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CALACAT
Literature Review

There is a growing body of literature to draw from in examining the potential of cooperative
housing for older people in Australia. This chapter reviews that literature, studying:

 ageing in place, an ideology which has gained popularity amongst governments in the
last few decades;

 cooperative housing and community building and their application to older people
overseas;

 the current status of cooperative housing in Australia; and

 an exploration of how older Australians are currently living to provide a context for
potential recommendations from this research.

The ageing population

Australia's population is ageing rapidly. Older people, defined by the Australian Bureau of
Statistics as those 60 years and older (ABS, 2009), are forecast to reach 22 per cent of the
Australian population by the year 2051 (ABS, 2009). The greatest increases are projected to be
among the very old, or those 85 years and older (ABS, 2006).

Australia is not alone in having an ageing population. International agencies such as the
Organization for Economic Co-operation and Development (OECD) and the United Nations
(UN) have in the past few years contributed significant research and policy recommendations to
the growing literature on the challenge of an ageing population (OECD, 2005; UN, 2009).

Particularly since the 1980s, researchers have been developing the body of work of critical
gerontology exploring the opportunities and challenges presented by a rapidly ageing
population. This field encourages the evaluation of older people through a multidisciplinary lens,
and in particular through an understanding of the ways that broader societal and policy norms
and decisions have formed our understanding and subsequent treatment of older people in
modern society (Minlker, 1996; Townsend, 1981, 1986; Walker, 1981; Westerhof and Tulle,
2007).

Aged care provision

In recent years, there has been enormous growth in the aged-care housing sector in Australia.
This growth has been largely directed at one segment of the market, those who can afford and
are interested in retirement village-style options, which perpetuate the traditional, isolationist
model of housing for older people. Despite the increased support for ageing in place,
government policies continue to provide financial incentives to developers for building retirement
villages and similar developments as a response to an ageing population. The number of people
living in retirement villages in Australia has grown 37% between 1981 and 2001 (ABS, 2006).
As of 2006, 4.35% of Australians aged 65 and over live in retirement villages (ABS, 2006).
Despite their growing popularity, retirement villages also present challenges; there are no
regulations as to what constitutes a retirement village, or what level of care they have to provide
(Cheek et al., 2006), and they are largely built by private developers, making them simply too
expensive for many (Finn et al., 2011). As such, many older Australians continue to live in their
family homes until they are no longer able to look after themselves and are then moved into
expensive institutional care away from their familiar communities (Andrews-Hall et al., 2007).

Ageing in place
Ageing in place, defined as remaining in one’s original house and or neighborhood while ageing
(Clark and Deurloo, 2006), is the focus of much of the recent literature on housing for older
people. Similarly, policy in many Western countries has come to recognize the value of
community and belonging for older people. Various research papers focus on diverse issues
from the reluctance to move to a new place increasing as one grows older (Costa-Font et al.,
2009), to the financial benefits of ageing in place (Wiles et al., 2012), and the importance of
good community and urban design to enable ageing in place (Lehning, 2012). A theme shared
by a lot of the work is the importance of community in the understanding of ageing in place.
Indeed, much of the research shows that older people are not as concerned with staying in the
same house as they get older, as they are with remaining in their familiar neighborhood, where
they know their way around, have friends and can access services more easily (Wagner et al.,
2010; Wiles et al., 2012).

Ageing and community

The current trend towards policies for ageing in place has been supported by research
highlighting the individual, societal and economic benefits of living within a strong, established
community, particularly for older people. Much of the literature refers to a "mutual support"
arrangement in which people who are not necessarily related help care for each other within a
community (Dono et al. 1979). Barker (2002) explores he ease with which mutual support can
be coordinated, even informally in a community through basic, frequent and direct contact
between residents of an area,

"…care giving arrangements did not arise between complete strangers, although connections before care
giving were often rather tenuous, confined to exchanging greetings or pleasantries with neighbors"
(Barker, 2002 p.161).

Although, according to Barker, only a base level of "neighborliness" is required to increase the
likelihood of mutual care-giving amongst members of a neighborhood or community in later
years, that base level cannot be achieved without an appropriate built form that aims specifically
to encourage frequent direct and personal contact between residents of a particular building or
neighborhood (O'Bryant 1985).

Cooperative housing
Cooperative housing has been employed as a model for providing affordable housing with a
community spirit, or element of mutual support, since the early twentieth century (Ganapati,
2010). As a model, it has been utilize to varying degrees of success for these purposes across
the globe, however it has been particularly successful and popular in the northern European
states (Robertson and Theisen, 2011).

There are many ways of running a cooperative housing project, with different projects focusing
on different priorities of community, spirituality, lifestyle and affordability (Glass, 2009). What
they often share however are similar financial arrangements, which are designed in order to
empower the residents and to ensure that a level of affordability is retained (David, 2010). Two
popular financial models are Low (or Shared) Equity Housing, and Community Land Trusts. The
former is a type of resalerestricted, owner occupied housing in which the cooperative defines
efficient and fair resale prices of housing in the cooperative when members move on. This
model has been viewed in much of the literature as a largely successful model for maintaining
affordable prices (David, 2010; Miceli, 1998). The latter is a model in which the community owns
and controls the land which can then be sold or leased to occupants at a controlled rate,
allowing the cooperative a measure of autonomy and continued affordability. This model has
recently grown in popularity as a successful strategy in the provision of affordable and
community based housing. Evidence of its success can be seen in the various case studies of
new Community Land Trust projects across Europe and the United States (Paterson and Dunn,
2009; Moore and McKee, 2012). A third type of cooperative housing is not-for-profit non-equity
cooperative housing focused on providing public or social, rather than private, affordable
housing. This type subscribes to similar priorities of community, lifestyle and shared governance
as the first two but relies on government and not-for-profit or private foundation funding in order
to provide the set-up and ongoing maintenance costs not covered by the controlled rent charged
to residents (Saegert and Benitez, 2005).

Cooperative housing and older people

The combination of cooperative housing and housing for older people is a relatively new
concept. In line with the recent policy movements toward focusing on housing as an integral part
of aged care, there has been some research into the role that cooperative housing could play as
a model for successful, sustainable aged housing in the face of a rapidly ageing community.
Borgloh and Westerheide (2012) have recently conducted a significant piece of quantitative
research underscoring the economic advantages of cooperative housing for elderly people in
Germany.
It is evident that different models of cooperative housing have seen success in providing
affordable, manageable housing with the added benefit of community for those who want or
need it. Indeed it could be said that cooperative housing facilitates a type of ageing in place
(Glass, 2009; Scharlach et al., 2012). Also, it is clear that 18 there is room for more research in
this area to examine what types of cooperative housing could best meet the diverse needs of
elderly people, and how those models could be successfully initiated in Australia.

Cooperative housing in Australia

Cooperative housing does not have as strong a foothold in the Australian housing market as in
the rest of the Western world. Alternative housing options, like cooperative housing, have been
sidelined by a combination of weak housing policy and a strong culture of the “Australian dream”
of a detached single family home with private garden. This has not always been the case; in
fact, in the 1950s and 1960s in Australia, cooperative societies were considered one of the key
players in housing finance, along with banks and building societies and credit unions. Their
decline is largely attributable to changes in economic policy, in particular the deregulation of
banks in the 1980s and the end of government guarantees to cooperative society loans (Abbott
and Doucouliagos, 1999; Abbott and Doucouliagos, 2001). Yates’ (2011) review of rates of
Australian home ownership finds that in the post-war period, when cooperative housing
societies reached their zenith, Commonwealth Government policies pushed private home
ownership as the pathway to financial security for Australian families, contributing to their rapid
decline. Indeed, Australians now have one of the highest rates of private home ownership in the
world (Kendig, 1990; Kupke, 2001).

The difference between these recent attempts at cooperative housing in Australia and their
counterparts overseas is that they are largely driven by a movement towards more sustainable
lifestyles and an attempt to regain lost social capital, rather than affordability or social housing
(Holtzman, 2012). Cooperative housing in Australia is often associated with the “hippy” and
alternative lifestyle communes from the 1970s and 1980s, such as the Aldinga Arts Eco-Village
and Crystal Waters, which were grounded in agricultural activities that adopted permaculture,
biodynamic and organic techniques (Holtzman, 2012). Moving into the twenty-first century, eco-
cities have 20 remained the more popular model of cooperative housing in Australia, as
sustainability and “green” culture have increasingly become part of the mainstream (Holtzman,
2012). Whether with an ecological bent or not, there are umbrella organisations in Australia
working in cooperative housing. Groups such as Common Equity Housing Limited, South East
Housing Co-operative Limited and the Community Housing Federation of Victoria provide
practical information and resources to those interested in setting up or taking part in existing
cooperative communities.
Literature of Review
Introduction
The focus of this study was to determine if independent living elderly adults would be willing to
have lifestyle monitoring technology in their homes. To study this problem the literature was
reviewed and is presented in the following sections:
1. Demography of the Elderly
2. Care for Elderly Adults
3. Technology Supported Aging in Place

Demography of the elderly

According to the U.S. Census (2008) there were nearly 38 million elderly adults living in the
United States. Of those elderly adults over 24 million were living in family households, 10 million
were living alone and nearly 15 million were living with a disability. The census projected that by
2010 there would be over 40 million elderly adults as the percentage of Caucasian American,
Black American, Asian American, Hispanic, American Indian, and Pacific Islanders were all
projected to increase. In light of these changing demographics it has become increasingly
important to focus research on the issues facing this growing section of the U.S. population
(Maas, Conn, Buckwalter, Herr, & Tripp-Reimer, 2009).

As far back as 20 years ago the U.S. Department of Health and Human Services commissioned
research projects which focused on the elderly and their use of assistive technology in the home
(Elliot, 1992). In the 1992 report, Elliot noted that persons aged 65 and over, were the primary
users of medical, social, and personal care services targeting functionally impaired individuals.
Additional projections from that report to the U.S. Department of Health and Human Services
estimated that by the year 2020 there would be 10.1 million functionally disabled elderly living in
community and 2.5 million in nursing homes. More recent figures show that in 2003, 1.5 million
elderly were living in nursing homes, giving some credence to Elliot‘s projections (Centers for
Disease Control and Prevention [CDC], 2008). With these projections it is understandable why
health and wellness services focused on the medical, social, and personal care of persons aged
65 and over has emerged as a significant health and social policy issue in the U.S. (CDC, 2008;
Elliot, 1992; Stearns, et al, 2001; Rhee, Sasso & Emanuel, 2009.

Care for elderly adults

Long term care which takes place in nursing home facilities is expensive and consumes a large
percentage of government spending through Medicare and Medicaid. Finding ways to control
costs is high on the agenda of the U.S. Department of Health and Human Services (Elliot, 1992;
Jacobson, Neuman & Damico, 2010; Spillman, Liu & McGilliard, 2002).
Home health care is another area of the U.S. health care system that caters to the elderly adult
population. This type of care is provided to individuals in their homes and is meant to promote,
maintain, or restore health so that individuals can retain a level of independence while staying in
the home. In 1996 the National Home and Hospice Care (NHHCS) Survey estimated that there
were almost 2 million patients 65 years and older who made use of home health care services.
These individuals received either assistance with activities of daily living such as bathing,
dressing, eating, or getting in and out of bed. Other activities tracked in this survey were
instrumental activities of daily living which are considered as more complex tasks that allows an
individual to stay in the home longer, such as, light housework, money management, shopping,
meal preparation, and medication compliance (Munson, 1999, p. 1).

As far back as 1992 the U.S. Department of Health and Human Services identified assistive
technology as part of the solution already being explored by researchers, caregivers, community
members, and the elderly themselves to support safely staying in the home as long as possible
(Elliot, 1992). According to the Technology Related Assistance Act of 1988 (P.L.100-407),
Assistive Technology is any item, piece of equipment, or set of products that helps a person
with a disability to increase or improve his/her functional capabilities (Congress of the US,
1988). These technologies can allow an elderly adult to function more independently, stay in the
home longer, and have been recognized by policy makers as making good fiscal sense since
they have the capacity to decrease the need for expensive formal care and intensive informal
care (Elliot, 1992).

Technology supported aging in place

Even though there has been a tremendous growth in technology over the past 10- 15 years the
elderly continue to be a group identified as slow to adopt technology usage. In contrast research
conducted by Torp, and colleagues (2008) to determine the effectiveness of information and
communication technology being used to monitor and enhance the health of adults over 60
years found that there was high level of technology usage. This particular study looked at
technology that supplied information about chronic illness, caring and coping, establishing
support networks, and reducing stress and related mental health problems.

One of the issues surrounding the use of such technologies relates to the privacy concerns of
users. Birnholtz and Jones-Rounds (2010) found that elderly persons placed a high value on
their privacy and independence. The study they conducted showed that technologies such as
an emergency help necklace that can be pressed to signal for emergency care allowed elderly
persons to maintain their need for privacy and independence (Birnholtz & Jones-Rounds, 2010).

Another study conducted by Demiris and colleagues (2004) examined the attitudes that a group
of older adults had towards ”smart home” technology and in-home monitoring devices. A smart
home is a house fitted with technology that creates a user controlled interface through a
computer or remote control. A smart home is created to either improve the quality of living,
monitor/transmit health information or a combination of the two. Analysis of the qualitative data
revealed themes that included the perception of usefulness of devices in health-related issues.
Sponselee, Schouten, Bouwhuis, & Willems (2008) conducted a study to explore possible
relationships between the key stakeholders in the field of smart homes (care 17 receivers, care
givers, designers, care institutions, service providers, housing corporations, insurance
companies, and the government) and the implementation of smart home technology in the
residences of the elderly. The researchers found that both care givers and care receivers are
likely to have resistance to technology in the home. When speaking about elders attitudes
toward today‘s technologies Bronson (1998) uses the term Technophobia to describe a fear or
aversion to technology. Bronsan suggests that this is due to participants‘ limited knowledge
about the functionality of many of the technologies. Another fear was that if more dependence
was placed on technology that elderly persons might become lonely because they lack human
interaction. The research also described the disconnection between the designer of smart home
technology and the elderly as users of the technology (Sponselee, Schouten, Bouwhuis, and
Willems, 2008). One of the findings was that a designer creates a product with function in mind
but does not necessarily understand that an elderly person might have resistance to the new
technology because of their lack of technological experience. The study concluded by claiming
that the designer of smart home technology might gain from an understanding of the
perceptions of the elderly when it comes to the use of technology for monitoring health related
issues as the persons age in the home (Sponselee et al., 2008).

Research into new technological developments that can contribute to the care of the elderly is a
clear recommendation based on the literature reviewed. Electronic sensors, video-monitoring,
remote health monitoring and equipment such as fall detectors, door monitors, and alerts,
pressure mats and smoke and heat alarms can improve patients’ safety, security and ability to
cope at home (Miskelly, 2001, p. 455). Care at home and in community has been determined to
be preferable and usually less 18 expensive than nursing home care. Comprehensive aging in
place systems which include technology to support the elderly staying in the home could benefit
the elderly and those closest to them (Miskelly, 2001 & Edes, 2010).

Summary

Much of the literature reviewed dealt with technology and its uses in elderly health care. One of
the general stereotypes about older adults is a resistance to technology, although, in the results
of nearly all of the literature reviewed, when it was explained how a particular technology could
be useful, elderly adults showed a positive response to new technology in their homes, even in
private places like their bedrooms or on their person (Edes, 2010; Miskelly, 2011; Roseman &
Stephenson, 2005; Sponselee et al 2008). However, it is noted that not everyone will benefit
from or accept new assistive technology and devices. Assessing each person‘s situation is
important, especially when taking privacy concerns into consideration. In addition, older adults
with physical or cognitive impairments may have difficulty adapting to new technologies
(Miskelly, 2011). Smart home technology was a well-represented field, the fact that much of the
research pointed towards a positive response by both potential elderly clients and caregivers
bodes well for future use and suggest that additional research should be conducted with diverse
populations (Edes, 2010; Miskelly, 2011; Roseman & Stephenson, 2005; Sponselee et al.,
2008).
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