Introduction

The debate concerning age-friendly cities and communities (AFCC) addresses issues of demographic change at a time of continuing global urbanisation, where inequalities between people and places become central. In many economically developed countries, health and social care policy encourages older people to live in their own mainstream housing. Throughout life people may relocate, primarily to seek employment, but in later years the idea of ‘staying put’ as a good idea has led to discussion in the UK of the lifetime home and, subsequently, the lifetime neighbourhood (DCLG, 2008; Bevan and Croucher, 2011). Both concepts are related to the AFCC mission. Globally and nationally, moving this dynamic form of social policy forward requires recognition of the heterogeneity of the ageing population and the importance of involving people in co-design and co-production of living spaces. Yet the lives of people experiencing disadvantage and faced with long-term health conditions can challenge the positive milieu of a global social policy portrayed as inclusive, particularly when compounded by cultural, social and economic circumstances (WHO, 2007; Phillipson, 2007, 2012).

This chapter tests the inclusivity of age-friendliness for the lives of older people with sight loss living within English urban and rural communities. Vision impairment can be a lifelong experience, but often occurs in later life alongside other long-term health issues. For many people, changing sensory perception will have happened in an environment that is familiar, possibly with their disability unrecognised externally. Everyday living with its routines and activities may alter as people find new ways of coping (Wahl et al, 1999), sometimes with the support of specific social and cultural groups, sometimes through home adaptation and assistive technology, or by a combination of the two. Yet given their changing circumstances, people may still experience forms of social exclusion in places that are not enabling.

Testing the principles of the AFCC

Since 2005, the AFCC initiative has aimed to promote active ageing ‘by optimizing opportunities for health, participation, and security in order to enhance quality of life as people age’ (WHO, 2016a). There are now over 500 cities and communities in 37 countries working towards being more age-friendly as part of the World Health Organization (WHO) Global Network for Age-Friendly Cities and Communities (WHO, 2016b), developing projects enabling participation across a wide range of areas (see Chapter Two, Figure 2.1).

Introduction

Over the years, ‘the scrap heap’ has been a popular motif in campaigns against mandatory retirement. For many older people it has represented the reality of being excluded from the labour market: thrown on the scrap heap, no use to anyone, next stop the workhouse. In the 1950s and 1960s, how to adjust to retirement was the subject of extensive research (Phillipson, 1993). Success was represented in part by evidence of contentment and in part by that of activity. The concept of ‘disengagement’ was much discussed. During the 1980s and 1990s, attention turned to ‘early’ retirement and the structured relationship between age and the labour market. It was evident that workers in some industries were being forced out through redundancy programmes and others were ‘induced’ into an early exit (Bytheway, 1986).

Now, at the time of writing (2006), as the government pushes through anti-discriminatory measures, attention once again is heavily focused on employment and how older people, alongside other disadvantaged groups, are excluded from the opportunities and rewards of paid employment. The White Paper Fairness for All, for example, introduces the situation of older people with the comment: “Older people – who already experience discrimination in the labour market – will need choices and opportunities to continue in work and save for their retirement” (DTI, 2004, p 14).

Although the UK government is seeking to promote ‘equality and human rights’ in many areas of public life (see Chapter Three), there is a growing risk that legislation could become overly associated with employment practices and a few other, narrowly defined, ‘third age’ issues. If this were to happen, such attention could be construed, paradoxically, to be discriminating against people in their ‘fourth age’, and the ways in which they are excluded from education, housing, citizenship, travel and the like will be overlooked.

This chapter is based on our experience of coordinating a participative UK-wide research project aimed at uncovering evidence of age discrimination against older people. We first describe how we have defined age discrimination, ‘older people’ and participatory research. Then we go on to detail our methods and, in particular, the use of diaries.

Introduction

In this chapter, we consider three environments that cross the age-related–mainstream housing divide, exploring ways in which structured technological and social interventions might enhance the domestic life of older people. We draw on recent empirical work, conducted separately by the authors, at locations in Scotland and in London. Brian McGrail examines the development of adapted high-rise housing in Edinburgh and Glasgow; John Percival looks at traditional sheltered housing in an inner London borough; and Kate Foster considers shared housing for people with dementia in Scotland. Further discussion of the issues raised by the individual studies, along with more detail on the settings themselves and illustrations from interviews, are available. Here the three studies have been merged to offer insights into variation.

The three types of housing provision discussed in this chapter represent different stages in the evolution of policy on housing the general population and those defined as ‘vulnerable’. High-rise housing (defined variously as over four or five storeys) had been a planning solution to urban density for some time in parts of Europe and in Scotland before most English high-rise schemes were developed in the 1960s and 1970s. As a consequence proportionately more older people live in high-rise housing in Scotland than in England, and Scotland has the stronger tradition of flat dwelling on the whole. The schemes investigated by Brian McGrail in this chapter are ‘tower blocks’ with many more than four or five storeys, and date from the 1960s.

In contrast, most sheltered housing schemes date from the late 1970s and 1980s, as public subsidies for housing were largely diverted from general social housing to ‘special needs’ and other specific purposes. Initially, sheltered schemes were provided by local authorities, but by the 1980s most were being developed by housing associations and trusts, with a smaller number being developed for sale. By 1997 there were 451,114 units of sheltered housing in the UK (DETR, unpublished data). In the early 1990s it became evident that the balance of provision was not entirely compatible with demand (McCafferty, 1994) and since then there has been more concentration on sheltered housing with extra care and the diversification of particular schemes in some areas.

Until the development of extra-care sheltered housing, and arguably since then, the situation of people as they cope with increasing frailty in sheltered housing has been precarious.

Introduction

These quotations illustrate a point about the image of housing for older people in the UK at the beginning of the 21st century. The first, an estate agent's description of a property on the open market, emphasises its attractiveness, privacy and convenience: a place which sounds pleasant to stay in, nice to visit, easy to get away from. The second presents the property as a provision for a particular group – by implication needy people more concerned about being cared for than caring about the place where they live (but not presenting behavioural problems). This reflects attitudes to ‘ordinary – age-integrated’ and ‘specialised – agerelated’ housing as much as the differences between the two places, raising issues about integration, segregation and the capacity of the environment – built and social – to support ‘ordinary life’. Social exclusion is currently a major political issue. The divisions between people who are able to take part fully in the life of the community, and those who are hindered from doing so by material and cultural deprivation, are seen as harmful to the whole of society, and the present rhetoric is one of inclusion and enablement. Older people – particularly the very old – are among those groups which, by virtue of their relative economic disadvantage and increased propensity for long-term limiting conditions and disabilities, are most at risk from social exclusion and its consequences. Our particular focus in this book is the environment of old age, which can help or hinder the integration of older people within their communities. We will explore some of the ways in which forms of housing and attitudes to the housing needs of older people have changed and will continue to do so as the 21st century progresses.

Introduction

In this book the contributors have looked at various ways in which living environments can be designed, arranged and supported so that people in later life can maintain autonomy and remain connected with communities. Until recently, most studies about older people's housing have concentrated on issues of independence and the ability of individuals to maintain themselves, with assistance if necessary, in their own homes or in ‘homely care in the community’ (DoH, 1989). Concerns about independence and dependency have centred on two major problem areas. The first of these is the need of many people living in the community, often alone, who have inadequate support mechanisms to maintain their independence as their physical or mental abilities decline. The second is the position of older people living in settings such as residential care, whose independence may have been undermined by a culture of structured dependency bordering sometimes on infantalisation.

While there remains much work to be done to improve the situation in both these areas, there is at least a general recognition of the issues among both policy makers and service providers that most older people aspire to a level of independence, which may be supported by others, but which enables them to maintain control over their own lives. It is also recognised that this is essential to the well-being of older people and that it relates to the physical, social and psychological environments they inhabit. But, if there is recognition of the value of independent living, why is inclusion now an issue for older people? Could this be a reflection of social trends and changing attitudes to ageing as the ‘baby-boomer’ generations grow towards old age? The problematisation of old age becomes less acceptable as older people increasingly expect to be recognised as people with everyday lives that can be carried out in everyday places.

Why are older people as a group (if not individually) vulnerable to social exclusion? In an analysis of the sociology of old age, Fennell et al (1988) focused on three significant social trends: segregation, rising living standards and widening social cleavage. They gave examples of formal and informal segregation in housing as groups of households with broadly similar characteristics congregated in particular areas such as ‘executive’ estates, strips of ‘retirement’ bungalows along the coast or inner-city ‘ghettos’.

In the first part of this text we raise a number of key issues around the future development of accommodation for people in later life. In describing new initiatives in housing design and regulation, the authors consider macro and micro approaches, and the extent to which mainstream housing can encapsulate accommodation-and-support throughout the life span by experiments in Lifetime Homes and through regulatory frameworks for building guidance. The chapters describe the tensions that exist between the values underpinning universal design, the demands of market forces, and the rights of people whose needs present a special challenge to the generally accepted parameters of housing. Considering how these needs might be met, the authors move on to examine what we mean by ‘smart’ homes and how technological advances might strengthen personal autonomy, relieve environmental press and prolong independent living. They also raise important ethical issues about these innovations.