Going Dutch: A Mixed-Use Housing Model from the Netherlands Responds to the Aging Demographic

Article excerpt

The decades ahead will produce an inevitable demographic: enormous numbers of mentally and physically frail older people. Some will stay at home with families, but many will require the help and assistance generally associated with assisted living or skilled nursing care.

What if there were a housing environment providing peripatetic homecare support at the margin of need? Might it be possible for services to escalate as they were needed, and be delivered in a 700to 1,000-square-foot apartment or condominium designed to meet the most up-to-date universal design standards- in short, a home where you could gracefully and independently age in place?

The good news is yes, it is possible. The not-so-good news is that so far, the model has been incubated only in the Netherlands.

Introducing Apartments for Life

Holland's Apartments for Life (A4L) movement has existed for nearly two decades, with the first A4L project, the Humanitas Bergweg development, situated in downtown Rotterdam. Individuals who range in age and competency from completely independent to extremely dependent may age in place there, in their own dwelling unit, until death.

Homecare workers provide scheduled help and assistance- once a day for more independent residents, or four to eight times in 24 hours for frailer residents. Unlike continuing care retirement communities (CCRC) here, which also provide a continuum of care, residents in A4L settings remain in the same unit and services are increased based on need. Some A4L buildings have a robust discretionary meals program, while others provide qualified individuals with pre-packaged meals via a government assistance program.

This housing type satisfies the desire older frail people might have to age in place, even to the end of life. It also makes it possible for couples to share a dwelling unit longer and for residents with dementia to transition to a separate shared unit in the building when that becomes necessary. These homecare-based service models create a more private, choice-rich setting, while using care personnel more effectively: this buildingservice hybrid can offer a better quality of life with a cheaper price tag- a combination that is hard to top.

The A4L Package

The A4L dwelling units average 800 square feet, are constructed to a universal design standard and typically contain a full kitchen and a fully accessible bathroom. Buildings tend to be larger than the typical 40- to 60-unit assisted living building: most are mid-rise structures with 150 to 200 units. Many buildings have atrium-type designs that let in sunlight between rows of units, support abundant plant life and offer attractive areas for sitting, eating or socializing.

The A4L buildings typically house first-floor common spaces that are open to neighborhood residents and those living in the housing above. These common areas include activity spaces, but also might have room for physical therapy as well as neighborhood-friendly services like a restaurant, coffee bar and beauty shop. The buildings' units are primarily rentals but, increasingly, are mixed with condominium-style choices. In the Dutch system, units can either be sold, rented at market rate or qualified for at belovv-market rate.

The A4L housing model serves both building residents and adjacent residents in the neighborhood because the buildings are natural settings for servicesmeals-on-wheels programs, homecare and emergency response aid- that can be organized and distributed to older people in nearby conventional housing. These mixed-use buildings often house grocery stores or child daycare centers. And their size and bulk make them natural choices for transit-orienteddevelopment, so that public transportation is conveniently accessible to homecare workers and older residents. …