A review in Seniors Housing & Care Journal examines an innovative example of senior housing and care known as Apartments for Life. This senior housing approach shows the types of efforts that can be made to maintain a sense of integration within a community, despite the onset of physical and cognitive challenges associated with aging.
In the Netherlands, Apartments for Life are available to individuals over the age of 55, and residents typically enter these apartments while still independent. What makes these residences unique is that when individuals require assisted living or nursing care, such care is brought to them. The housing is designed to allow the resident to remain in the same apartment until death, for true aging in place. The “age-proof dwellings” can accommodate patient lift equipment, oxygen, and wheelchairs as needed. They also include modifiable components, such as sinks that can be raised or lowered as needed. For the most part, only in cases of dementia do residents eventually need to move. In some instances, these individuals are relocated to clusters of units designed to accommodate individuals with dementia.
The philosophy behind this approach is a belief that older adults want to remain independent and involved in society as much as possible, and want to avoid the stigma and other associated issues related to relocation. The Apartments for Life philosophy incorporates four key values: The first is autonomy, allowing individuals to remain bosses of their own lives. Second is the value of “use it or lose it,” which in this case reflects a Dutch philosophy of personal strength, which “views the over-provision of care as more damaging than the under-provision.” As a result of this philosophy, older adults are challenged to do as much as they can for themselves. Third is the value of embracing a “yes culture” that promotes the idea that older adults should be given the freedom to enjoy simple pleasures as well as challenges and stimulation—even if it means sleeping until noon or drinking at a bar. The fourth value endorsed by this approach is a family-centered approach to caregiving.
The Apartments for Life approach leads to a mix of individuals needing a variety of levels of care from apartment to apartment. The residents retain their ability to stay surrounded by familiar belongings and neighbors, not to mention enjoying continuity of the same care staff. This continuity alleviates the fear and stigma that has been observed in Continuing Care Retirement Communities (CCRCs), where residents can experience anxiety about entering areas of facilities where individuals with mental and physical disabilities are clustered together. Also, this article points to the specific benefits of this approach for married couples, since the provision of assisted living and nursing home care in the same apartment means that couples can continue living together for longer than in other models of senior living.
Since their inception in 1995, there are now 15 Apartments in Life in the Netherlands, housing around 2,500 residents. There is great demand for more of these apartments, with a reported 10,000 to 12,000 people on waiting lists. Moreover, available anecdotal evidence suggests that the costs of these non-institutional settings providing care are 10 to 25 percent lower than comparable institutional care. The reasons suggested for this are a high level of volunteering that builds interdependence and a strong focus on self-actualization in these communities.
While the Apartments for Life model has been advocated in the United States, “ambiguity in regulations has made it difficult to implement these ideas in a straightforward way.” Despite these hurdles, there are some low-income housing facilities that bring services to residents. There are also some organizations that provide services to older adults in their homes that are known as “CCRCs without walls” or “CCRC at home,” and about 12 of these currently exist in the United States.
However, even if logistical hurdles prevent the provision of Apartments for Life in the United States, the popularity and practicality of such residences in the Netherlands suggests that the American senior living industry should explore options for implementing the values behind Apartments for Life in ways that organizations can accommodate.