Optimising care delivery models to support ageing-in-place towards autonomy affordability and financial sustainability – ODESSA

The study uses a mixed-method design, combining data mining and in-depth analysis, robust measures of the quality of the built environment, together with qualitative data from a range of key stakeholders. It is designed through six interrelated work packages.

WP 1: Based on quantitative data from three surveys focusing on health (CHARLS for China, ELSA for the UK, SHARE for Europe), data analyses are carried out based on micro and macro data for each country from various perspectives including ageing patterns, living environment, health condition as well as geographical distribution.

WP 2 will concentrate on residential mobility and rely on the multi-disciplinary data available, namely SHARE, ELSA and CHARLS used in WP1.

WP 3: This part of the project relies upon an approach combining social network analysis and study of local resources (connected communities). French, British and Chinese teams have created a survey in order to better measure and evaluate the role that local networks play in helping elderly to access health services. The WP3 follows a transdisciplinary approach, combining sociology and geography.

WP 4: A review of existing best practice of age-friendly housing environments that promote ageing-in-place in the three partner countries will be conducted. A case study from each country will be visited and assessed to identify design responses to older people’s needs and requirements. Stakeholders’ consultation through focus groups will be organised to take place in the three countries.

WP 5:The research will predominantly use a case study approach for the collection of information and data on older people health and long-term care funding schemes. Questionnaire surveys, Delphi group workshops and steering group discussions will be used to confirm outcomes of the case study.

WP 6: A comparative database will be built and a comparative cross-national approach constructed by considering heterogeneous culture, economic, behaviour will be applied.

On WP 1&2 so far, we harmonized SHARE data from wave1 (2004) to wave5 (2013) and included variables related to demographics, income, wealth, health, activities, family relations and well-being. Then, we defined living arrangement based on household size, household composition and distance to children.
The first results obtained thanks to these data show that less than 20% of older people don’t have any child. This rate increases with age. We also observe a North-South gradient of geographical proximity with a child: seniors from southern European countries (France, Italy, Spain) more often live with or close to their children than those from northern European countries (Germany, Sweden).

On WP 3 the collaboration with the British and Chinese teams has led to the development of a common questionnaire. The survey will be conducted jointly in several territories in France, UK and China. The French team has also realized a cartographic analysis of the territories of aging (16 annotated maps). This analysis will help to resituate local results in their broader context.

On WP4 a report was written in the three countries about «smart homes» and their technological innovations. In addition, an inventory of «living labs» was conducted in each country. We started to visit these structures.

On WP 5 we analyzed three main types of financial circuits. Surveys have been conducted about all of these financial circuits. Results are planned to be obtained for autumn 2016. We aim to write scientific papers based on these results.

The study will help to understand ageing-in-place in the three countries and will identify common features for integrated care under different policy and society circumstances. It will examine the potential of such models, their impact on improvement to the care of older people and finance implications.

It is the aim of this research to translate its findings as quickly as possible.
A range of guidelines will be produced by the research detailing how the built environment relating to housing design should be adapted, in addition to social and health care delivery guidelines, to meet the needs of older people and their families, and sustainable mechanisms to afford age-friendly housing. This information will be of direct benefit to policy makers, social and health care and housing providers who are in the position to modify and update policy recommendations relating to programs of care delivery and design of homes and their affordability. In addition to policy makers, the recommendations produced will be of direct benefit to practitioners.

As a result of the adoption of the study findings, older people will have access to a supportive environment that will facilitate a personalised care delivery, improved mobility and enhanced participation in social and physical activity. As a direct result, it is anticipated that carer burden will be reduced.

Researchers and academics within the study will benefit through their development of increased levels of multidisciplinary knowledge and the creation of a shared language through their involvement with the multidisciplinary work plan within the research. The working structure of the research project will provide an opportunity for those from all domains within the study to work together and hence gain a further insight into a number of new areas of work and multicultural awareness.

Publications

Population ageing has been recognised for some time in European countries like UK and France. However, this has been acknowledged in China only recently but with more urgency due to the tremendous population size and predicted growth; China will have 64 older people for every 100 workers by 2025. China presents what is, in effect, a different ageing trajectory from European countries, and has unique characteristics shaped by its distinct historical, cultural, economic and political contexts. Recent demographic changes and significant economic transformations have led China to move from a traditional familial dominated elder system of care in which older people are being cared for by the extended family structure, to one which seeks to be based on efficient and sustainable social care support. The importance of building up a long-term care system to adequately and sensitively serve the diverse needs of ageing individuals appears however, selfevident for both Europe and China. In both settings, there is a persistently increasing trend for older people to choose to live independently in their own home (ageing-in-place). In Europe, care provision is being shifted to accommodate this trend, though it is acknowledged that this shift will require investment for homes that provide for independent or semiindependent living and that in doing so, can meet the range of later life physical needs. However, it is probable that targeted investment in adaptation for improved levels of accessibility and in specialised and/or supported housing for older people to live independently for longer in their own homes can lead to substantial cost savings in associated health and long-term care.
This research will attempt to contribute to the processes for meeting older people's needs in terms of these changes by exploring the relationships between living arrangement, living environment and the design of care delivery from technological, financial, political and social perspectives. Taking account of the factors that impact on the different ways in which older people in China, UK and France see care delivery, this proposal will build a common framework for the study of care delivery mechanisms and options available to older people that includes consideration of the role of cultural, socioeconomic and welfare system dimensions. This will allow scenario building and in-depth comparative analyses among the three partner countries.
The study will use a mixed-method design, combining data mining and in-depth analysis, robust measures of the quality of the built environment, together with a participative action research approach to generate the engagement of key stakeholders and a range of qualitative data. It has six work packages which will be conducted in parallel in the three partner countries. The research will provide comparative studies and a synthesis that will inform recommendations to benefit China and Europe.
The study will help understand ageing-in-place in the three countries and will identify common features for integrated care under different policy and society circumstances. It will examine the potential of such models, their impact on improvement to the care of older people and finance implications. The involvement of academic and non-academic stakeholders will strengthen the methods, reach and impact of this research.