Organisational Structures
Assisted Living Arrangements
structures that facilitate preserving and maintaining informal family relationships
COUNTRY / LOCATION: Denmark
Keywords: assisted living, social housing, care home
Keywords: assisted living, social housing, care home
Social housing for older people in the Act on Social Housing
Summary
The history of social housing for older people in Denmark goes back to the 1980s when the construction of nursing homes was generally abandoned, and rules on housing for dependent people were separated from rules on the provision of care. The national legislation concerning social housing for older people is effective for all types of housing for (older) people in need of care. The most relevant rules within this legislation state that housing for older (dependent) people should be built under the general rules of social housing. Among other things this means that the residents of dwellings with related long-term care services are considered as tenants and not as clients or even as patients, with easy access to all integrated care facilities. This serves to ‘normalise’ the status of older people.
What is the main benefit for people in need of care and/or carers?
The basic intention behind this national initiative has been to secure continuity in the life course, so that lifelong external support systems as well as autonomy are preserved to ensure self-determination for dependent (older) people. In addition, the negative stereotyping that comes from being labelled a patient is avoided.
What is the main message for practice and/or policy in relation to this sub-theme?
The example demonstrates that it is possible to amend the legislation in a way that the autonomy of older and dependent people can be significantly maintained and increased.
Why was this example implemented?
The intention of passing a legislation where general rules on social housing apply to housing for older (dependent) people and of abandoning nursing homes was to increase continuity in the life course and self-determination for people in need of extensive care. In an institution, the autonomy and individual activity of residents is reduced, while living as a tenant in an ordinary dwelling with easy access to necessary integrated care services is more preferable than living in a nursing home, as older people can continue their “normal” life.
Description
In the mid-eighties several municipalities began experimenting with new types of dwellings for dependent older people with the intention of substituting nursing homes in the long term.
These experiments, together with recommendations from a national commission on ageing, constituted the background for a new legislation on housing for older people in 1988. According to this legislation, municipalities could no longer build conventional nursing homes, where there was less autonomy; for example residents received pocket money from the institution rather than managing their own pensions.
In 1996 the legislation regulating housing for dependent (older) people became part of the general Act on Social Housing. This emphasised that housing for dependent (older) people should be a type of social housing or an ordinary dwelling with access to special facilities.
The idea was to separate the housing and care in a way that a certain type of housing is not necessarily connected with a certain amount/type of care. The provision of care should be flexible for the older person in need of care.
In the Act on Social Housing, dwellings for long-term care are defined as social housing with care and service functions attached in accordance with the needs of the residents (LBK nr. 884 af 10/08/2011: Bekendtgørelse af lov om almene boliger m.v. Socialministeriet). Service areas (offices for professional care providers, therapy, etc.) are integrated in this type of housing and financed by the municipality and not through the rent paid by the residents.
The residents are tenants with a contract like in any ordinary dwellings and they receive their pension as normal. Out of their pension they have to pay for rent, food and other necessities. As in ordinary dwellings the rent can be subsidised depending on the individual income level.
In most cases the dwellings consist of a flat with one or two rooms and kitchen facilities. In a few cases, dwellings are rebuilt within former nursing homes and consist of a single living room and shared kitchen facilities. However, residents do live as autonomous people as a tenant on their own.
What are/were the effects?
The rules according to the legislation have been implemented for all kinds of housing for (older) people in need of care. In Denmark (institutional) nursing homes are now non-existent and all types of newly built housing for (older) people with care needs come under the auspices of social housing and can be called assisted living arrangements. General studies of the life in dwellings with integrated long-term care services have not been carried out. However, having more space than in a nursing home as well as a kitchen improves the possibility of receiving visits in privacy and keeping in contact with social networks.
People living in a dwelling with integrated long-term care services can choose a package of services from the housing facility. While most residents make use of these services, it is still possible to choose which services are needed from the facility and which will be received from outside of this arrangement. There are no doctors attached to the facilities - the residents continue to see their GP.
Personal care and help with aspects such as cleaning are provided by facility staff. It is unusual to receive help from professionals or volunteers from outside. In some facilities, however, volunteers provide assistance with social activities for example going on tours, help with buying new clothes or reading the paper.
What are the strengths and limitations?
The general rules as well as the construction of the new types of long-term care dwellings give the residents the opportunity for maintaining autonomy and to be respected as an individual.
However, not all residents are able to maintain autonomy within their living space because of cognitive impairments such as dementia. So the process of making decisions about everyday matters for the individual may be a challenge.
Many residents will experience an improvement in their economic situation compared to a situation in a nursing home where they only had ‘pocket money’. But in some cases payments for rent and services will leave a resident with the same amount that would equal ‘pocket money’.
In some cases, care staff may still hold on to institutional ways of working in terms of routines within the social housing context.
Credits
Author: Eigil Boll Hansen, Danish Institute of Governmental Research, CopenhagenReviewer 1: Michael Bech
Reviewer 2: Georg Ruppe
Verified by:
Links to other INTERLINKS practice examples
External Links and References
- Bekendtgørelse nr. 610 af 21. Juni 2005 af lov om almene boliger m.v. (Executive order no. 610 of 21 June 2005 of the act concerning council housing, etc.)
- Margrethe Kähler (1992): Ten years after the commission on ageing – ideas and results. Danish Medical Bulletin.39: 216-219.
- Mary Stuart and Eigil Boll Hansen (2006): Danish Home Care Policy and the Family: Implications for the United States. Journal of Aging & Social Policy. 18(3/4): 27-42.
- Velfærdsministeriet (2008): Standarden af plejehjem og beskyttede boliger 2008. Copenhagen. (Ministry of Interior & Health (2008): The standards of nursing homes and sheltered housing 2008. Copenhagen.)
- Wagner L. (2006). 'Two Decades of Integrated Health Care in Denmark' in: Tidsskrift for Sygeplejeforskning 2/2006:13-20.
- Ældreboligrådet (2008): Fremtidens boligpolitik for ældre – udfordringer og forslag. Copenhagen. (Senior citizens council for housing (2008): The future housing policy for elderly – Challenges and suggestions. Copenhagen.)
