes making sure the environment, especially the home, is functional and meets the changing needs of seniors (HomeStars, 2017). Home renovations and adaptions can be implemented to improve safety and accessibility. Modifications can enhance seniors overall functioning and well-being (Boland et al., 2017). Home modifications might be effective in helping seniors age at home and may prevent the need to move to other locations.

The 2012 General Social Survey (GSS) on Caregiving and Care Receiving provides a picture of the general adequacy of senior’s households regarding accessibility and adaptations (CMHC, 2017 Research Insight July).

• About one quarter (24%) of households and one third (32%) of senior households had an accessible entrance, with either a level, no-step entrance or a ramp. A large proportion of survey respondents 65 years and older claimed their homes had doorways wide enough for a wheelchair (70%), easy-to-open doors including lever handles (53%) and grab bars in the bathroom (41%)
• Seniors’ apartments, whether in low-rise or high-rise buildings, were much more likely than detached, semi-detached or row houses to have an accessible entry, and also to have other accessibility features. About 19% of seniors in single-detached dwellings reported having accessible entries compared to 33% of those in multi-unit dwellings, 62% in low-rise apartments and 89% in high-rises
• More than half (55%) of seniors requiring a wheelchair, mechanical support or aid from other people as a result of mobility limitations lacked an accessible entrance in their homes
• Seniors who recently moved were more likely to have accessible features in their homes. For example, 58% of recent movers (in residence less than one year) had an accessible entrance compared to 26% of those who had been in their homes for 10 or more years

Certain assistive technologies, such as motorized scooters, can also help seniors age in place by allowing them to remain in their homes as long as possible. Home technology can support aging in place by assisting seniors with functional impairments, communication challenges or need for monitoring of chronic diseases (Peek et al., 2014). Technology has also been shown to help alleviate social isolation, depression, anxiety and loneliness. However, individuals’ use and acceptance of technology to support aging in place varies. Overall, seniors express several concerns with using home technology to help facilitate aging in place (Peek et al., 2014). For example, they report concerns about cost, difficulty in its use, false alarms and forgetting or losing portable technology (Peek et al., 2014). Furthermore, seniors might view use of technology as an indicator for decline in function (Reeder et al., 2013).

8.1 Housing options

There are various types of existing housing options available to meet the integrated housing needs of seniors in Canada including: Mainstream Housing, Naturally Occurring Retirement Communities, Independent Living and Active Lifestyle accommodation (inclusive of home share, life lease, cooperatives and flex housing), Assisted Living / Supportive Housing accommodation, and Seniors Residential and Long-Term Care accommodations) (Ministry of Municipal Affairs and Housing, 2014; Hashim et al., 2014). These options are described below with examples.

1. Mainstream housing is a housing model where seniors stay in their usual homes or downsize to ground-oriented options (for example, one-level floor plans usually on a ground level), apartments or condominiums which are not specifically intended for seniors. These dwellings are generally at the market rate. An example of a modified housing model is in La Crete, Alberta, where bungalows are designed specifically for seniors. They have wider doors and a walk-in shower stall and are priced at the lower end of the market rate (Hashim et al., 2014).
2. Naturally Occurring Retirement Communities (NORCS) are examples of mainstream housing that are not specifically built for seniors but have a large proportion of senior residents. The term NORC was coined in the United States in the early 1980s to describe a geographic area that has naturally developed a high concentration of older residents. This phenomenon is due to seniors remaining in their own homes as they age, or because they have congregated to an area after retirement or downsizing. The NORC-Supportive Service Program (NORC-SSP) model was developed in United States to wrap around these naturally occurring groups of seniors, and to help them remain living independently for as long as possible (Bedney et al., 2010). They offer supportive services in the home or immediate community, which address the social determinants that are not typically managed through government programs: social connections and supports; care navigation; nutrition and exercise, among others. While the model does provide some direct health care services, it is largely a preventative health model with the goal of increasing access to ancillary supports that slow down the need for more extensive home care, at the same time as providing opportunities for seniors to meaningfully participate in their communities.
   
   OASIS Senior Supportive Living Inc. in Kingston, Ontario, is an example of a NORC SSP. OASIS was established by a grassroots group of seniors as tenants in an ordinary apartment building of mid-range rent in the Kingston area market. This regular rental apartment building had a high proportion of units occupied by seniors. With a small but growing number of frail seniors, they co-created a partnership model between seniors, the landlord and the South East Ontario Local Health Integration Network (LHIN). The landlord agreed to provide and modify space within the building for a common dining and recreational space for use by seniors and supported by voluntarism by seniors. Funding was provided by the South East Ontario LHIN to provide onsite coordination of supportive services tailored to what the seniors needed and wanted to enable them to stay in their homes and age in place.
3. Independent living and active lifestyle accommodation are a seniors-only housing option that combines accommodations and amenities. These can vary from single detached homes to apartment buildings. An example of an independent living accommodation is shared home ownership where a house is shared among individuals each with their own room and share common areas such as the kitchen. This type of housing allows seniors to remain in their communities and be surrounded by friends and families. Services can also be provided at lower costs due to the efficiency of multiple seniors in one home. An example of this type of housing is Solterra Co-housing in Bracebridge, Ontario where four to six seniors share ownership of a home and each home has a staff member that provides meal preparation, shopping, and housekeeping.
4. Another example of independent living accommodation is a not-for-profit housing option called Abbeyfield houses, whish is a form of co-housing in which residents live in one house and each have their own room and bathroom but share common areas. This type of housing is generally for low-income seniors since the house is run on a not-for-profit basis. There are Abbeyfield houses in Caledon and Ottawa, Ontario where a manager does regular cleaning and maintenance, prepares meals, and provides support to residents. The rent each month covers the cost for accommodation, utilities and meals (Hashim et al., 2014).
5. Life lease housing is another independent living housing option in Canada that is usually managed by non-profit organizations and is specifically for seniors who can live independently (Ontario Ministry of Municipal Affairs and Housing, 2014). Life lease units can be houses or apartments and are generally priced lower than others in the area. There are several types of life lease agreements. These agreements are governed by contract law which may vary from province to province. Seniors first pay an entrance fee to the landlord or trustee to become a tenant of a life lease unit and then pay a monthly maintenance fee. In some instances, a redemption fee is payable to the estate at the time the life lease ends. Seniors typically choose this housing option due to affordability, low maintenance, and access to services offered by the non-profit organizations. With life leasing, seniors do not own the property but have the right to own the housing unit (Ontario Ministry of Municipal Affairs and Housing, 2014).
6. Supportive housing housing options that often include design features for safety and accessibility, as well as providing support services such as counselling, personal support and assistance with medication, recreational activities, housekeeping, and meal preparation. It is important to note that the terminology used to define supportive housing varies widely across Canada (for example, planners in British Columbia use the term ‘assisted living’ as equivalent to supportive housing in Manitoba; while in Alberta these dwellings are called residential facilities, in Ontario Long Term Care Homes, a term used elsewhere to define Personal Care Homes or Nursing Homes).
   
   Data from Statistics Canada’s 2007 General Social Survey (GSS) showed that about 7% of seniors live in supportive housing. Of those aged 45+, 62% said they would consider moving into supportive housing later in life (Canada Mortgage and Housing Corporation, 2016c). Data also showed that renters aged 75+ were more interested in supportive housing than homeowners.
   
   A study of supportive housing use in Winnipeg, Manitoba noted that 10% of new admissions to Personal Care Homes (PCH) (nursing homes) were similar in terms of functional needs to new admission to supportive housing (Doupe et al., 2016). The supportive housing tenants typically received: help with meals, laundry, and light housekeeping; 24-hour on-site access to assistance to complete personal tasks like bathing, dressing, and grooming; and some (but not 24-hour) professional home care services as deemed to make them eligible by the home care program. The primary difference between the PCH residents was they had lower income, or their informal caregivers had health challenges themselves. In terms of government/health region contributions, the median annual cost for a resident in a PCH was $45,348 vs in supportive care of $14,400. The cost to the resident in a PCH was $15,444 vs $19,500 for a supportive housing tenant. This suggests that removing cost disincentives for the supportive housing tenant and family may potentially avoid or delay the need for a more expensive PCH placement in some instances.
   
   Residence Parc Jarry in Montreal, Quebec is an example of supportive housing where a private developer converted an abandoned home to a residence for seniors. Half of the units are below the market rate and the other half are at the market rate. This is an example of how current houses can be converted to affordable housing for seniors (Hashim et al., 2014).
   
   In an Alberta study, residents living in a senior supportive housing facility located on the Red Deer College Campus in Red Deer were asked to rate their satisfaction with the built environment. The residents particularly valued design features that accommodated mobility devices and having accessible showers which helps them maintain their functional independence. However, respondents were not as satisfied with the lighting of the built environment. Many of the respondents lived in the community near the facility previously and had family members that live close to the facility so were able to preserve social networks.
   
   Other examples of creating a supportive living model without relocation include the Georgian Village in Simcoe County, Ontario, which offers a continuum-of-care campus to enable residents to move between levels of care without having to move to a new facility if their care needs change. In addition to providing a variety of housing options, there is a strong focus on socialization, a flexible series of support options, promoting of voluntarism and a readily accessible community hub with a range of amenities including a health clinic, pharmacy, fitness centre, library, chapel, recreational areas, bistro and shops.
   
   The Assisted Living Southwest Ontario’s (ALSO) model is a “hub and spoke” model. ALSO offers a basket of supports for daily living to clients living in several supportive housing sites across Windsor (for example, “hubs”), as well as individuals in their own homes within a given geographic radius from the supportive housing sites (for example, spokes). ALSO locates staff in each of the hubs to flexibly support clients, with 24/7 availability.^{Footnote 7}
7. Retirement residences are usually privately owned, and residents are responsible for all or most costs. Accommodation in most retirement residences includes different sized units and common areas, which include a dining room and lounge. Residences that are targeting more affluent seniors may include other amenities such as recreational facilities, swimming pools, libraries, and gift shops. The Ultimate Goal Retirement Village in Lewisporte, Newfoundland is an example of an affordable retirement residence where all units are below the market rent and some units are funded by the Affordable Housing Program (AHP).
   Seniors’ lodges offer rooms, meals, services and recreational opportunities for independent seniors. Community-based services may help offer these amenities and opportunities. The Seniors’ Lodge Program is unique to Alberta, and has been serving low-income seniors needing safe, suitable, and affordable accommodation for over 50 years. Each local housing provider sets their own lodge rates, and rates vary between regions. Regardless of the monthly lodge rate, each resident must be left with at least $315 in monthly disposable income.
8. Long-Term Care accommodation is a housing option for seniors who require 24-hour support and assistance in daily living activities as well as nursing supervision and care. Unlike many of the other housing options reviewed, it is generally the case that access to LTC homes requires an assessment through a provincial/territorial health system. Examples are individuals living with moderate to severe Alzheimer’s disease. LTC homes offer more personal care and support compared to that offered in retirement residences or supportive housing. There is generally a co-pay requirement for publicly-funded facilities. LTC homes are subject to government regulation and often require an operating license. Accommodation may be shared with more than two residents in a room or a private room.

8.2 Home modifications

In British Columbia, there is a Home Renovation Tax Credit for Seniors and Persons with Disabilities assists individuals 65 years or older and persons with disabilities with the cost of certain home renovations to improve accessibility and safety in the home.

British Columbia also offers the Rehabilitation Assistance Program On-Reserve, which provides financial assistance to Band Councils and Band members to repair substandard homes to a minimum level of health and safety and to improve the accessibility of housing for people with disabilities.

Alberta introduced the Seniors Home Adaptation and Repair Program (SHARP) in 2016. SHARP is a low-interest home equity loan program to help senior homeowners finance home repairs, adaptations and renovations. Examples include but are not limited to; plumbing, heating, electrical, tree removal, windows, roof repairs, widening doorways and stair lifts. SHARP allows seniors to use their home equity to remain in their homes and maintain their independence. Eligible seniors can apply for a low-interest home equity loan with the Government of Alberta to cover repairs, adaptations, and/or renovations to their primary residence. In addition to government programs to support home modifications, the private and non-private sector can provide new innovative opportunities to help older adults modify their homes to fit their changing needs as they age.

In New Brunswick, the Minor Home Repairs Grant is available to low-income residents over 65 years old, and offsets the cost of renovations focused on fall prevention, such as ramps and repairs to home entry, handrails, grab bars, improved lighting, non-slip and non-skid floor surfaces, and repairs to flooring.

In the United States, there are a number of programs that help reduce the cost of home modifications for older homeowners. For example, federally funded HOME or Community Development Block Grant programs provide loans for accessibility modifications. The U.S. Department of Agriculture also provides loans and grants for home modifications for rural owners aged 62 and over with very low income (Baker et al., 2014). There are also non-profit organizations such as Rebuilding Together that help low-income, older, and disabled homeowners maintain their homes through partners and volunteers (Baker et al., 2014). It is important to provide seniors with information on how renovations can benefit them in the future and on tax benefits that are available for aging in place renovations.

Tax credits can also be implemented for builders and homeowners to facilitate universal design features. For example, Ohio’s Livable Homes Tax Credit provides income tax credits to builders who construct accessible homes and to homeowners who add accessible features. At the federal level and in Ontario, governments had tax credits in place in the past but because of lack of uptake especially among low income seniors, the tax credits were ended.^{Footnote 8}

At the local level, there are also examples of programs to encourage home modifications. In Vancouver, there is a building bylaw that requires all new housing to have various universal design elements. These include: a barrier-free or adaptable shower; wide stairs, halls, and doors; reachable switches and outlets; a fully accessible bathroom on the ground floor; installation of kitchen sink drainpipes at a lower height; and lever-style door handles (Baker et al., 2014). Additionally, the City of Ottawa has a home renovation program funded through the federal/provincial Investment in Affordable Housing (IAH) program that provides funding to low-income seniors to modify their homes (Federation of Canadian Municipalities, 2015).

Secondary Suites are an option available to homeowners to make use of property to create an income stream and create a housing option for seniors. They offer the opportunity for affordable accommodation to seniors in neighbourhoods where they might not otherwise be able to afford to live. For example, the City of Kingston, Ontario, has a grant program that helps homeowners with the costs of developing a secondary suite that is contingent on offering affordable rental space for a specified time (City of Kingston, 2018).

In Appendix B, there is a list of financial supports for home repair, renovations and adaptations.

8.3 Housing options for vulnerable seniors with dementia

Special consideration should be given to housing options for vulnerable seniors with dementia. The home environment can contribute to the overall well-being of vulnerable seniors living with dementia. When enhancing the comfort and quality of life among seniors with dementia, the environment should consider the physical, emotional, and psychosocial well-being of individuals (Canada Mortgage and Housing Corporation, 2014). Familiarity is also extremely important for people living with dementia since one of their coping mechanisms is to rely on familiar places and routines (Canada Mortgage and Housing Corporation, 2014).

In Canada, Adult Day Programs provide supervised recreation activities outside of a person’s home. The purpose of these programs is to help people with dementia remain connected in their community. They offer meals, assistance with daily living, transportation and dementia appropriate activities. Adult Day Programs may be collated within residential homes or long-term care facilities where access to some health care professional services may also be readily available (Canada Mortgage and Housing Corporation, 2014).

There are also various housing models to support seniors living with dementia, which include the Green House model, the Planetree Model, and GENTLECARE (Canada Mortgage and Housing Corporation, 2015). The Green House model combines small homes where care is provided by consistent staff in a family type setting. The Sherbrooke Community Centre in Saskatchewan is an example of this type of model. The Planetree Model focuses on a holistic approach that meets the needs of an individual’s body, mind, and spirit. Conventional medicine is combined with complementary therapies. The Donald Berman Maimonides Geriatric Centre in Quebec is an example of this type of model. Lastly, GENTLECARE supports the existing functional abilities of an individual rather than forcing the individual to adapt to new changes. Delta View Adult Day Program, Assisted Living and Life Enrichment Centre in British Columbia is an example of this type of model.

9.1 Housing options

1. Lifetime neighbourhoods: The United Kingdom has adopted the concept of Lifetime Neighbourhoods where the built environment is created in a way that is inclusive for people of all ages and abilities. These neighbourhoods offer a variety of services and aim to be accessible and safe (Harding, 2007). Although this concept has not yet been fully adopted in neighbourhood design, it has potential to promote the well-being and social inclusion for seniors
2. Co-housing communities: In Denmark, the concept of co-housing communities was first established. The primary aim of this housing model is to promote social connectedness among residents to reduce loneliness (Pedersen, 2015; Brenton, 2017). This concept combines privacy with social interaction where members in the community support each other to encourage aging in place (Canadian Senior Cohousing Society, 2016). For example, members may choose to run errands together, cook together, or take walks together (Canadian Senior Cohousing Society, 2016). With co-housing communities, houses are built as clusters or single-story rows centred around shared spaces such as gardens and walkways. Residents collaborate with each other to manage activities and shared spaces. A Danish study found that residents made the decision to move to a co-housing facility because houses required less maintenance and the community promoted social connectedness. Results showed that 95% of residents were satisfied with their co-housing community (Pedersen, 2015)
3. Producer driven / resident driven senior homes: In Finland, there are four senior housing concepts that either represent a producer driven or a resident driven approach. One article presented a comparative analysis of the four housing concepts (Pirinen, 2016). Aktiivikoti and the Virkkula Senior Village are housing concepts developed for seniors (producer driven) whereas Ars Longa and Loppukiri are developed by seniors (resident driven). Aktiivikoti are homes with added features that promote accessibility and safety. These features include: sound insulation, elevators with automatic doors, and fire alarms. The houses are also built near amenities, services, and public transportation (Pirinen, 2016). The Virkkula Senior Village is another housing concept for rural areas. Many senior houses are built in a village-like community and centred around a larger building that provides services and amenities to all residents. This model allows services to be delivered more efficiently due to the higher concentration of seniors in one area (Pirinen, 2016). Ars Longa is the third housing concept that is mainly targeted to specific professional groups such as artistic seniors or senior economists. The main distinguisher of Ars Longa is that the houses are rentals, which may be ideal for seniors with low or unstable income (Pirinen, 2016). Loppukiri is the final housing concept in which residents manage and provide services. The goals of this model are to promote social connectedness and to allow seniors to live in a more communal way (Pirinen, 2016)
4. Apartments for Life: In the Netherlands, is an Apartments for Life concept where individuals and couples aged 55 and over can buy or rent units (Glass, 2014). Universal design is adopted in each unit and care is provided to individuals once they eventually require health related assistance. This model relies heavily on volunteering and as a result is 10% to 20% less expensive than institutional care. The housing model is specifically designed to prevent seniors from relocating even when their health starts to deteriorate as they age (Glass, 2014)
5. Homeshare: In Europe, particularly France, Homeshare is an intergenerational housing option where a senior homeowner rents out a room to a younger individual at a very low cost (Garland, 2018). In exchange, the younger individual, typically a university student, supports the senior with daily tasks such as shopping, cooking, or cleaning. Evaluation of homeshares in Spain found that 93% of seniors and 99% of university students benefited from this living arrangement (Labit & Dubost, 2016)
6. Villages: In the United States, there is a housing model known as “Villages” where volunteers and staff provide adults aged 50 and over with services such as transportation, grocery shopping, housekeeping, and referrals to community services. Membership is low cost and most villages provide subsidies to those of low-income. Furthermore, residents can benefit from villages while remaining in their own homes (Scharlach & Graham & Lehning, 2011). An example of this housing is the Village-to-Village network in Boston, Massachusetts where neighbourhoods contain a large proportion of seniors, with community supports that provide affordable services including transportation, home repairs, and medical care (Hashim, Pacini, Starr, SHS Consulting, & CBCL Limited, 2014)

9.2 Home modifications

A study in the UK analysed the effectiveness of home modifications and how people experience adaptations (Centre for Ageing Better, 2018). The decision to make home adaptations is often due to common triggers, including an event such as a fall. However, the need for home adaptations is often associated with vulnerability and loss of independence. Therefore, many seniors delay making modifications to their home until a specific event, such as a fall, occurs. There needs to be a wider understanding of the benefits of home modifications and encouragement of positive messaging surrounding home modifications to promote making changes earlier.

This study also found that there is a lack of knowledge on how to access home modifications, with many participants obtaining information from family members or friends with previous experiences. It was suggested that local services and health services collaborate to provide accurate and up to date information of locally available services and funding support. It was also found that the best outcomes are achieved when individuals, families, and caregivers are involved during the entire decision-making process of what individuals hope to achieve from home adaptations.

Participants in this study said that it took time to adjust to their new adaptations, but many expressed positive experiences. For example, one participant said, “It means independence. I don’t have to ask for help. I find it very hard to ask for help. I mean, everybody has got busy lives. They haven’t got time to be bothering on with you. If you can manage yourself, then it’s half the battle” (Centre for Ageing Better, 2018, p. 14). Another person stated, “In terms of there being a problem and in terms of me falling as much, I don’t fall so much now. It just gives away now and then, but because I’ve got all sorts of grab rails and things like that I’m able to cope a lot better” (Centre for Ageing Better, 2018, p. 14). It was also suggested government guidance be provided on outcome measures to better evaluate the impacts of home adaptations (Centre for Ageing Better, 2018).

9.3 Universal design

The design and planning of the built environment may augment or hinder how well the individual adapts to aging and age-related disease processes. The concept of universal design is to design an environment in a way that meets the needs of a wide range of individual needs (Persson et al., 2015). It aims to provide accessible features, without stigmatization, that can benefit everyone who uses the features (Carr, 2013). For the aging population, universal design can provide a barrier-free and accessible environment, which enhances their ability to perform daily activities independently (Crews & Zavotka, 2006). Examples of universal design features that help prevent falls and injuries include: grab bars in showers or tub, no slip flooring, and a no step door entry (Crews & Zavotka, 2006). Moving to or adapting one’s existing family home with universal design features can increase independence and promote aging in place.

New buildings and homes could be developed with standard requirements that enable aging in place, and governments could update policies regarding construction and housing regulations. A case study in Sweden analysed the living environment of rental senior apartments and found that living spaces with a low universal design score were associated with more falls particularly in the kitchen and bedroom (Bamzar, 2018). Although universal design can enhance the built environment, there are some limitations in its use including: lack of education among planners and architects, gaps in building standards and the cost of implementation.

9.4 Housing options for vulnerable seniors with dementia

In the Netherlands, there is the dementia village called De Hogeweyk (Glass, 2014). Residents live in small houses with six to seven bedrooms, two bathrooms, and a kitchen. The unique concept of De Hogeweyk is that residents can choose to live with others who share common interests and live in a home where the decoration aligns with their personal tastes. Residents or family members fill out questionnaires regarding interests and then the organizers put individuals together in a house with similar interests. This model could be adapted to Canada but may be difficult due to a highly diverse population. The grounds of De Hogeweyk also have restaurants, a hair salon, grocery stores, a theatre etc. with trained staff as employees of these businesses. With this model, residents live their lives as independently and safely as possible (Glass, 2014).

Information and communication technologies can also support seniors living with dementia to age in place. In Europe, there is a project called ACTION (Assisting Carers Using Telematics Interventions to Meet Older People’s Needs) that supports seniors with chronic conditions such as Alzheimer’s and their family caregivers (Connelly, Ur Rehman Laghari, Mokhtari, & Falk, 2014). This program promotes aging in place by providing seniors and their caregivers with access to education, information, and support in their homes utilizing a combination of familiar technologies (for example, the carers' own TV and remote-control units,) and additional technologies, (for example, video reception/transmission, fast computer processors and access to interactive communication). Results from this project showed that caregivers were more confident in their abilities to take care of an individual with a chronic condition. They also liked that ACTION allowed them to connect with other family members in the same situation and health care professionals during an emergency.

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