Housing Models for an Ageing Population

Prepared for the City of Onkaparinga

Dr Debbie Faulkner
Professor Andrew Beer
with
Mr Keith Hutson

September 2006

Southern Research Centre – Australian Housing and Urban Research Institute

Participating Universities: Flinders University, University of South Australia, University of Tasmania
Director: Professor Andrew Beer
Hosted by School of Geography, Population and Environmental Management, Flinders University, Adelaide, SA
 Executive Summary
This report outlines the implications of an ageing population in the City of
Onkaparinga for housing demand. As well as outlining the population trends, policy
context and the factors driving housing needs, the report canvasses the range of
housing models for an older population in Australia and elsewhere in the world and
sets out to comment upon their suitability and appropriateness for the City of
Onkaparinga and South Australia more generally.

At the most basic level, the number of persons aged over 65 within Australia, South
Australia and the City of Onkaparinga will grow rapidly over the next 15 years. There
will be more older people and there will be more of the ‘old old’ – those aged over 85.
This change in the population will have significant implications for housing and care
needs within the City of Onkaparinga.

In addition, there will be a qualitative change in the housing older Australians are
seeking within the City of Onkaparinga. Baby boomers will have higher housing
aspirations than their parents’ generation and some parts of the City of Onkaparinga
may emerge as a preferred retirement destination. The formal recognition by the
State government of the importance of housing, the community and the provision of
care as a priority issue will hopefully assist the City of Onkaparinga in planning for its
growing ageing population.

An important first step in catering for the housing needs of an ageing population is a
clear understanding of the housing models, currently available to older people in
Australia, and more significantly overseas, where there is a much greater experience
of a range of housing options. In reviewing the housing models available nationally
and internationally, the report notes that there are three basic models for the
provision of housing to older persons:

•
•
Conventional housing;

•
Unassisted communities;
Assisted communities.

The report finds that conventional housing is, and will remain, the most important
form of housing for older people in Australia, including the City of Onkaparinga.
There are strong health, financial and wellbeing grounds for encouraging people to
age in their own homes and successful ageing could be assisted by the provision of
additional supports including:

•
•
Advice and information about home modification;

•
The application of universal design principles;

•
The adoption of assistive technologies;

•
Advice on available housing options;

•
The promotion of homesharing;

•
Co-ordination of services;
Provision of transport in order to gain access to services and facilities.

The City of Onkaparinga can have an important role in many of these areas of policy
and program delivery, though often its role should be that of an advocate for change
and in co-ordinating existing services.

ii
Unassisted communities include retirement villages, lifestyle villages and co-housing.
Retirement villages are a small but growing component of the supply of housing to
older people and are now dominated by private industry. They are, however,
unaffordable for a segment of the aged population and while the City of Onkaparinga
may represent an attractive location for providers, retirement villages may not offer
affordable housing for the local aged population. The State Government’s
affordability targets for new developments, however, may ensure some affordable
retirement village housing in new developments. Lifestyle villages are more
affordable because the purchaser gains ownership of the house but not the land.
However, this raises greater questions around security of tenure. CoHousing
comprises intentional communities of older persons who choose to live as a group.
There appear to be multiple benefits from this form of housing and there are strong
grounds for the City of Onkaparinga advocating – and potentially working with a
community group – to pilot this model.

Assisted communities are a diverse group and provide varying levels of care and
support. Some of the models available in the UK and the US in particular appear
readily applicable to Australia. While they offer the prospect of significant cost
savings to the public sector, they remain relatively expensive housing solutions and
there are questions around which tier of government (if any) would subsidise this
form of housing and support.

The report examines likely trends in that section of the housing industry geared to the
provision of housing for the older population. The report notes that it is difficult to
accurately predict trends in this industry because much material is treated as
commercial-in-confidence and that, in large measure, the industry itself has not come
to grips with the emerging housing demands of persons currently aged 55 to 65. It is
concluded that:

•
•
The retirement village sector is likely to grow;
Persons entering retirement do not express a desire for small housing. Many
retirees have substantial equity as a result of the recent boom in house prices

•
and many have some – often limited – superannuation;
The not-for-profit sector will be transformed over the next decade. Some form
of the Continuing Care Retirement Communities model is likely to emerge as

•
a major form of housing in Australia over the next decade.
The nursing homes sector is most unlikely to grow at a pace that matches the
expansion of the aged population, or even, the population of persons aged
over 85.

Finally the report acknowledges that despite the development of alternative models,
the international evidence base notes the on-going importance of nursing homes for
end of life care.

iii
 Table of Contents
1. Introduction 1
2. Housing Trends in Relation to the City’s Aged Population
and How this Compares with State and national Outcomes 2
3. Current Policy Context 6
3.1 Key Issues from this Section 7
4. Factors Driving Housing Needs and Preferences for an Aged
Population 8
4.1 Key Issues from this Section 11
5. The Future of Residential Care 12
5.1 Key Issues from this Section 14
6. Potential Housing Models and Their Prospects 15
6.1 Introduction 15
6.2 Conventional Housing 16
6.2.1 New Homes 16
6.2.1.1 Lifetime Homes (Universal Design) 17
6.2.1.2 Labelling of the Suitability of Homes for
Older People – Senior Citizens Label,
Netherlands 18
6.2.1.3 Smart Homes 19
6.2.1.4 Evaluation of Lifetime Homes and
Smart Homes 20
6.2.2 Existing Homes 21
6.2.2.1 Home Modification Services 21
6.2.2.1.1 Home Improvement Agencies –
United Kingdom 22
6.2.2.1.2 Home Improvement Agencies –
US 22
6.2.2.2 Housing Option Services 23
6.2.2.3 Homeshare 24
6.2.2.4 Community Services 25
6.2.2.5 Evaluation of Strategies Relating to
Existing Homes 26
6.3 Unassisted Communities 27
6.3.1 Retirement Villages 27
6.3.1.1 Lifestyle Villages 29
6.3.2 CoHousing 29
6.3.3 Evaluation of Retirement Villages, Lifestyle
Villages and CoHousing 30
6.4 Assisted Communities 31
6.4.1 Sheltered Housing and Extra Sheltered Housing 31
6.4.2 Assisted Living 32
6.4.3 Continuing Care Retirement Communities
(CCRC) 33
6.4.4 Evaluation of Assisted Community Housing 35
6.5 Trends in the Supply of Housing to Older Persons 35
6.6 Key Issues from this Section 36
7. Conclusion 38
References 40

iv
1. Introduction
The objective of this report is to provide the City of Onkaparinga with information on
the implications of the ageing of the population and the demand for housing within
the City.

Current trends indicate that the population aged over 50 years of age in the City of
Onkaparinga has been increasing at a faster rate (5.5 per cent average annual
growth rate) than within the Adelaide Statistical Division and for South Australia in
total (2 per cent and 2.2 per cent respectively). A better understanding is required of
how the ageing population may drive housing demand in the City of Onkaparinga. In
addition, given the anticipated changes in the housing preferences as the baby
boomers move into retirement, it is important to explore the models of housing that
are likely to emerge as the population ages.

This report canvasses the range of housing models for an older population in
Australia and elsewhere in the world and sets out to comment upon their suitability
and appropriateness for the City of Onkaparinga and South Australia more generally.
Planning for the housing needs of an older population is a challenging task. There is
great difficulty in predicting the demands of older people for specific types of housing
as there is a range of demographic and economic factors which impinge on the
decision making of older people (Beer, Faulkner and Gabriel 2006). While for
younger groups in society economic factors such as income, wealth, prices and
interest rates strongly influence housing demand, these factors are more likely to be
secondary influences for older people. Demand for the older population is driven by
retirement and changes in health status and marital status, the last two factors of
which are difficult to predict.

The challenge for the market place and all levels of government is to accurately
predict the needs and desires of an increasingly heterogenous group; provide a
range of models to cater for varying needs; ensure older people and their families are
aware of the options available to them; adequately fund and support the models that
are desirable; and, best support the ongoing lifestyle choices and wellbeing of older
people.

This report addresses the following issues:

• Housing trends in the City’s aged population and how this compares with SA and

•
nationally;

•
Current policy context (State and Federal Government);

•
Factors driving housing needs and preferences for the aged population;

•
The future of residential care;
A review and assessment of different housing models for the older population

•
nationally and internationally;
Implications for the City of Onkaparinga in terms of options suitable for housing
and land supply.

This report has been prepared to inform a review of the strategic directions of the
City of Onkaparinga as well as assisting the City in engaging in an informed dialogue
with stakeholders such as housing providers, the State Government and other local
governments around future housing needs.

1
2. Housing Trends in Relation to the City’s Aged
Population and How this Compares with State and
National Outcomes
This section considers trends in the population structure of Australia and South
Australia. It highlights the growth in the ageing population and compares these
broader trends with those both evident and expected in the City of Onkaparinga.

The ageing of the population both numerically and structurally is the most dramatic
change that will occur to Australia’s population over the next 50 years.

• At the 2001 Census 12.6 per cent (ABS 2003a) of Australia’s population was
aged 65 years and over and 23 per cent of private households were occupied by

•
at least one older person (AHURI 2004).
By 2021 nearly one fifth (19 per cent) (ABS 2003b) of the population will be aged
65 years and over and it is estimated that every four in ten households will be

•
occupied by at least one older person, with many living alone (AHURI 2004).
Growth in the population aged 85 years and over is projected to be even more
pronounced, more than doubling between 2001 and 2021 to more than 500,000
people and by 2041 they will number over 1.2 million (ABS 2003b).

Of course these are projections and it is possible they may be an undercount of what
will happen if net overseas migration is less than 100,000 persons per year, the Total
Fertility Rate continues to decline and life expectancy continues to increase.

The ageing of the Australian population is the outcome of a combination of

processes, including a fall in fertility levels (with fertility rates below net replacement
levels since the mid 1970s), greater life expectancy, a lower rate of immigration
relative to the total population and the ageing of particular cohorts. The latter is
important because the ‘baby boom’ generation – born between 1946 and 1961 – is
significantly larger than its predecessor, up by approximately 1.6 million persons at
the 2001 Census (Table 2.1).

Table 2.1: Australian Generations: Age Ranges, Numbers and Per

Cent of Populations at the 2001 Census
Generation Year of Per
Label Birth Age Persons Cent
Before 1931 more than 74 years 1,710,291 9.1
The Austerity
Generation 1931-1946 55 to 74 years 2,420,329 12.9
Baby Boomers 1946-1960 40 to 54 years 4,004,987 21.3
Generation X 1961-1976 25 to 39 years 4,154,821 22.1
Generation Y 1977-1991 10 to 24 years 3,902,926 20.8
under 10 years of
post 1991 age 2,575,895 13.7
18,769,249 100.0
Beer, Faulkner and Gabriel 2006 p. 17.

2
The ‘baby boom’ generation is also important because their household structures,
experience within the labour market and expectations in retirement – including their
housing aspirations – differ from those of earlier generations. This will be discussed
in greater detail later.

Figures 2.1 and 2.2 show that the City of Onkaparinga has a younger age profile than
the Adelaide Statistical Division (essentially all of metropolitan Adelaide). This is to
be expected given that:

• South Australia has the oldest age profile of any of the mainland Australian

•
states;

•
The City includes areas that are still experiencing residential development;
As a relatively recently developed outer suburban area, the City of Onkaparinga
is both attractive to younger households and has not developed an older age
profile through ageing in place.

Figure 2.1: Age of Onkaparinga and Adelaide Statistical Division

Population by Category, 2001 Census

9
% of Population

8 Onkaparinga
7 Adelaide SD
6
5
4
3
2
1
0
14

24

34

44

54

64

74

84
4
to

to

to

to

to

to

to

to

to
0

10

20

30

40

50

60

70

80

Age
Source: ABS 2001

Despite the historically younger age profile of the City of Onkaparinga, structural
ageing will affect the City:

• Between 1996 and 2001 the percentage of the City of Onkapringa population
aged over 65 rose from 8.9 per cent to 10.3 per cent. Comparable data for all of

•
Adelaide indicate a rise from 14.1 per cent to 14.6 per cent;
Over the same time period the population aged over 55 rose from 15.6 to 19 per
cent and this needs to be compared with data from the Adelaide Statistical

•
Division of a rise from 22.5 to 24 per cent;
Clearly, while the City of Onkaparinga has maintained a younger profile than the
total metropolitan region, it is ageing at a faster rate.

3
Figure 2.2: Age of Onkaparinga and Adelaide Statistical Division
Population by Category, 1996 Census

10 Onkaparinga
% of Population

9
8 Adelaide SD
7
6
5
4
3
2
1
0
14

24

34

44

54

64

74

84
4
to

to

to

to

to

to

to

to

to
0

10

20

30

40

50

60

70

80
Age
Source: ABS 2001

It is important to note also that most older Australians are either home owners or
home purchasers. In 2001 69 per cent of Australians aged over 65 were outright
home owners and a further five per cent were home purchasers.

In terms of family structure, 65 per cent of persons aged over 65 lived in family
households at the 2001 Census, 26 per cent lived in lone person households, just 1.5
per cent lived in group households, and 8.1 per cent lived in a non-private dwelling.

Finally, it is important to consider possible population growth and its likely impact on
the City of Onkaparinga. GISCA (2005) has attempted to calculate the likely
distribution of population if the South Australian Government’s population target of
two million persons by 2050 is achieved. Their forecasts are at the level of Statistical
Local Areas (SLAs) of which there are seven in the City of Onkaparinga (Hackham,
Hills, Morphett, North Coast, Reservoir, South Coast and Woodcroft). GISCA’s
estimates suggest that if the State Government’s population target is achieved, the
areas of Woodcroft, South Coast and Morphett would be most affected. While
population growth may inject younger households in the area and reduce the aged
population as a percentage of the total, it will not see a reduction in the number of
older persons living within the City and may, in fact, contribute to a further influx of
older persons.

2.1. Key Issues from this Section

• The City of Onkaparinga has a younger population than for SA in total and for

•
metropolitan Adelaide, but it is ageing rapidly;
The City of Onkaparinga was – in large measure – settled in the 1970s and
1980s by a population cohort who are now on the edge of retirement, if not retired

•
already;
The ageing of the baby boom generation is going to affect all parts of the

•
Australian population, including Onkaparinga;
Older Australians are more likely to be outright home owners than the total
population and the majority live in family households;

4
• Lone person households comprise just over a quarter of all households for
persons aged over 65 and this household type has grown in relative terms over
the last two decades.

5
3. Current Policy Context
All levels of government recognise the importance of housing and associated care to
the wellbeing of older people. There is however no coordinated approach across all
levels of government and government policy has focussed on the provision of care
rather than about the suitability of housing and the development of a housing and
community care strategy.

Since the mid 1980s the Federal Government has recognised the desire of older
people to remain in the community (ageing in place) however the Federal
Government does not play a direct role in the provision of housing. Involvement at
this level in housing policy is through the provision of housing assistance and such
programs as the first home owners grant. This assistance is not solely for the aged
population but for all in the community who are eligible to apply. The Federal
government does play a role in housing for the older population specifically through
its funding of the accommodation component of aged care programs such as the
Assistance with Care and Housing for the Aged Program (ACHA)1 (Faulkner 2001;
Howe 2003). The City of Onkaparinga is one of the few organisations in South
Australia to have supported this project and received funding. It is an excellent
program providing support to low income older people and older people at risk of
homelessness.

The Federal government’s role – in collaboration with the States and local
government – has concentrated on the provision and funding of residential care (high
care, low care and residential respite care) and a diverse community care program
(which includes Home and Community Care (HACC) program services, Community
Aged Care Packages (CACPs), the Extended Aged Care at Home (EACH) program
and Veterans’ Home Care (VHC)) aimed at ‘enabling the frail aged and people with a
disability to live independently in their homes for as long as it is reasonably possible
by ensuring they have access to appropriate services’ (Commonwealth Department
of Health and Ageing 2003, 7). Given the focus of national policy to assist people to
stay in their homes for as long as possible, it essential that with an increasingly
ageing population the City of Onkaparinga continue to support care packages such
as HACC, CACPs and EACH and associated collaborative projects. As the
population ages there will be increasing demands upon the City for care and home
assistance.

The need to plan for an ageing population has been recognised from a policy
perspective in South Australia for some time. State policy documents on ageing –
Ageing A Ten Year Plan for South Australia (Office for the Ageing 1996) and Moving
Ahead (Department of Human Services SA 1999) aim to provide ‘a more customer-
focussed and integrated service delivery system with a strong focus on healthy
ageing’ (DHS 1999, 1). These documents have provided the direction for planning
and service delivery in this state. While these documents provided broad direction,
housing was not recognised as a specific issue until the release of Improving with
Age: Our Ageing Plan for South Australia (Government of South Australia 2006).
This plan outlines initiatives and funding to ‘encourage the provision of affordable,
appropriate and well located housing that works for South Australians as we grow
older.’ It recognises the importance of:

1
ACHA is a federally funded program introduced in1992/3 that assists financially
disadvantaged older people who find themselves homeless or in a vulnerable housing
situation. It provides funding to 46 agencies across the country to assist in linking low income
homeless and at risk clients to appropriate housing and support (Judd et al 2004).

6
 •
•
ageing in place;

•
the Home Assist program;

•
developing options for care at home;

•
the promotion of adaptable housing;
development of collaborative partnerships to develop affordable rental

•
housing and aged care accommodation;

•
promoting good urban design by working with local government;

•
the importance of community services; and,
the role of private developers.

Formal recognition by the State Government of the importance of housing and the
local environment is important in supporting local government plan for the ageing of
their populations.

3.1. Key Issues from this Section

• All levels of government recognise the importance of housing and associated

•
care for the wellbeing of older people.
Federal Government policy promotes and supports ageing in place. To facilitate
ageing in place, however, Federal Government policy has focussed on the
provision of care rather than the provision and suitability of housing and the

•
development of an overall housing and community care strategy.
While the need to plan for South Australia’s ageing population has been a policy
issue for well over a decade it is only this year that the State Government has
formally recognised the important of housing, the community and the provision of

•
care as a priority issue.
This formal recognition will hopefully assist the City of Onkaparinga in planning
for its growing ageing population.

7
4. Factors Driving Housing Needs and Preferences for an
Aged Population
This section examines the factors driving housing needs and preferences for the
population of older population, and the likely implications for the City of Onkaparinga.
The section begins with a general discussion of the broad scale processes and
characteristics that distinguish the baby boom generation before discussing their
implications for the demand for housing into the future.

As outlined previously, it is inevitable that over the next two decades there will be
growth both in the number of older persons in the City of Onkaparinga and the
percentage of population aged over 65. This change in the size of the aged
population will be matched by a shift in the housing needs and preferences of the
aged population.

In the past the housing careers2 of the population were thought to be fairly
uncomplicated; linear and forward or upward in nature and generally everyone
followed or desired the same housing pathway or career, however there is an
emerging body of evidence to suggest that housing careers in Australia have
changed over time. There is now greater diversity in the housing careers of
individuals and households (Figure 4.1). These changes reflect a range of factors
and processes occurring within society and these processes are shaping the context
within which individuals and households are make housing, and in the case of older
people, care and support choices. The housing careers of the older population are
likely to present the most significant area of change in 21st century housing careers
when compared to the 20th century. In large measure this will reflect the ageing of
the baby boom generation. Where previous generations had relatively modest
aspirations in retirement, baby boomers are expected to have higher aspirations with
respect to their quality of housing, use of services, travel and recreation (Salt 1994;
Beer, Faulkner and Gabriel 2006).

The baby boom generation participated in substantial social change. For example,
baby boomers were the first generation to experience the full impact of feminism and
the rise of female participation in the paid work force; increasing marital separations
associated with the introduction of ‘no fault’ divorce in 1975 (Legge 2005); and,
increasing acceptance of co-habitation before marriage (Hugo 1996). Baby boomers
were also the first generation to experience the growth of service industry
employment, with a consequent demand for higher level skills within the labour force,
more employment opportunities for women and changes in the nature and
organisation of paid work. While many baby boomers came from families with a
relatively large number of siblings, baby boomers themselves had relatively few
children with birth rates falling through the 1970s. Changed attitudes to child rearing
and improvements in contraception saw the number of children per household fall,
and this both facilitated the participation of women in paid work and added to the
resources available to meet their housing aspirations.

2
Housing careers can be defined as a sequence of housing circumstances an individual or
household occupies over their life (Beer, Faulkner and Gabriel 2006).

8
Figure 4.1: Changed Life Histories and Changing Housing Careers

$
Family formation Children leave home Retirement

Income

Expenditure

Outright Aged
Renting Home Purchase
Ownership Care
Age
20 30 40 50 60 70 80

Industrial Australia

$
Divorce Providing care Being cared for
Inheritance
Income

Expenditure

Home Outright Living in

Renting Renting Home Purchase
Purch. Ownership Aged Unit
Age
20 30 40 50 60 70 80

Post Industrial Australia

Source: Adapted from Williams 2003, 166

Key features of the baby boomers with respect to their housing include:

• Most Baby Boomers have achieved home ownership at some stage in their lives
and for most baby boomers home ownership has been associated with

•
conventional detached housing;
A rising incidence of divorce and separation has contributed to an increasing
number and percentage of households falling out of home ownership (AHURI
1998). This in turn has seen a rapid increase in the number and percentage of
households comprised of one person or sole parents. While this phenomenon is

•
not limited to the baby boom generation, it has been a feature of their housing;
The arrival of the first child post marriage was delayed amongst this generation
and this was linked to increased female participation in the labour force. The

9
 number and percentage of women who never had children increased for this

•
generation compared with earlier generations;
Increased female participation in the paid workforce has added to the capacity to
take out loans and repay debt. Up to the late 1960s financial institutions
commonly discounted the earning capacity of married women because it was
anticipated that they would leave work. Including the earnings of women in
mortgage repayment calculations has significantly increased the borrowing
capacity of households and this has contributed to an increasing tendency to

•
‘trade up’ dwellings;
Baby Boomers have been strongly associated with the ‘Sea Change’ and ‘Tree
Change’ phenomena (Burnley and Murphy 2004; Salt 1994). As Burnley and
Murphy (2004, 34) note, Sea Changers can be divided into two groups, those
who chose to move having acquired sufficient assets to leave for an attractive
locality, and those pushed out of the city because of the high cost of living there.
Baby boomers are likely to be represented in both categories as they are more
likely than subsequent generations to have accumulated sufficient assets to
choose to leave the capital cities, and they would represent a significant
percentage of ‘welfare’ immigrants seeking a better quality of life and lower
housing costs outside the major metropolitan areas. Welfare-related Sea
Change migration involves significant numbers of Australians (Marshall et al
2003). Importantly, the Sea Change phenomenon is a type of migration – and
housing move – unknown to previous generations of Australian households. It
reflects the relative prosperity of this generation and its on-going ability to secure

•
government assistance to maintain its lifestyle aspirations;
Over recent years some baby boomers have been confronted by the reality of
insufficient savings for their life post retirement. Whereas previous generations
were seen to have modest lifestyle aspirations after they leave paid work, the
baby boomer generation is considered to hold expectations more in keeping with
their life while in paid work. At an individual level, a number of commentators
have argued that baby boomers rushed into the property market in the late 1990s
in order to boost their total wealth in preparation for retirement. Others have
suggested that this generation will need to sell the family home in order to fund
their life once they complete work (McKinnon 2005). The growing incidence of
manufactured housing estates in coastal Australia suggests a rising acceptance
of this form of equity release amongst some sections of this generation (Mowbray

•
1994);
Finally it is worth noting that the housing careers of the baby boom generation
have been greatly affected by economic restructuring. While baby boomers had
a relatively easy entrée into the world of paid work, staying in paid work has been
a greater challenge. Labour market economists such as Bob Gregory and Sue
Richardson have discussed the ‘hollowing out’ of the income distribution and the
loss of employment opportunities for middle aged and older blue collar male
workers3. Many baby boomers will experience redundancy later in their working
lives and this will affect their housing. Some will be discouraged from further
investing in housing, others will use the security of outright ownership to maintain
their life style, while a third group may invest one or more redundancy packages
in their mortgage and achieve outright home ownership more quickly.

The broadscale changes discussed above will affect the housing preferences and
aspirations of baby boomer households in the City of Onkaparinga over the next
twenty years.

3
Note, for example, the age profile of workers who lost their jobs with the closure of the
MMAL plant at Lonsdale.

10
• Parts of the City of Onkaparinga are likely to emerge as ‘Seachange’ locations for
baby boomer households seeking an attractive coastal environment. Importantly,
while seachangers are likely to move into conventional housing in the first
instance, in the longer term they will look for retirement villages and nursing
homes in the region;

• Some sections of the baby boomer generation will be far wealthier than their
predecessors and able to afford higher quality housing in their retirement. Others
will have more limited financial resources, but may still have relatively high

•
expectations;
More female-headed households will be entering retirement. This group of
households may have different housing preferences from those previously seen
in the housing market. They could, for example, be more willing to embrace co-

•
living arrangements;
OIdsberg and Winter (2005) suggest that older people are increasingly willing to
draw down their housing equity – through the sale of the family home or via
reverse mortgages – to meet their lifestyle aspirations in old age. Given the
escalation in house prices in South Australia since the year 2000, this trend may
result in a larger number of older households able to purchase higher quality

•
retirement housing and support services;
Some baby boomer households will have limited financial resources and may
look to alternative housing arrangements – such as manufactured housing
estates – for their post-retirement accommodation.

4.1. Key Issues from this Section

• The leading edge of the baby boom generation will pass the age of 65 in 2011.
Many would have retired before then. The housing preferences of this group will

•
differ from earlier generations, as will their capacity to achieve them;
The City of Onkaparinga may emerge as a preferred retirement destination for
some baby boomers – offering both a ‘seachange’ and good access to major

•
medical facilities;
Potentially there will be greater resources for post retirement housing as
households draw down on their housing equity and as some couples draw upon

•
two sets of lifetime earnings to fund their retirement;
There will be a greater range of outcomes in the housing of older persons.

11
5. The Future of Residential Care
Within many OECD countries, including Australia, there is a policy objective to
reduce the need for residential care. This section considers the likely continuation of
residential care in Australia and the City of Onkaparinga as the population ages.

Residential care (hostels and nursing homes) along with community care programs
comprise aged care services provided by the three levels of government (Australian,
State, Territory, local). As the population ages the need for residential care will
continue at least in the near future and may even increase as greater proportions of
the population survive beyond age 80. This was recognised by the Federal
government in the 2004 Budget when the government announced a number of
changes to the residential care system including an increase in the target for the
provision of operational aged care places from 100 for every 1000 people aged 70
years and over to 108 operational places. Some of these places will be targeted to
care in the community (AIHW 2005, x).

Many OECD countries aim to lower the number of people living in institutions and
some have deliberate policies (Belgium, Netherlands) and programmes to replace
residential care with other forms of housing and care (OECD 2003). In Australia
however the demand for residential care will continue, and there are a number of
reasons for this.

• The ageing of the population will result in considerable growth in the oldest age
groups. While the population in South Australia aged 65 years and over will
increase by around 57 per cent by 2021 the population aged 85 years and over

•
will double between 2002 and 2021 and then nearly double again by 2041.
Although only a small proportion of the population aged 65 years and over is in
residential care at any point in time (6.2 per cent in 2001 in South Australia, Hugo
2003) this figure is misleading in terms of understanding the use of residential
care over the lifetime by individuals. An analysis of the lifetime probability of
entering residential care indicates that as people age their chances of entering
residential care increases considerably, particularly for females (Table 5 1).

Table 5.1: Likelihood of Using Residential Care Over a Lifetime and at

Older Ages (Per Cent)
Lifetime At age 65 At age 80 At age 95
Hostel care*
Males 13 17 27 41
Females 28 33 51 45
Persons 21 25 42 44
Nursing home care*
Males 21 27 40 61
Females 35 41 61 95
Persons 28 34 53 86
*Estimates include both permanent and respite care.
Howe and Sarjeant (1999, 365)

• Health status and disability especially as people age becomes a defining

parameter in whether people can remain living independently. Based on the ABS
surveys of disability in Australia current evidence suggests that for the population
aged 65 years and over there has been a slight increase over time in the

12
 proportion of people reporting profound or severe core activity limitations4 (ABS
2004; AIHW 2003). Disability levels increase considerably with age such that
43.9 per cent of males and 65 per cent of females aged 85 years and over have
profound or severe core activity limitations. These limitations can lead to entry
into residential care particularly if housing is unsuitable and appropriate support
services are unavailable or inadequate. How disability levels within the
population will vary over the coming decades is unknown but even if the
proportion with a disability remains the same the numbers of people with a

•
disability will increase.
Even if the health status of the population improves over time, some evidence
suggests this has little effect on the proportion of later life spent in residential care
or the percentage of cohorts who enter residential care (Howe and Sarjeant
1999). The reasoning for this is that health improvements occur for the younger
groups of older people therefore allowing them to age into the older age groups

•
where demand on residential care is the greatest.
As a consequence of health status and disability levels, the availability and
access of older people to assistance (formal or informal) influences their ability to
remain living independently in the community. While support services can be
purchased privately many older people are reliant on publicly funded services
and/or the help of family and friends. The degree to which this assistance can
meet demand will influence whether older people enter residential care. Publicly
funded aged care services are targeted to the most frail and functionally limited
people in the community and therefore represent only a small proportion of

•
assistance provided to, and needed by, older people.
The major ongoing issue for government provided aged care services is that
demand far outweighs supply. In 2003 over one third (35.7 per cent) of all
persons aged 65 years and over living in households who needed assistance
with at least one daily activity did not receive help (Productivity Commission
2006, 12.34). The willingness and capacity of family, friends and neighbours to
provide care is vitally important as a supplement to formal care to enable older
people to remain outside the residential care system. The availability of informal
carers however diminishes as old age advances. Informal carers are increasingly
in the workforce and are themselves ageing and hence may become less
capable of intensive caring responsibilities (Productivity Commission and
Melbourne Institute of Applied Economic and Social Research 1999, 322). As
the baby boomers move through the older age groups the availability of care and
assistance informally may also diminish as they will have fewer children than the
present generation of older people and these children are not necessarily likely to

•
be located nearby (Hugo 2003).
The desire by government for a low incidence of long term aged care in public
hospitals highlights the need for the residential care system. Hospitals are
geared towards shorter periods of care and are not an appropriate resource for
providing effective care for older people who can no longer live independently in
the community (Productivity Commission 2006). Hospitals therefore need
suitable places to transfer such patients and at present nursing homes seem the

•
most appropriate place.
At present there are few housing-with-care alternatives, other than residential
care, available in Australia

4
Core activities comprise communication, mobility and self care. A profound limitation means
the person is unable to do, or always needs help with a core activity task. A severe limitation
means the person sometimes needs help with a core activity task; or has difficulty
understanding or being understood by family and friends; or can communicate more easily
using sign language or other non-spoken forms of communication.

13
It therefore appears that for some time yet residential care is a necessity however the
ongoing need for residential care will be closely linked to the housing models
developed.

5.1. Key Issues from this Section

• As the population ages the need for residential care will continue at least in the
near future and may even increase as greater proportions of the population

•
survive beyond age 80.
The ongoing need for residential care in the longer term will depend on the
development of a range of housing with care models.

14
6. Potential Housing Models and Their Prospects
6.1. Introduction

This section of the report provides a review and assessment of different models of
housing available throughout the world to cater for an ageing population. Each model
is evaluated with reference to its potential suitability for South Australia and the City
of Onkaparinga; the ‘degree of fit’ with existing policy frameworks; potential barriers
to implementation; and possible relationships with private providers and government
policy/actions.

From a review of the literature our research has found there is a plethora of models.
These models can be categorised into three broad housing model frameworks:

•
•
Conventional housing in the community;

•
Unassisted living communities; and
Assisted living communities.

The three models are shown diagrammatically in Figure 6.1.

Figure 6.1. Models of Housing for Older People

Conventional Housing

New Homes Existing Homes

Lifetime/Adaptable Labelling of Programs to assist staying put or moving

homes suitability of homes

Homeshare Housing Option

Smart Housing Services

Community Home
Services Improvement
Agencies

Unassisted Communities

Retirement Villages CoHousing

Assisted Communities

Assisted Living Sheltered ExtraCare Continuing Care

(USA) Housing UK) Housing (UK) Communities
(USA)

Before considering the major models it is worth reflecting upon the differences
between the three. In large measure these differences reflect decisions about how
much support to provide, who meets the cost of housing and support services and
what role is played by community involvement. It is important to recognise that the
City of Onkaparinga would need to make these types of decisions as it goes forward
with its planning – and delivery – for new models of housing in later age.

15
6.2. Conventional Housing

Conventional housing is the most prominent model advocated within the published
literature and reflects the desire of people to remain in the community rather than
enter residential care. Under this model people remain in individual homes scattered
throughout the neighbourhood or community. Two types of initiative lie at the core of
ageing in place policies:

• first, there is the need to put in place services and supports that assist people

•
to remain in their home as they age;
second, there is a need to encourage adaptability or universal design within
the conventional housing stock in order to create homes that are suitable for
people as they age and develop conditions that result in functional limitations.

Local governments in particular – but not exclusively – have a role in both these
areas through the provision or co-ordination of support services, and control of the
building process. Planning policies that seek to integrate universal design principles
into new housing construction may reduce the costs of providing aged housing in the
long term. Alternatively, there may be a role for local government in providing
information – and even limited subsidies – for the installation of universal design
features.

In Austria, considerable attention is paid to the co-ordination of service provision

through Integrated Health Care and Social Services Districts. These districts operate
to ensure comprehensive and high quality care in medical, nursing and social
services and also work to expand preventative health care and health promotion
activities. The House of Representatives (2005) also noted that access to transport
is critical in ensuring the capacity to age in place, and local government has a role in
this area through the provision of community buses and similar services. The co-
ordination and range of services offered to older people is an important matter and all
of the these are issues that should be considered by local government in conjunction
with State and Federal Government.

Over recent years a number of financial instruments have been developed to provide
the finance needed to assist older people remain in their homes. These have
included Home Equity Conversion Plans (NY State Office for the Aging nd) as well as
reverse mortgages, which are more well known in Australia. Indeed Olsberg and
Winters (2005) suggest that older people are now more willing to accept reverse
mortgages as a strategy for financing their lifestyle aspirations.

Finally, it is worth noting that the majority of older persons in Australia live in
conventional housing and do so for most – if not all – of their senior years.
Retirement villages, by contrast, accommodate only four per cent of the supply of
accommodation for older people, although their market share is expected to grow.
Critically, however, policies that make conventional housing more suitable for older
people will have the greatest impact with respect to the number of people assisted.

6.2.1 New Homes

The suitability of housing as people age clearly affects one’s ability to age in place or
creates the necessity for a change in housing. While the size of the garden and
maintenance may first come to mind as features of a home that may make housing
less desirable for older persons, there are many other features within a home that
become a problem with age and a decline in function. Very small changes in an
older person’s abilities can create problems. For example, stairs may become a

16
challenge for an older person who has problems with mobility and lower body
strength, while a person who has trouble with flexibility, reaching, or grasping may
not be able to use conventional door knobs (Pynoos et al 2003; Faulkner et al 2004;
Luszcz et al 2006). The development of adaptability or universal design within
conventional housing and the labelling of such housing would have significant
benefits for the individual and the community as a whole.

6.2.1.1 Lifetime Homes (Universal Design)

In many European countries and the United States the concept of universal design
for products, public buildings and housing is gaining widespread acceptance (Hanson
2001; Christophersen 2002; OECD 2003). However as the Australian Network for
Universal Design (n.d.) states ‘Australia lags behind other western countries in
implementing strategic action to meet the increasing demand for safer and
universally accessible housing’. Japan’s ‘Gold Plan’, for example, aims to have half
its housing stock suitable for ageing in place by 2015 (House of Representatives
2005).

The concept of universal design was first used by Ron Mace, the founder of The
Center for Universal Design in Raleigh, North Carolina. In the 1980s he observed
that features designed for people with disabilities often benefited everyone (Perry
1999). Mace defines universal design as ‘The design of products and environments
to be usable by all people, to the greatest extent possible, without the need for
adaptation or specialized design.’ (The Center for Universal Design 1997).

Based on the principles of universal design the Lifetime Homes Concept is an

example of quality adaptable homes. The Lifetimes Homes concept was developed
by the Joseph Rowntree Foundation in the UK and was based on concerns about the
quality of British housing and how inaccessible and inconvenient many houses were
for a significant proportion of the population. Lifetime Homes are designed to look no
different but include features that enable adaptations to be easily and cost effectively
made to meet changing needs over a lifetime. Lifetime Homes have sixteen design
features that ensure a house will meet the requirements of most people over their
lifetime. The design features cover:

•
•
access to the home;

•
moving about easily inside;

•
reducing difficulties in moving between levels in a two or more storey home;

•
making toileting and bathing easier and safe;
and making light switches and windows accessible and easy to operate.

The adoption of universal design in housing is believed to offer significant benefits to

individuals and the government. The Australian Network for Universal Housing
Design (ANUHD) (Ward and Daly Smith 2005) anticipates significant cost benefits to
governments and individuals through:

•
•
fewer injuries to older people;
less demand on institutional care arrangements for older people and people

•
with a disability, because they can stay in their own home longer;
more appropriate and efficient use of acute care hospitals and rehabilitation

•
facilities;

•
safer work environments for both paid and unpaid care-givers; and
less demand for home modifications, assistive equipment and paid assistance
for daily living tasks.

17
Research by the Joseph Rowntree Foundation estimated that the use of universal
design features (Lifetime Homes) in all new homes in the UK would result in a saving
to taxpayers of ₤5.5 billion over sixty years. These savings would arise from the
reduction in expenditure on building modifications and adaptations and cost savings
from reduced relocation to residential care. They anticipated there would be further
savings in health care and re-housing costs (Joseph Rowntree Foundation a and b).
While recognising the potential benefits, the building industry in Australia has no
obligation through building regulations to provide adaptable housing. Similarly, there
are no financial incentives for builders to construct adaptable housing. Experience
elsewhere has demonstrated that builders are mostly unwilling to voluntarily raise
standards of design (Imrie 2002). This is due to a number of reasons, including a:

• lack of knowledge of the needs of people with a disability and their design

•
needs;

•
belief that the quality of homes would decline;
belief it will add to costs within a competitive market and thereby make the

•
builder’s product uneconomic;
reluctance to innovate as innovation is often unwelcomed and difficult to
implement (Imrie 2002; Minnery et al 2003).

There are, however, a number of groups within Australia that are working in
association with state governments to promote housing which conforms to adaptable
or universal housing principles including the Australian Network for Universal
Housing Design, the Master Builders Association, the Housing Industry Association,
the Royal Australian Institute of Architects, the Real Estate Institute and Local
Government Associations. For example the Master Builders Association (Master
Builders Association 2003) has an award category for Lifestyle Housing for Seniors
as part of its National Building and Construction awards.

The need to promote universal design features has been recognised by the State
Government in the Ageing Plan for South Australia (Government of South Australia
2006). Through this plan the State Government endeavours to:

• Collaborate with the housing industry to promote South Australian Housing

Trust (SAHT) design Guidelines for Sustainable Housing and Liveable
Neighbourhoods to ensure that new SAHT housing has improved

•
accessibility, affordability and sustainability features;
Provide improved consumer information about design features of housing for

•
older people;
Work at the national level to incorporate adaptable housing design elements
into the Building Code of Australia.

Local government can play a role by supporting the State government initiatives, be
proactive in providing information to consumers and encouraging builders and
developers to consider adaptable housing features.

6.2.1.2 Labelling of the Suitability of Homes for Older People. – Senior Citizens
Label, Netherlands

In some jurisdictions new homes are labelled for their suitability for older persons.
Such labelling reflects the inclusion of design and construction features that assists
ageing in place. Similar schemes have not been applied in Australia but are
comparable with the star rating system used in the Australian Capital Territory where

18
every new home, and every home that is sold, has to be assessed for its energy
efficiency and that information is made available to purchasers.

When choosing to move to new accommodation identifying housing that is

appropriate to peoples’ needs, in particular housing that includes adaptable or
universal design features is very difficult. In the Netherlands to overcome this
problem a Senior Citizen Label was developed and adopted in 1991 to identify
housing that was suitable for older people. The label is defined as a ‘consumer
quality certificate for housing for older people’ (OECD 2003, 153). In order to be
eligible for the label building projects need to satisfy 31 basic requirements. These 31
requirements are based on four principles:

• Flexibility of the dwelling – people in the dwelling should not have to move

•
because of a disability;
Cost neutrality – the total cost of the requirements should not be higher than

•
normal;
Importance of environment – not only are features of the house taken into
account but also the environment in terms of accessibility to shops, services

•
and transport; and
Space for local accent – in all there are 71 requirements that can be included
in any building but only 31 are mandatory so local requirements can be taken
into account.

A new or renovated building can only be credited with the label when it is completed
(OECD 2003).

6.2.1.3 Smart Homes

There is no single accepted definition of a smart house but essentially it is a home

with electronic and computer controlled technology where those technologies
‘facilitate automatic or user-initiated communication, involving a range of appliances,
sensors, actuators and switches’ (Fisk 2001, 101). The core functions to be included
in a smart home for older people and others such as people with a disability include
window, blind or curtain control; property security; door surveillance; automatic
lighting; temperature monitoring; cooker safety; and emergency help. There are a
number of smart home initiatives within the UK and other parts of the European
Union. Within the UK the Joseph Rowntree Foundation has developed smart home
demonstration sites in York and Edinburgh specifically to cater for the needs of older
people. Besides the core functions mentioned above, these homes incorporate the
additional functions of memory joggers and a diary facility; lifestyle monitoring;
medical monitoring; and dementia care (Edinburgh) (Fisk 2001).

Smart home technology has the potential to provide numerous benefits to older
people and improve their quality of life. As it requires special wiring and expensive
computer and communications hardware it is however expensive and therefore
outside the reach of people on low incomes. A study conducted by King’s College
London and the University of Reading (2004) however suggests that costs may
become more reasonable with the progress in wireless networks and mobile phones,
‘these new consumer technologies may ultimately replace existing wired home
technology and prove to be cheaper and more flexible to install, and cheaper to
maintain. Also, as it is a standard consumer technology, it is likely to find increasingly
easier acceptance and use by a new generation of older people and their families’
(King’s College London and the University of Reading 2004, 5) and be applicable to
existing homes as well as newly built.

19
6.2.1.4 Evaluation of Lifetime Homes and Smart Homes

o Potential suitability for South Australia and the City of Onkaparinga

The principles of Lifetime Homes and universal design would appear to have
considerable potential within the City of Onkaparinga and South Australia more
broadly. The City has some control over the planning and building approval
processes and efforts could be made to encourage builders to include universal
design features – possibly through the provision of incentives such as planning
bonuses. The City of Onkaparinga could also encourage developers to include smart
home technology in both standard housing construction and retirement village
development.

The State Government has already accepted elements of universal design, but
implementation has been limited to the Housing Trust and in lobbying for changes to
the Building Code of Australia. It could be argued that the State Government could,
and should, do more to extend the principle of Lifetime Homes to the private sector.
This could be enacted through:

•
•
a greater push through the Building Code of Australia for universal design;

•
the funding of universal design demonstration projects;
the setting of targets for the percentage of new buildings constructed as

•
Lifetime Homes (possibly as part of the South Australian Strategic Plan);
a requirement that at least the 5 per cent ‘high needs’ housing to be
constructed on all new developments (Government of South Australia
2005) be constructed to universal design principles. There is a potential
to extend it to the full 15 per cent affordable housing in new estates
specified in the State Housing Plan.

o The ‘degree of fit’ with existing policy frameworks

There is a high degree of fit with existing policy frameworks as State and local
government between them effectively control building regulation, planning policy and
development approval. Clearly, the South Australian Government would be reluctant
to implement changes in building regulation without the other states, but more could
be done to implement change.

o Potential barriers to implementation

The building industry would oppose proposals that require them to change their
current business practices and which may add to the costs of construction. However,
universal design does not necessarily add greatly to building costs and in the longer
term there are significant individual and community savings. Policies to implement
the labelling of housing appear to be a greater challenge as there could be
considerable costs and limited capacity within the industry to adequately assess the
lifetime suitability of housing. These barriers may rule out implementation.

o Possible relationships with private providers and government

policy/actions

There is a role for the City of Onkaparinga to lobby the State Government for change
in building regulations. There may also be scope for working in partnership with

20
developers and home builders to encourage them to include Lifetime Homes in their
developments.

6.2.2. Existing Homes

As the majority of older people in conventional housing are going to be living in

housing that has already been built there is a range of service models available to
assist people with ‘staying put’ or making choices about whether to move or not.
These services can range from the provision of community care in the person’s
home, to advice and assistance with modifications, to more specialised programs
that help older people decide whether it is preferable to stay or move.

Federal, State and local governments in Australia provide telephone services,

websites, fact sheets, information booklets and offices to assist the older population
with advice and information on a range of topics to do with housing, including home
modifications, moving to a retirement village, accessing community services, housing
support and housing options. Despite the availability of a wealth of information it is
not always easy for people to make decisions. The decisions that older people are
expected to, or need to, make as they get older, are some of the most important
decisions of their lives. Making the ‘right’ decision is very difficult and the process is
often very stressful. Often older people are reluctant to make critical decisions about
their living arrangements or to seek help even when people know what needs to be
done and what is available to them in areas where they live or want to live (Peace
and Holland 2001; Luszcz et al 2006). Therefore services such as those described
below can assist in make such decisions and the actions that need to follow.

6.2.2.1 Home Modification Services

Internationally, a number of agencies provide assistance with home improvement

and maintenance for older people. These programs recognise that older people are
often confronted by low incomes, housing that is often aged and may not have been
maintained at an appropriate standard in the past and a limited capacity to undertake
home maintenance for themselves.

In Australia there is no coordinated approach to home modification services or

significant public funding to undertake needed alterations. Although money is
available through the Home and Community Care (HACC) program the distribution of
funds among the various HACC funded services depends on the priorities of each
state and territory. New South Wales seems to be the most advanced in organised
home modification and maintenance services with the Department of Ageing,
Disability and Home Care funding (through HACC) approximately 90 home
maintenance and modification service outlets throughout the State.5 In 2004-2005
NSW spent $4291 dollars per 1000 people aged 70 years and over plus Indigenous
people aged 50-69 years, on home modification services while in South Australia
only $584 was spent (Productivity Commission 2006, Table 12A.20). In the UK
however Home Improvement Agencies (HIAs) operate in most local authorities (over
90 per cent coverage) and have done so for more than twenty years.

5
A detailed study of The impact of home maintenance and modification services on ‘ageing in place’
currently being undertaken for AHURI should provide an overview of the range of home modification
services in Australia (www.ahuri.edu.au/publications/projects/p20335).

21
6.2.2.1.1 Home Improvement Agencies – United Kingdom

Home Improvement Agencies are small, not for profit, organisations which provide
advice, support and assistance to older people, people with a disability and other
vulnerable people to enable them to stay in their homes. For this reason HIAs are
often referred to as ‘Staying Put’ schemes or ‘Care and Repair’ Schemes. HIAs are
managed by Housing Associations, Local Authorities, Charities and Independent
Management Committees. Although funding is provided by a number of sources
including local authority grants, charities, loans and equity release most receive
some financial support from the government through the Department for
Communities and Local Government (DCLG). Funding from the DCLG is currently in
the order of ₤8.5 million each year. HIAs deal with a large number of enquiries each
year, around 98,000, resulting in 38,000 jobs with a total value of over ₤85 million
(Foundations, n.d).

HIAs have been credited with combating much of the stress older people face in
organising the necessary repairs or modifications needed to make their housing more
suitable. HIAs help people identify the improvements and adaptations required, help
with organising the financial aspects such as applying for local authority grants or
loans, identifying reputable local contractors to undertake the work, overseeing the
building work through all stages as well as liaising with other professionals involved
in the delivery of the service. HIAs can help people with a range of needs from small
repairs and fitting locks to doors and windows to major renovations of bathrooms for
example costing thousands of pounds. Some of the agencies have broadened the
range of services they provide. In addition to their ‘core’ services they may also
provide such services as energy efficiency improvements, improvements to home
security, training to home owners in home maintenance and accident prevention and
home safety (Foundations n.d.).

6.2.2.1.2 Home Improvement Agencies – US

In the US, for example, Housing and Urban Development (HUD) has 23 programs
targeted to meeting the needs of the elderly (Wood 2005). These include the:

• Section 202 program which subsidises the development and operating costs
of multifamily properties for the elderly;

Box 6.1. Section 202 Supportive Housing for the Elderly – HUD
Since 2002 the Section 202 program has provided capital advances (grants) to non-profit organisations
and non-profit consumer organisations to fund the construction and rehabilitation of multifamily rental
housing for very low income elderly people. The capital advances need not be repaid as long as the
property remains available for at least 40 years to elderly households with very low incomes. Capital
advances are subject to per-unit development cost limits, which can be adjusted to reflect higher costs
in some areas. Property based sponsors also receive project based rental assistance under the Section
202 program to defray some of the operating expenses. The combination of a debt-free project and
rental assistance payments enables sponsors to offer units at rents that are generally equal to 30 per
cent of the tenant’s income.

These properties are intended exclusively for the elderly or the disabled.

When applying for a capital advance, sponsors must demonstrate how they will address tenants’ needs
for supportive services, either by providing them on-site or providing them with access to off-site
services.

• Assisted Living Conversion Program which provides grants to not-for-profit

organisations to convert dwellings for assisted living for the frail elderly;

22
 • Section 232 Mortgage Insurance program which provides mortgage insurance

•
for the construction or rehabilitation of nursing homes;
Section 515 program which provides finance for not-for-profit organisations to
build multi-family housing for elderly people in rural areas.

It is worth noting that in the US State Governments may also provide subsidies for
home modification to assist people to age in place (Enright 2006) and that the
community housing sector is seen as an important mechanism for the provision of
affordable housing for low income seniors (Chicago Mutual Housing Network 2004).

6.2.2.2 Housing Option Services

Housing option services is a generic term used to describe a range of services that
help older people make informed choices about their housing. These services range
from simply providing information via a telephone helpline or a website through to
home visits where a worker discusses the housing options available to an older
person. The services may even extend to providing practical help with moving home.
These services can be provided at a national, regional or local level and in the UK for
example, are generally provided free of charge to service users.

There is a range of service models that aim to assist people in ‘staying put’ or in
making a decision to move or stay. These services range from the provision of
community care in the person’s home, through to advice and assistance with
modifications, as well as more specialised programs that help older people decide
whether it is preferable to stay or move.

Box 6.2. Aims of Care and Repair’s Should

I Stay or Should I Go program
Governments in the UK recognised that 1. To enable older people to take control of their
staying put was not always the most housing situation and make their own decisions
feasible option yet there were few about the future, prior to a crisis when the matter
services to assist people in making may be taken out of their hands;
2. To provide someone impartial to talk about
choices about their housing options. housing decisions in old age. Research in the UK
Housing option services were found for many older people having someone who
established to fill this gap. While initially was impartial to talk through the pros and cons of
such services were provided at a possible housing alternatives and help sort out the
practicalities was of even greater importance than
national or regional level through a obtaining factual information;
telephone helpline or via a website, the 3. To establish a range of ‘housing service /
Care and Repair, (one of England’s first options’ projects operating in a variety of
HIAs) initiative Should I Stay or Should I settings including rural areas;
Go? Program has encouraged the 4. To stimulate service development and provide
lessons for good practice;
development of local housing options 5.To fully develop training materials to improve
services. The objective of this program knowledge and awareness of housing options for
is to provide practical help, advice, older people among professionals in the housing,
information and support to older people health and social care sectors. Care and Repair
(England, n.d. pt 1.4, p2)
who are finding their current
accommodation problematic (e.g., difficult to manage, unsuitable, or in a poor state)
or who are facing the possibility of moving. This is achieved through the provision of
local specialist housing-options services. Specialists in key areas help individuals
reach a decision about their possible future housing situation. Once a decision has
been made, their role is to provide any necessary practical help to enable the
decision to be implemented. If the older person decides that moving is their best
option the local service can help with finding suitable alternative accommodation, be
this through arranging visits to special needs accommodation or help with the
practicalities of buying and selling a home. If remaining in their existing home is the

23
best option, help with current problems will be given. Care and Repair (England, n.d.
pt 1.4, p2). Evaluation of the program (Care and Repair England 2005) concluded:

The help provided for some service users was literally life transforming. The
extensive support with all aspects of moving home that housing option
services offer was highly valued, as was the provision of unbiased information
about housing options.

The program was funded solely from private investment and charitable funds.

6.2.2.3 Homeshare

Homeshare is a program that has been established internationally where people

share their home with another person in exchange for support. This support may
include help around the home or financial support or a combination of both. Though
it applies to all age groups in the community, it is most appropriate for older people
who may be faced with the prospect of losing their independence or who are
struggling with housing costs and other expenses. Home sharing is an affordable
and viable alternative. It allows older people to remain in their homes and
neighbourhood as they receive assistance with household tasks such as shopping,
cooking, cleaning and gardening. There are similar programs elsewhere around the
globe, with the New York State Office for Aging encouraging shared housing as a
mechanism to reduce living costs in older age (NY State Office of Aging n.d.).

The Homeshare program originated in the USA in 1953 and now operates in the UK,
Canada, Spain, the Czeck Republic, Germany, Austria and Australia. In Australia it
first began in the mid 1990s and there are now programs in Victoria, New South
Wales and Queensland. Homeshare programs are run by not-for-profit agencies and
although there are several models of Homeshare, the underlying philosophy is the
same and the roles and duties of the auspicing organisation are similar. These roles
as outlined by the NSW Homeshare Program include:

• the careful selection and matching of all homesharers and householders –

this includes face to face interviews, reference checks, probity checks etc;
• negotiation by the auspicing Homeshare organisation of a detailed agreement
between the householder and homesharer listing tasks and responsibilities of
both parties;
• a one month trial period;
• ongoing support and contact by the auspicing Homeshare organisation with
both parties, including ongoing sessions with homesharers to discuss issues,
and some joint meetings with both parties;
• ongoing monitoring of the match.

A number of benefits have been associated with the homesharing program for the
householder, homesharer and the community. These benefits (Homeshare
International; Benevolent Society 2001; Montague 2001; Carstein 2003) include:

• allowing ‘at-risk’ people to remain in their homes and remain involved in their
communities – these people might otherwise have needed to find alternative

•
forms of accommodation including residential care;

•
provides alternative housing for younger people;
the families of both the householder and homesharer report a considerable
decrease in anxiety because they know that their family member has support;

24
 • reducing or delaying the reliance of older people on community support

•
services;
the program can lead to a reduction in isolation of older people and alleviate
their feelings around security and vulnerability about living in a home on their

•
own;
it is claimed the program ‘builds self-esteem by reminding older people how
much they have to give. And, given that most homesharers are young people,
it develops respect, empathy, and understanding between the generations’
(Homeshare International).

Although the homesharing program caters for a small group within the community it
is a housing option for older people that is most effectively run locally. Local
government can provide support in terms of the promotion, and development of the
homesharing program and can assist in establishing avenues of funding. One of the
problems with this program in Australia has been the lack of ongoing recurrent
funding (Proceedings of the First National Homeshare Workshop 2004).

6.2.2.4.Community Services

The provision of services within the community is the ‘central element’ of the
Australian Government’s aged care policy (Department of Health and Ageing) and is
essential to older people being able to age successfully in housing in the community
rather than enter residential care. This policy direction mirrors that occurring in many
other countries experiencing an ageing population. The community care program
(which includes Home and Community Care (HACC) program services; Community
Aged Care Packages (CACPs); the Extended Aged Care at Home (EACH) program
and Veterans’ Home Care (VHC)) is complex and diverse involving Federal, State
and local governments, providing a wide range of services to people in their homes.
These services include nursing care; allied health care; meals and other food
services; domestic assistance; personal care; respite care; counselling, support,
information and advocacy; home modification and maintenance and transport.

The Community Care program faces a number of issues which may impinge on
people’s ability to maintain independent living (and place increasing pressure on the
residential care system) despite the range of housing options that may become

• The demand for services already far outweighs supply and the ageing of the
available. The major issues confronting the Community Care program are:

population is expected to result in increasing demands for community care

• Recent research indicates the cost of community based care is considerably

support;

more expensive than residential care. Without a concerted effort by

government to prioritise funding this situation can only worsen as the baby

• Many organisations find it difficult to recruit and retain staff (Angley and
boomers age (L.E.K. Consulting 2006);

• The situation is likely to be compounded by the fact that the availability of

Newman 2002);

informal care may diminish over time. The family and its willingness and
capacity to provide care is vitally important as a supplement to formal care
however:
o the availability of informal carers declines as old age advances;
o the informal carers are also increasingly in the work force and are
themselves ageing and hence may become less capable of intensive
caring responsibilities (Percival and Kelly 2004; Productivity

25
 Commisssion and Melbourne Institute of Applied Economic and Social
Research 1999);
o the baby boomers have fewer children to take on caring
responsibilities and these children are likely to live at greater distances
from their parents than has been the case for previous generations
(Hugo 2003).
o NATSEM’s (Percival and Kelly 2004) projections of the ratio of carers
to people with a severe or profound disability over the period 2001-
2031 shows that in 2001 there were 57 primary carers for every 100
persons in private dwellings aged 65 years and over needing care. In
2031 it is projected this will have fallen to 35 carers for every 100
persons.

In the US the provision of services is not so well coordinated. Generally, programs

run by the US Government’s Housing and Urban Development agency (HUD) do not
require organisations in receipt of grants for capital works to ensure the provision of
services to elderly residents (Wood 2005). However four programs do provide
services (Wood 2005):

• The Congregate Services Program provides grants for the delivery of meals

•
and non-medical services;
The Neighbourhood Networks Center encourages property owners,
managers and residents of HUD-insured and assisted housing to develop

•
computer centres;

•
The ROSS grant scheme links public housing residents with services;
The Services Co-ordinator Program provides funds for managers of
multifamily housing for the disabled and the aged to hire co-ordinators to
assist residents in obtaining services.

In Canada CHOICE – the Comprehensive Option for Integrated Care for the Elderly –
assists elders to live in dignity and with autonomy. Older people receive a flexible
range of health and social supports and these services can change as needs
change. Models of inclusive care provide a day centre to which care recipients are
transported, where meals, personal support and supervision of medication programs
is provided (Ontario Coalition of Senior Citizens Organisations 2004). Evidence from
Canada suggests that older persons who make use of supportive care in their homes
make less use of more expensive health services and CHOICE is seen to be a
significant alternative to institutional care.

6.2.2.5 Evaluation of Strategies Relating to Existing Homes

o Potential suitability for South Australia and the City of Onkaparinga

There are a number of options available to the City of Onkaparinga and the South
Australian Government with respect to supporting people to stay within their existing
homes. The international evidence suggests that key issues include:

•
•
Access to support services;

•
Modification of the home;

•
Adoption and implementation of assistive technologies;
The potential to share housing, and thereby gain access to both care and

•
reduced costs; and
The provision of information about housing options.

26
There is a role for the City of Onkaparinga in many of these policy areas. The City
provides some services to older people and can look to better co-ordinate the
services it provides, as well as work to achieve the better integration of State and
Australian Government services. It could consider both advice on ways to modify the
home as a person ages, and may consider limited subsidies, though such a
responsibility may better sit with the State and Australian Governments. It can use
its planning powers to promote the adoption and use of assistive technologies.

There appears to be a clear role for the City of Onkaparinga in investigating, and
promoting with the Office of the Ageing, the Homeshare program. This program
would offer considerable potential benefits to the community, ageing individuals and
governments. The City of Onkaparinga could play a strong advocacy and facilitation
role in developing a pilot of this program in South Australia. It could play a similar
role with respect to a housing options information service.

o The ‘degree of fit’ with existing policy frameworks

All of the options and approaches discussed above are compatible with existing
policy frameworks. Some initiatives would better sit with the State of Federal
Government as they have responsibility for those areas of policy. However there is
considerable potential for the City of Onkaparinga to take an advocacy role in those
areas.

o Potential barriers to implementation

Most of these programs are relatively inexpensive, certainly when compared to the
cost of nursing home care. There may be difficulties in encouraging the State
Government to invest in new services – such as Homeshare – and the co-ordination
of services across State, Federal and local governments remains a challenge in any
policy domain.

o Possible relationships with private providers and government

policy/actions.

There is a range of non-government organisations that could operate as key partners

in this area and clearly any initiatives would also need to involve the other two tiers of
government.

6.3 Unassisted Communities

Unassisted communities include retirement village style living (retirement villages,

lifestyle villages) and CoHousing. The retirement village model is well known in
South Australia and elsewhere and is likely to continue to expand as developers
identify and exploit market opportunities.

The role of the City of Onkaparinga in this instance would be to set appropriate
planning and service guidelines, as well as providing appropriate infrastructure and
services.

6.3.1 Retirement Villages

Retirement villages are the most recognised form of alternative housing for older
people in Australia, however by international standards it is a housing option chosen
by a very limited number of older people. Retirement villages while remaining a

27
small segment of the housing sector have grown significantly over the last two
decades. Current estimates suggest around 3 per cent of older South Australians live
in self care retirement villages (McInerney 2006, 8) compared to around 7 per cent of
US citizens (Schafer 2000, 10).

There is no clear definition of what constitutes a retirement village and the legal
definitions vary between the States and Territories (Stimson et al 1997; Eardley and
Birch 1998). In fact it has been suggested that the term ‘retirement village’ may be
‘too generic for the myriad of forms of accommodation that have evolved, and
continue to evolve under this mantra’ (Cheek et al 2003). Retirement villages are
however, characterised by a number of features. They are segregated housing
complexes specifically for aged people which includes a range of accommodation
from independent living units to hostels to nursing homes.

In the next 10-15 years in Australia there is likely to be considerable growth in the
retirement village sector. This will be due both to the ageing of the population and
the increasing prominence of the active marketing of retirement villages to the older
population as an excellent housing and lifestyle option.

Box 6.3. Retirement Villages in South Australia

In fact, it is expected the retirement
Retirement villages are regulated under the
village industry will ‘boom over the next Retirement Villages Act 1987 (“the Act”) and the
20 years with investment opportunities Retirement Villages Regulations 2006 (“the
in the construction of new villages Regulations”).
estimated at between $8-$19 billion’
(University of Queensland 2002). Retirement villages are complexes of residential
Retirement village living only really units or a number of separate complexes of
residential units on common land. These units are
becomes an attractive option as people intended for residential use under a retirement
reach their mid 70s. Demand over the village scheme. There are over 325 villages in
next decade or so will stem from people South Australia housing an estimated 15,000
who are currently retired or close to residents. The Act defines a Retirement Village
Scheme as one that is established
retiring and who will move into the older
(predominantly), for retired persons and their
age groups over this time. It is spouses under which:
assumed their needs and aspirations 1) residential units are occupied under a lease or
are similar to those retirees who have licence; or
already taken up retirement village living 2) the right to occupation is conferred by
ownership of shares; or
(Stimson 2002). There is little research 3) residential units are purchased from the
about how the baby boom generation administering authority, subject to a right or option
will view retirement village living but with of repurchase; or
the shift away from church and 4) residential units are purchased by prospective
residents on conditions restricting their
charitable organisations as the major
subsequent disposal.
providers to ‘ownership by profit- It does not include a scheme where residents do
motivated private companies’ (Stimson not pay a premium for admission as a resident
and McGovern 2002b, 6) the retirement (Dept For Families and Communities,
village sector has been remarkably Government of SA)
responsive to current demands and has
developed a diversity of products and this should continue as they respond to the
needs and aspirations of the baby boomers.

Projections for South Australia for the period 2001 to 2021 indicate that if there is no
increase in the take up rate over the projection period there will be a need for an
additional 2157 independent living units, an increase of 43.4 per cent. If retirement
village living becomes more attractive to South Australians over this period such that
there is a 3 per cent per annum growth in the take up rate then an additional 6435

28
units will be needed, an increase of 129 per cent (Stimson and McGovern 2002a,
185).

At present the retirement village industry is generally geared towards the higher
socioeconomic groups and retirement villages are offering a wide range of facilities
including a community centre, library, restaurant, internet café, workshop, bowling
green, croquet green, swimming pool, spa, sauna, putting green and so on. These
are leisure facilities and it will be important for the retirement industry to ensure these
are the facilities and services that older people want. Increasingly numbers of older
people seek a range of housing options and the challenge for the retirement industry
– and governments – is to provide a mix which will ensure affordability of access, so
as to make retirement living desirable and a feasible choice for the full
socioeconomic spectrum of retirees (Stimson 2002, 201). Mixed-tenure
developments may be one way of extending the accessibility of retirement villages to
older people with a wide range of levels and types of income.

One of the issues facing the retirement village industry and local council planning is
the availability of broad acre land for the current low rise villages particularly with
good access to public transport, shopping centres and health facilities (Stimson
2002). It may be necessary for developers and local councils like the City of
Onkaparinga to consider medium density designs and high rise developments on
redeveloped land (Stimson 2002).

With the movement of private enterprise into the retirement village industry not all
developments that resemble a retirement village fall within the Retirement Village Act
and therefore are not regulated by government.

6.3.1.1 Lifestyle Villages

Lifestyle villages are a type of retirement village developed by National Lifestyle

Villages (NLV) that it is claimed offer ‘the relaxed, simple ambience of a caravan
park, the security of a retirement village and the luxury and energy of a ritzy resort’
(National Lifestyle Villages). These villages are marketed to people who ‘are too fit,
too young or too healthy for a retirement village and no longer want a typical home in
the suburbs’. (National Lifestyle Villages). The villages are designed to provide
people with the lifestyle they desire at a cost that is affordable. To achieve this the
expense of land ownership is removed from home ownership. The NLV retain
ownership of the land while the resident has ownership of the home and they have
security of tenure via a lifetime lease (the term of which is dependant upon the NLV
Village you move to). Prices range from $180,000 to $320,000 including GST. These
villages have become established in Western Australia but concerns have been
raised in the Western Australian parliament regarding the meaning of a lifetime lease
and the conditions under which a homeowner may sell their home (Western
Australian Parliament 2005a and b).

6.3.2 CoHousing

One of the successful models in Europe, in the Netherlands, Denmark and Germany
in particular, (mentioned by Olsberg and Winters 2005) is intentional community
housing or CoHousing. CoHousing schemes vary in size but are characterised by
shared communal areas, private self-sufficient accommodation for individual
residents, resident structured routines, resident management and resident
participation in the development process. The developments can be
intergenerational or for older people only, but their aim is to offer a contemporary
model providing independence with the advantage of creating neighbourhoods with a

29
sense of place and the security and sense of belonging (Brenton 2001; Croucher et
al 2006).

Intentional communities are comprised of groups of individuals who choose to live

and age in the same area. As the Ontario Coalition for Senior Citizens Organisations
(2003) notes

This can happen when friends move to a particular region in a warmer

climate. It can also happen amongst gay men, who have greater financial
resources, and agree to live near one another in order to provide support,
directly and indirectly.

The Ontario Coalition (2003) comments that these groups benefit from formal
recognition of their role and this assists in their continuation. Lawler (2001) notes
that these groups offen receive multiple benefits as their skills and experience may
help in negotiating access to goods and services.

In a review of the appeal of this housing model to the UK, Brenton (2001, 179)
suggests that the CoHousing model may be attractive to baby boomers, particularly
women. They have different life experiences from those of their parents – higher
standards of living, more freedom of movement, more exposure to different cultures,
greater labour market participation, are more likely than their parents to find
themselves living alone at the end of their lives and they know this. They also have
the personal resources and collaborative skills necessary for community building,
which is the most important aspect of CoHousing.’

Box 6.4 An Example of CoHousing

The Glacier Circle Senior Community is an example of Co-Housing. It was established in Davis
California in March 2002 in a private home and has 12 members ranging in age from 70 to 84. The
group bought a .83 ha site within a larger planned neighbourhood and the community holds weekly 2
hour meetings. The members have known each other for a considerable period of time (up to 40 or 50
years).

6.3.3 Evaluation of Retirement Villages, Lifestyle Villages and CoHousing

o Potential suitability for South Australia and the City of Onkaparinga

Retirement villages represent a ‘mainstream’ option for the provision of housing for
older people. The significant shift to greater private sector involvement in housing for
older persons (McNelis and Herbert 2005) may present challenges to the City of
Onkaparinga and its community, because while the City may be a preferred
destination for retirement village investment, many of its current residents will not be
able to afford entry into such estates. There are issues also around the status of
some estates that fall outside the definition – and regulation – of the Act. This may
be an issue that the City of Onkaparinga wishes to examine when reviewing its
planning regulations and in considering development proposals. It would also be
worth examining whether retirement villages are subject to the State Government’s
requirement that 15 per cent of all new developments constitute affordable housing.
This could be a mechanism for ensuring a better supply of affordable housing for
older persons. Alternatively, there may be scope to use planning mechanisms – eg
planning bonuses – to ensure the supply of affordable retirement village
accommodation. Finally, it is worth noting that the non-profit sector remains active
and that strategies may be pursued to attract them into the City.

30
Lifestyle Villages represent a more affordable alternative, but they too raise issues of
regulation and the rights of older persons. In some ways their structure is very
similar to that of caravan parks/manufactured housing estates and while they offer
adequate and appropriate housing for some, they raise significant issues with respect
to security of tenure and costs (Bunce 2006).

CoHousing represents a much more innovative approach to the housing of older

persons and there is a role for the City of Onkaparinga in this area. The City could
become involved in promoting the formation of such groups of individuals and
provide some – limited – facilitation role in establishing these groups. There may be
scope to secure Australian Government or State funds for a pilot project. There may
also be a role for the City in using co-operative housing models – through Housing
Services SA – to meet the accommodation needs of older, low income persons.

o The ‘degree of fit’ with existing policy frameworks

These initiatives fall within the mainstream of policy frameworks at the State and
local government levels.

o Potential barriers to implementation

There would appear to be few potential barriers to implementation of CoHousing

models or reform of the way in which the City of Onkaparinga deals with retirement
villages.

o Possible relationships with private providers and government

policy/actions

There is a range of not-for-profit organisations, private companies and community

groups active in this sector. Any and all could serve as a partner in the development
of unassisted communities. Housing Services SA may also be an important partner
with respect to community housing models.

6.4. Assisted Communities

Assisted communities is a term that is applied to housing that includes some level of
support. There is a range of individual models and names to cover this type of
housing. Abbeyfield is a familiar form but it is also known as sheltered housing, extra
care housing, assisted living housing and continuing care retirement housing. There
have been intentions for this type of housing in parts of Europe to eventually replace
residential care.

6.4.1. Sheltered Housing and Extra Sheltered Housing

Sheltered and extra care housing is the most common form of housing with care
model for older people in the UK. It is estimated there are 500,000 sheltered housing
properties and 25,000 units of extra care housing accounting for around five per cent
of UK citizens aged 65 years and over (Allardice 2005, 20; Tinker 1999, 13).

Sheltered housing has been provided in the UK by local authorities since the mid
1960s. During the 1980s some local authorities began to build housing to cater for
occupants with a greater range of needs – extra care housing (Hanson 2001).

31
 Box 6 5. Definitions of Sheltered and Extra Care Housing
This form of housing has
As with most forms of assisted living no one definition can
come to be seen as adequately encapsulate the range of schemes available but
preferable to residential Allardice (2005, 42) offers the following definitions:
care and is marketed as Sheltered housing ranges from purpose built bungalows to
an attractive option, self contained flats, bed-sits and rooms with shared facilities.
(unlike residential care, it The presence of a scheme/estate manager living on the
premises or nearby differentiates it from other types of housing.
allows couples to live Many also provide 24-hour emergency assistance through an
together) though alarm system. All residents pay a service charge, whether they
research suggests that own or rent their home. Sheltered housing is provided by four
while some schemes main organisations: local authorities (rent only); housing
associations (rent or part-buy); voluntary sector (rent only); and
provide a level of care private sheltered housing developments (buy only).
equivalent to residential Extra care housing can offer flexible care, with 24-hour
care this is not always support from social care and health teams. It can be new build
the case and therefore it or remodeled from existing buildings or a mix of both. The basic
is not a replacement for design features include self contained flats with kitchen and
bathroom facilities; staff facilities; a range of services such as
residential care (Allardice laundry; communal areas; guest facilities; good links to the
2005; Tinker 1999; community; and staff on-site to maintain the building and
Croucher et al 2006). manage the delivery of care and support services
While the demand for
extra care housing is greater than supply, there is some concern about expanding
this type of housing as the ‘costs of providing purpose-built extra care as a
replacement to residential care are likely to be prohibitive’ (Allardice 2005, 21) and
that it may be perceived as institutional housing into the future, if not now, as other
housing models and options are developed.

In Canada there are a number of models to assist people in older age. In British
Columbia the mental health foundation and the health service offer a residential
program involving satellite apartments and suites. Outreach support is provided to
these private market apartments and rents are subsidised by the mental health
service, the housing authority or Ministry of Health (SHIP 2005). In Calgary a short
term shelter was opened for abused older persons in 1999 and it is the first purpose
built shelter for abused seniors in North America. The shelter is staffed all the time
and offers a range of supports to male and female residents but residents must be
self sufficient with respect to their health care.

6.4.2. Assisted living

Assisted living is the term used to describe one of the two major models of housing
with care in the US (the other is Continuing Care Retirement Communities CCRCs).
There is no standard definition of assisted living facilities and the type of facility and
the level of care provided, varies from state to state and facility to facility. Basically an
assisted living facility is a residential setting where help with personal care is
provided (Spillman et al 2002). Stone (2000) identifies some key characteristics:

• An explicit focus on privacy, autonomy and independence, including the

•
ability to lock doors and use a separate bathroom;
An emphasis on apartment settings in which residents may choose to share

•
living space; and
The direct provision of, or arrangement for, personal care and some nursing
services, depending on degree of disability.

32
These facilities need to be licensed and they differ from residential care as they are
licensed as nonmedical facilities and there is no requirement for nurses or other
medical staff to be employed.

Assisted living facilities are the fastest growing type of supported housing in the US,
catering for an estimated one million people (Croucher et al 2006; Begley et al 2001).
A number of reasons are offered by Spillman et al (2002, 1) to account for the
increasing popularity of this form of accommodation:

• The number of older people requiring such assistance is growing more rapidly

•
than the supply of residential care beds;
Older people with a disability are substituting assisted living facilities for

•
nursing home care;

•
These facilities have a better image than nursing homes;

•
The cost of assisted living facilities is often cheaper than nursing homes;

•
Changes in the disability composition of older adults;
Perceived higher quality of life in assisted living facilities than in nursing

•
homes;
State policy changes that stimulate increases in the use of assisted living
facilities.

The future of assisted living facilities however, according to Begley et al (2001) is yet
to be determined. The uncertain future of assisted living is partly due to the fact the
cost of living in such a facility is significant, estimated to range from US $2000-$4000
per month and therefore out of reach for low to moderate income people (Schuetz
2003, 2). As assisted living facilities appear preferable to nursing homes, efforts are
being made to explore ways to make the model more affordable and therefore
accessible to a wider range of older people (Schuetz 2003).

6.4.3 Continuing Care Retirement Communities (CCRC)

Continuing care retirement communities as the name implies are retirement

communities that allow people to age in place, to age on-site. They provide a range
of living and service arrangements to cater for people’s changing needs. They have a
long history in the US and can vary in size from several thousand residents (Sun City
Arizona) to just a few hundred.

In comparison with older people living in conventional housing, residents of CCRCs

tend to be older, middle to upper class white people, the majority of whom live on
their own and they have fewer children living nearby (Croucher et al 2006; Schafer
2000).

CCRCs are an attractive option compared with nursing homes for people who
foresee they may need care eventually. Nursing home residents pay a large annual
fee to cover the cost of care. In CCRCs most residents pay a one off entry payment,
or a fee every week if they are renting the accommodation, and then a less
substantial annual or monthly fee for the duration of their stay to cover such things as
maintenance, shared services and care costs. This regular fee remains the same
even if the level of care required increases. In this way the cost of care is spread
over a period of time (operating in a manner comparable to insurance) and this
allows for people to be cared for on a long term basis without depleting life savings,
as would be the case if they were to enter a nursing home (Tetlow 2006).

33
 Box 6.6 Characteristics of CCRCs
In the UK, CCRCs are increasingly
1. Self contained flats or bungalows. Dwellings
seen as a better option than the incorporate design features, equipment and
traditional models of sheltered and technology to facilitate independence and provide
extra care housing. This is because of a safe environment.
the high levels of care available, the 2. Often incorporate a mixture of tenures.
24-hour on-site staffing and the 3. Provision of an appropriate package of care, in
the person’s home to a high level if required.
extensive facilities in CCRCs. 4. Catering facilities with the provision of one or
more meals per day.
In Australia we have various forms of 5. 24 hour care staff and support available on site.
assisted living communities. For 6. Comprehensive communal facilities –
restaurant, lounges, activity rooms, library,
example: computer suite, health suite, consultation room

•
etc.
In Abbeyfield Housing groups 7. Staff offices and facilities, domestic support
of older people live in a group services including help with shopping, cleaning
and possibly making meals.
setting within a large house
8. Specialist equipment to meet the needs of frail
and this allows the provision of or disabled residents – laundry, assisted bathing,
additional services – such as charging and storage facilities for electric
24 hour nursing care and wheelchairs and scooters/gophers.
meals – not possible in a 9. Social and leisure activities/facilities and
additional individual or shared services – shop,
private dwelling. Abbeyfield hairdressing, chiropody, alternative therapies,
Housing is seen as a more cash machine, post box, etc.
attractive alternative to 10. Mobility and access assistance, for example a
conventional nursing homes or communal buggy or a shared pool car.
(Tetlow 2006, 16)
other institutionalised housing

•
forms;
SunnyCove and Villlage Life are forms of assisted communities filling a niche
for affordable rental retirement housing in Australia. SunnyCove has 13
villages in Queensland and Village Life over 50 throughout Australia. Rent is
based on 85 per cent of the pension plus government provided rental
assistance (regardless of whether you actually receive the age pension or
rent assistance). Residents are provided with meals, bed linen and towels
and a manager is constantly on site. While such villages provide a housing
option for low income older people, with few financial resources, they are very
vulnerable to contract changes, changes in circumstance and other rising

•
costs which significantly limit future housing choices;
The practice of locating independent living units and a residential care facility
on the same site constitutes a basic continuing care retirement community in
that theoretically they offer three levels of accommodation and cater for
increasing care needs. These communities are generally provided by not-for-
profit organisations or charities or through partnerships between charities and
not-for-profit organisations, the private sector and government departments.
Though residents of the independent living units often get preference to enter
the on-site residential facility if the need arises, the operating body cannot
guarantee that a vacancy can be offered to one of their residents. Access to
residential care facilities is controlled by independent Aged Care Assessment
Teams.

34
6.4.4 Evaluation of Assisted Community Housing

o Potential suitability for South Australia and the City of Onkaparinga

The implementation of Sheltered Housing, Extra Sheltered Housing or Continuing

Care Retirement Communities models of housing in Australia may, in large measure,
fall outside the remit and powers of the City of Onkaparinga. There is, however,
scope for the City to lobby the South Australian and Australian Governments to
investigate and test these alternative models. The SunnyCove and Village Life forms
of continuing care are present within the Australian housing market and while they
are attractive to some people, they present a number of policy challenges with
respect to their cost, standards, sustainability and regulation.

o The ‘degree of fit’ with existing policy frameworks

In the first instance, the regulation and funding of these models would fall within the
responsibilities of State and Federal Government. The City of Onkaparinga,
however, would have a role with respect to planning and development controls.

o Potential barriers to implementation

The most significant barriers to implementation of these alternatives to nursing

homes relate to their cost and regulation. The models discussed have lower costs
than nursing homes but still require significant funding. Residents alone may not
have the capacity to fund such systems and one or other tier of government may
then need to be willing to provide a part or full subsidy.

o Possible relationships with private providers and government policy/actions

In the US the CRRC model is largely funded by the residents. There may be scope
for the City of Onkaparinga to work in partnership with an aged housing provider from
either the non-government or private sectors to investigate and pilot these models
within the council area.

6.5. Trends in the Supply of Housing to Older Persons

It is always difficult to discuss trends in housing supply because developers and

builders tend to treat such information as commercial-in-confidence and there is,
therefore, very little published. In addition, the housing industry itself has a limited
understanding of how demand will change over time, with the Property Council of
Australia recently commissioning a study into how the housing needs of the ageing
population are likely to change. This said, we can draw out some broad trends:

• The retirement village sector is likely to grow. When compared with the
US the retirement village sector in Australia represents a relatively small
percentage of aged housing. It is likely that an increasing proportion of aged
persons will choose to live in retirement villages, and this will be an outcome
of both demand processes (an increased willingness to sell the family home
to in order to fund retirement lifestyle aspirations) and supply, with ever more
attractive marketing and packaging of retirement villages. We have
discussed above projections for the construction of housing units within
retirement villages;

• Persons entering retirement do not express a desire for small housing.

Other research undertaken by the authors and other unpublished sources

35
 show that persons entering retirement do not want small dwellings, but
instead see two bedrooms as a minimum, but there is a greater preference for
three or four bedroom dwellings;

• Many retirees have substantial equity as a result of the recent boom in

house prices and many have some – often limited – superannuation.
This has meant that they have the capacity to afford a greater range of
housing options, at least in the first part of their retirement;

• The not-for-profit sector will be transformed over the next decade.

Research be McNelis and Herbert (2005) suggests that the traditional model
of Independent Living Unit (ILU) provision is no longer viable and that these
organisations – including Southern Cross Homes, the RSL, ACH, ECH – will
need to restructure their businesses in order to maintain their operations.
Restructuring could take the form of withdrawal from provision, rebuilding
their stock, working in partnership with others, raising fees and investigating
new funding models. This change may generate significant opportunities for
the City of Onkaparinga;

• Some form of the Continuing Care Retirement Communities model is

likely to emerge as a major form of housing in Australia over the next
decade. While there are questions with how this model will be implemented
in Australia, at least a basic form of CCRC will be implemented. Retirement
villages that offer meals have been popular with a group of older persons for
some time and there is a demonstrated demand for this style of
accommodation. Indeed the financial collapse of Village Life was precipitated
by too rapid expansion in the face of strong demand but limited profit margins;

• The nursing homes sector is most unlikely to grow at a pace that

matches the expansion of the aged population, or even, the population
of persons aged over 85. The failure to keep pace in the nursing homes
sector is likely to generate considerable pressure for new, less expensive
models, of the types discussed in this section. The great challenge in this
respect will be securing funding from the Australian Government.

6.6. Key Issues from this Section

• There are a plethora of housing models available internationally to cater for

•
an ageing population.
The models can be categorised into three main groups – conventional

•
housing; unassisted communities; and assisted communities.
Conventional housing is, and will remain, the most important form of housing
for older people in Australia, including the City of Onkaparinga. There are
strong health, financial and wellbeing grounds for encouraging people to age
in their own homes and successful ageing could be assisted by the provision
of additional supports such as advice and information; promotion of

•
homesharing and coordination of services.
The City of Onkaparinga can have an important role in many of these areas of
policy and program delivery, though often its role should be that of an

•
advocate for change and in co-ordinating existing services.
Unassisted communities include retirement villages, lifestyle villages and co-
housing.
o Retirement villages are a small but growing component of the supply
of housing to older people and are now dominated by private industry.

36
 They are, however, unaffordable for a segment of the aged population
and while the City of Onkaparinga may represent an attractive location
for providers, retirement villages may not offer affordable housing for
the local aged population. The State Government’s affordability
targets for new developments, however, may ensure some affordable
retirement village housing in new developments.
o Lifestyle villages are more affordable because the purchaser gains
ownership of the house but not the land. However, this raises greater
questions around security of tenure.
o CoHousing comprises intentional communities of older persons who
choose to live as a group. There appear to be multiple benefits from
this form of housing and there are strong grounds for the City of
Onkaparinga advocating – and potentially working with a community

•
group – and piloting this model.
Assisted communities are a diverse group and provide varying levels of care
and support. Some of the models available in the UK and the US in particular
appear readily applicable to Australia. While they offer the prospect of
significant cost savings to the public sector, they remain relatively expensive
housing solutions and there are questions around which tier of government (if

•
any) would subsidise this form of housing and support
It is difficult to accurately predict trends in the housing industry because much
material is treated as commercial-in-confidence and that, in large measure,
the industry itself has not come to grips with the emerging housing demands
of persons currently aged 55 to 65. It is expected however that:
o The retirement village sector is likely to grow;
o Persons entering retirement do not express a desire for small housing.
Many retirees have substantial equity as a result of the recent boom in
house prices and many have some – often limited – superannuation;
o The not-for-profit sector will be transformed over the next decade.
Some form of the Continuing Care Retirement Communities model is
likely to emerge as a major form of housing in Australia over the next
decade.

37
7. Conclusion
The City of Onkaparinga is faced with inevitable change in the demand for housing
by older persons. At the most basic level, the number of persons aged over 65 within
Australia, South Australia and the City of Onkaparinga will grow rapidly over the next
15 years. There will be more older people and there will be more of the ‘old old’ –
those aged over 85.

In addition, there will be qualitative change in the housing older Australians are
seeking within the City of Onkaparinga. Baby boomers will have higher housing
aspirations than their parents’ generation and some parts of the City of Onkaparinga
will emerge as an attractive ‘seachange’ location, offering both beautiful coastline
and ready access to high quality services. Aged housing in the City of Onkaparinga
– as with the rest of Australia – is likely to see a greater range of outcomes over the
next two decades as some relatively wealthy self-funded retirees either move into the
area or stay within the region after leaving paid work, while others retire on much
more modest means.

The overwhelming desire of older people is to remain in their homes and to have
their choice from an array of housing options. For the young aged (60 years to early
70s) this may mean a move for lifestyle reasons, for example to a pleasant desirable
environment, or downsizing to a smaller house or unit. As people move into their 70s
however they become more vulnerable to illness, disability and widowhood and look
for housing options that provide a sense of community, safety and care services.
There will be a strong demand for community services that both support older
residents in their home and provide outlets for activity. In some ways this is likely to
have positive impacts, for while there may be greater demands on Council budgets,
there will also be a larger pool of volunteers to help with community based initiatives.

Importantly, while many older persons will seek to stay in their own home, most will
need support in older age and many will enter retirement specific housing of some
form at some stage. The retirement village sector has been one of the fastest
growing – and most profitable – parts of the land development and building industries
in Australia over the previous decade. It is inevitable that there will be proposals for
additional retirement villages within the City of Onkaparinga.

Besides retirement villages there are few choices or alternative housing models in
Australia. This report has considered a range of international housing models and
their potential for application in the City of Onkaparinga. The various programs and
models have been evaluated for their potential value in meeting the needs of the
City’s ageing population as well as the implications for the functions performed by the
City of Onkaparinga. Overall the evidence suggests that there is a clear and on-
going role for the City in assisting older persons to age successfully in conventional
housing. As a locally based institution, the City is well placed to:

•
•
help people gain access to information;

•
assist people in applying for home modification grants;

•
lobby State and Federal governments for new services;
facilitate the introduction of new services – such as HomeShare – into South

•
Australia and the City of Onkaparinga; and,
work in partnership with community groups.

38
In addition, the City has an important role in planning and development approvals
and could be an important agent in encouraging the adoption of universal design
principles.

The City of Onkaparinga has a regulatory role in the development of unassisted

communities and assisted communities. While it might play a part in the
development of new models, it would be reasonable to expect that any subsidy for
these new approaches would need to be financed by either the State or Federal
Government. However, the anticipated growth of retirement villages and the strong
likelihood that some form of continuing care housing will emerge within Australia will
require the City to remain abreast of developments and make informed decisions in
planning for, and approving, these initiatives.

Finally the report acknowledges that despite the development of alternative models,
the international evidence base notes the on-going importance of nursing homes for
end of life care. Within many OECD countries, including Australia, there is a policy
objective to reduce the need for residential care. However, alternative forms of
housing cannot completely replace residential care for highly dependent people. In
this report a number of reasons are presented as to why the demand for residential
care in Australia will continue and some of the overseas research has highlighted the
problems confronting cities and regions where residential style accommodation has
been wound back. It is worth noting that while Denmark placed a freeze on the
construction of new nursing homes, it then invested significant public monies in
alternative housing options. While this strategy has its merits, it ignores the needs of
a small group of older persons and means that there is no accommodation option for
people with high needs to move into. Indeed, a comprehensive review undertaken in
Britain concluded that housing with care (ie assisted living) cannot replace residential
care due to the intensity of care needed at the end of life (Croucher et al 2005, 95).
An absence of residential care creates a ‘choke point’ elsewhere in the aged housing
system (Canadian Centre for Policy Alternatives 2005). Nursing homes must,
therefore, remain an important part of the ‘mix’ of housing options for older people.
Clearly there is a role for the City of Onkaparinga in ensuring that a balanced system
is achieved in aged persons housing, even if that role is limited to lobbying Federal
Government.

39
References
ABS 2003a Ageing in Australia 2001 Census of Population and Housing, Cat no
2048.0, Australian Bureau of Statistics, Canberra.

ABS 2003b Population Projections Australia 2002-2101, Cat no 3222.0, Australian

Bureau of Statistics, Canberra.

ABS 2004 Disability, Ageing and Carers: Summary of Findings Australia 2003, Cat
No 4430.0, ABS, Canberra.

AHURI 1998 Quarterly Housing Monitor, AHURI, Melbourne.

AHURI 2004 Housing Futures in an Ageing Australia Research and Policy Bulletin,
Issue 43 May Australian Housing and Research Institute Melbourne.

AIHW 2003 Disability Prevalence and Trends, Disability Series, Australian Institute of
Health and Welfare (AIHW) Cat No DIS 34, AIHW, Canberra.

AIHW 2005 Residential Aged Care in Australia 2003-04: A Statistical Overview,

AIHW cat. No. AGE 43, Aged Care Statistics Series no. 20, Australian
Institute of Health and Welfare, Canberra.

Allardice, J. 2005 A 2020 Vision for Housing and Care, Research Report, Jane
Allardice Communications Limited for Hanover Housing Association, UK.
www.hanover.org.uk
Angley, P. and Newman, B. 2002 Who Will Care? The Recruitment and Retention of
Community Care (Aged and Disability) Workers, Brotherhood of St Laurence,
Melbourne.
Australian Network for Universal Design n.d. About the Network, Australian Network
for Universal Design, www.pwd.org.au/anuhd/about.html
Beer, A., Faulkner, D. and Gabriel, M. 2006 21st Century Housing Careers and
Australia’s Housing Future: Literature Review Positioning Paper, Australian
Housing and Urban research Institute (AHURI), Melbourne.
Begley, T.D., Klein, M., Lootens, V.l., Carlson, E., Mason, D., Edelstein, S. and
Edelman, T. 2001 White Paper on Assisted Living, National Academy of Elder
Law Attorneys Inc, US.
Benevolent Society 2001 Progress Review of Homeshare NSW, Benevolent Society,
New South Wales.
Brenton, M. 2001 Older people’s CoHousing communities, in Peace, S.M. and
Holland, C. (eds) Inclusive Housing in an Ageing Society Innovative
Approaches, The Policy Press, UK, pp 169-188.
Bunce, D. 2006 Manufactured Housing Estates, Paper presented to the Australasian
Housing Researcher’s Conference, 19-22 June, Adelaide.
Burnley I. and Murphy P. 2004 Sea Change: Movement from Metropolitan to
Arcadian Australia, University of NSW Press, Kensington.
Canadian Centre for Policy Alternatives 2005 Cuts to Residential and Home Health
Care in BC, Canadian Centre for Policy Alternatives, BC Office, Vancouver.
Care and Repair England n.d. Should I Stay or Should I Go? Program outline,

40
www.careandrepair-england.org.uk/sisosig/prog.html
Care and Repair England 2005 Housing Options Services Can Help…,Evaluation
Overview, Care and Repair England, The Renewal Trust Business Centre,
Nottingham. http://www.careandrepair-
england.org.uk/sisosig/downloads/housingoptions.pdf
Carstein, B. 2003 Economic Evaluation of Homeshare Victoria, Homeshare Victoria,
Melbourne.
Cheek, J., Ballantyne, A. and Byers, L. 2003 Changing Places: An Exploration of
Factors Influencing the Move of Older People from Retirement Villages to
Residential Aged Care, University of South Australia and Village Care Ltd,
Adelaide.
Chicago Mutual Housing Network 2004 Affordable Housing Networks, Their
Conditions and Prospects in Chicago, University of Illinois, Chicago.
Christophersen, J. (ed) 2002 Universal Design 17 Ways of Thinking and Teaching,
Norwegian State Housing Bank, Norway.
Commonwealth Department of Health and Ageing 2003 A New Strategy for
Community Care, Consultation Paper, Commonwealth Department of
Health and Ageing, March.
Croucher, K., Hicks, D. and Jackson, K. 2006 Housing with Care for Later Life,
Joseph Rowntree Foundation, Published OnLine.
Department for Families and Communities, SA Retirement Village Information for
Prospective/Residents, Office for the Ageing, Government of South Australia
http://www.familiesandcommunities.sa.gov.au/Default.aspx?tabid=914

Department of Human Services South Australia 1999 Moving Ahead, A Strategic

Plan for Human Services for Older People in South Australia, 1999-2004,
Department of Human Services, Adelaide.

Eardley T. and Birch M-R. 1998 Retirement Villages, Residents’ Housing Costs and
Living Circumstances, Social Policy Research Centre, Reports and
Proceedings, no. 139, July, university of New South Wales.
Enright, S. 2006 Testimony Submitted to the Standing Committee on Aging, New
York State Assembly, New York Association of Homes and Services for the
Aging, Document # 2550161.

Faulkner D. 2001 Linkages among housing assistance, residential (re)location, and

use of community health and social care by old-old adults: shelter and non-
shelter implications for housing policy development, Positioning Paper,
AHURI, Melbourne and Centre for Ageing Studies, Adelaide.
Faulkner, D., Findlay, M., Barrington, R. and Luszcz, M. 2004 Factors that make
Housing More Suitable for Older People, Preliminary Paper, Department of
Human Services, South Australia, Rundle Mall Adelaide, April.
Fisk, M.J. 2001 The implications of smart home technologies, in Peace, S.M. and
Holland, C. (eds), Inclusive Housing in an Ageing Society, Innovative
Approaches, Policy Press, Bristol, pp 101-124.
Foundations, The National Co-Ordinating Body for Home Improvement Agencies,
About HIAs: Facts and Figures,
www.cel.co/foundations/about_hias/facts_and_figures.htm

41
GISCA 2005 2050 Two Million State Population Target, Implications for Statistical
Local Areas, Draft, Unpublished.
Government of South Australia 2005 State Housing Plan, Government of South
Australia, Adelaide.
Government of South Australia 2006 Improving with Age: Our Ageing Plan for South
Australia, Government of South Australia, Adelaide.
Hanson, J. 2001 From Sheltered Housing to Lifetime Homes: An Inclusive Approach
to Housing, Bartlett School of Graduate Studies, University College, London.
Homeshare International website http://www.homeshare.org/index.asp
House of Representatives 2005 Inquiry into Long Term Strategies for Ageing over
the Next 40 Years, Parliament of Australia, Canberra.
Howe A.L. 2003 Housing an Older Australia: More of the Same or Something
Different? Keynote address to the Housing Futures in an Ageing Australia
Conference, Australian Housing and Urban Research Institute (AHURI) and
The Myer Foundation, 10th November, Melbourne.

Howe A. and Sarjeant H. 1999 Strengthening the financing of aged care in Australia,
in , Policy Implications of the Ageing of Australia’s Population Conference
Proceedings, Productivity Commission and Melbourne Institute of Applied
Economic and Social Research, AusInfo, Canberra, Chapter 14.

Hugo 1996 Atlas of the Australian People, National Overview, BIMPR, Melbourne.
Hugo, G. 2003 Australia’s ageing population, Australian Planner, vol 40, no 2, pp
109-118.
Imrie, R. 2002 Housing Quality and the Provision of Accessible Homes, Paper
presented at the European Network for Housing International Research
Conference, Housing Cultures Convergence and Diversity, 1-5 July University
of Vienna, Austria.
Joseph Rowntree Foundation (a), An introduction to Lifetime Homes,
www.jrf.ork.uk/housingandcare/lifetimehomes/default.asp
Joseph Rowntree Foundation (b), The market for Lifetime Homes,
www.jrf.ork.uk/housingandcare/lifetimehomes/market.asp
Judd B., Kavanagh K., Morris A. and Naidoo Y. 2004 Housing Options and
Independent Living: Sustainable Outcomes for Older People Who are
Homeless Final Report, UNSW/UWS Research Centre, Australian Housing
and Urban Research Institute, Melbourne.
King’s College London and the University of Reading 2004 Introducing Assistive
Technology into Existing Homes of Older People: Feasibility, Acceptability,
Costs and Outcomes, Institute of Geronotology, King’s College London.
Lawler, K. 2001 Aging in Place: Co-ordinating Health and Health Care Provision for
America’s Growing Elderly Population, Joint Centre for Housing Studies,
Harvard.

Legge K. 2005 Lives on the faultline, Weekend Australian Magazine, 24-25 Sept, pp
23-26.
L.E.K. Consulting 2006 Summary of Review of Aged Care Delivery Costs, L.E.K.
Consulting Pty Ltd, Sydney.

42
Luszcz, M., Faulkner, D., van Emden, J., Findlay, M., Barrington, R., Landorf, C. and
Sheppard, L. 2006, Factors that Make Housing More Suitable for Older
People, Final Report, Southern Research Centre AHURI and Department for
Families and Communities, South Australian Government.
Marshall M., Murphy P. Burnley I. and Hugo G. 2003 Welfare Outcomes of Low
Income Earners from Metropolitan to Non-Metropolitan Australia, Final
Report, Australian Housing and Urban Research Institute (AHURI),
Melbourne.
Master Builders Association Australia 2003 2003 National Building & Construction
Awards, Master Builders Association Australia.
www.masterbuilders.com.au/awards-2003/seniors.html
McInerney, M. 2006 What happens when the baby-boomers retire, Place, vol 6, pp 6-
10.
McKinnon M. 2005 Boomers ‘must sell homes to retire’, The Australian, June 6.
McNelis, S. and Herbert, T. 2005 Independent Living Units: A Social Housing Option
for Older Persons, National Housing Conference, 27-28 October, Perth.
Minnery, J., McFallan, S., Mead, E. and Fedrick, D. 2003 Barriers to Safer Housing,
Final Report for the Queensland Department of Housing and Queensland
Health, CSIRO and Queensland University of Technology.
Montague M. 2001 Increasing Housing and Support Options for Older People An
Evaluation of Homeshare Victoria Pilot Phase I: Planning, Implementation
and the First Year of Matches, Homeshare Victoria, Research and Policy
Services, Melbourne Victoria.
Mowbray M. 1994 Wealth, Welfare and the city: developments in Australian urban
policy, Urban Policy and Research, vol. 12, no. 2, pp 91-103.

National Lifestyle Villages, www.nlv.com.au

New York State Office for the Aging (n.d.) Housing Alternatives for Seniors in New
York State, Unpublished.
OECD 2003 Ageing, Housing and Urban Development, Organisation for Economic
Co-Operation and Development, Paris.
Office for the Ageing 1996 Ageing – A Ten Year Plan for South Australia, Office for
the Ageing, Adelaide.

Olsberg D. and Winters M. 2005 Ageing in Place: Intergenerational and Intrafamilial

Housing Transfers and Shifts in later Life, Final Report, Australian Housing
and Urban research Institute, Melbourne.

Ontario Coalition of Senior Citizens Organisations 2003 Health and Housing Options:
Alternatives to Institutional Long Term Care Facilities, Unpublished.

Ontario Coalition of Senior Citizens Organisations 2004 Senior Citizens and Housing
Crossroads, Exploring Alternatives to Long Term Care Facilities, Toronto.

Peace, S.M. and Holland, C. 2001 (eds) Inclusive Housing in an Ageing Society,
Innovative Approaches, Policy Press, Bristol.
Percival R. and Kelly S. 2004 Who’s Going to Care? Informal Care and An Ageing
Population, Report Prepared for Carers Australia by the National Centre for
Economic and Social Modelling, NATSEM, Canberra.

43
Perry, J., 1999 Love those designer grab bars (the growing popularity of homes with
‘universal design’ that will accommodate older people, or people with
disabilities), U.S. News & World Report, June 28, vol 126, issue 25, p 82.
Productivity Commission 2006 Aged care services, Report on Government Services
2006, Chapter 12, Australian Government, AGPS.
Productivity Commission and Melbourne Institute of Applied Economic and Social
Research 1999 Policy Implications of the Ageing of Australia’s Population,
Conference Proceedings, AusInfo, Canberra.

Pynoos, J., Nishita, C., and Perelman, L. 2003 Advancements in the Home
Modification Field: A Tribute to M. Powell Lawton, Co-published
simultaneously in Journal of Housing for the Elderly, vol 17, no 1/2, pp105-
116; and Physical Environments and Aging: Critical Contributions of M.
Powell Lawton to Theory and Practice, Scheidt, R. J and Windley, P.G (eds),
The Hawthorn Press Inc, pp 105-116.

Salt B. 1994 The Big Shift, Hardie Grant Books, South Yarra.
Schafer, R. 2000 Housing America’s Seniors, Joint Center for Housing Studies of
Harvard University, Cambridge, Massachusetts, www.gsd.harvard.edu/jcenter

Schuetz, J. 2003 Affordable Assisted Living: Surveying the Possiblities, Joint Center
for Housing Studies of Harvard University for Volunteers America.
Senior Housing Information Program (SHIP) 2005 SHIP Temporary Housing Pilot
Project, SHIP, New Westminster, British Columbia.

Spillman, B.C., Liu, K. and McGillard, C. 2002 Trends in Residential Long-Term

Care: Use of Nursing Homes and Assisted Living and Characteristics of
Facilities and Residents, paper prepared for Office of Disability, Aging and
Long-Term Care Policy, Office of the Assistant Secretary for Planning and
Evaluation, US Department of Health and Human Services, Washington.
Stimson, R. 2002 The way ahead, in R. Stimson (ed) The Retirement Village Industry
in Australia, Evolution, Prospects, Challenges, Centre for Research into
Sustainable Urban and Regional Futures, The University of Queensland,
Chapter 15 pp 201-216.
Stimson, R. and McGovern, S. 2002a Future demand and construction opportunities
for retirement villages, in R. Stimson (ed) The Retirement Village Industry in
Australia, Evolution, Prospects, Challenges, Centre for Research into
Sustainable Urban and Regional Futures, The University of Queensland,
Chapter 13, pp 173-190.
Stimson, R. and McGovern, S. 2002b Retirement villages: an alternative housing
lifestyle for retirees, in R. Stimson (ed) The Retirement Village Industry in
Australia, Evolution, Prospects, Challenges, Centre for Research into
Sustainable Urban and Regional Futures, The University of Queensland,
Chapter 1, pp 1-8.

Stimson R., Manicaros M., Kabamba A. and Murray A. 1997 Ageing and Retirement
Housing in Australia Australian Housing and Urban Research Institute
(AHURI) and Queensland University of Technology, Brisbane.
Stone, R.I. 2000 Long-term Care for the Elderly with Disabilities: Current Policy,
Emerging Trends, and Implications for the Twenty-First Century, Milbank
Memorial Fund, New York.

44
Tetlow, R. 2006 Continuing Care Retirement Communities, A Guide to Planning, The
Joseph Rowntree Foundation, York. www.jrf.org.uk
The Center for Universal Design 1997, The Principles of Universal Design, The
Center for Universal Design,
www.design.ncsu.edu/cud/univ_design/principles/udprinciples.htm
Tinker, A. 1999 Ageing in Place: What Can We Learn From Each Other? The Sixth
F. Oswald Barnett Oration, Ecumenical Housing Inc and Copelen, Victoria,
Australia.
Proceedings of the First National Homeshare Workshop, Wesley Mission, Victoria,
www.wesley.org.au/pdfs/proceedings_of_2004_national_homeshare_worksh
op.pdf
University of Queensland 2002 Retirement village industry poised for growth, UQ
News Online, University of Queensland, 22 October.
Ward, M. and Daly Smith P. 2005 Universal Housing Design “It just makes good
sense” paper presented to National Housing Conference, Perth
www.anuhd.org/publications/It-just-makes_good_sense.doc
Western Australian Parliament 2005a National Lifestyle Villages Pty Ltd and Lake
Joondalup Lifestyle,
www.parliament.wa.gov.au/pq/qsearch.nsf/0/0e8cff337b35511348257062007
ba161?OpenDocument
Western Australian Parliament 2005b National Lifestyle Villages Pty Ltd, Lease
Terms,
www.parliament.wa.gov.au/pq/qsearch.nsf/0/f0929db62fab31e5482570a1007
b9d7e?OpenDocument
Wood, G. 2005 Elderly Housing, Federal Housing Programs and Support Services,
Testimony before the Senate Committee on Banking, Housing and Urban
Affairs, Washington.

45