Living and Aging in Place – Publication by christelpang

Hello Aging

The Story of Living and Aging in Place in Canada Research Report

IwB

The Story of Living and Aging in Place in Canada

Research Report.

Research Report

Interdisciplinary Design Strategy

EXECUTIVE SUMMARY

Aging is inevitable – whether we are prepared for it or not. As of July 1, 2020, there were 6,835,866 people aged 65 and older living in Canada (StatCan), and older adults are the fastest-growing age demographic group. By 2030, this number will reach over 9 million, representing close to one quarter of Canada’s population (Canada). Individuals rely on the supports from various existing systems in Canada to ensure healthy, independent aging. From our perspective, older adults rely on, and are most impacted by, Canada’s sound political, social, and economic policies to govern them. As older adults will comprise a greater portion of our population than ever before, we need to ensure the systems in place can support and withstand the anticipated challenges to come. Through our research, we have identified areas where these systems work successfully for older adults, and areas in which they are flawed. Through a synthesis of our research, we have identified seven (7) core insights, alluding to gaps in these systems, and potential opportunities for design interventions. Our seven (7) key insights follow: • Aging in place requires policy solutions that support the process of aging at the individual level. • There is no one-size-fits-all solution for aging. • Successful aging in place involves planning and preparedness. • Having access to information empowers older adults’ ability to make informed choices. • Aging in place should accommodate for different needs in order to provide equitable solutions for older adults. • A social support network is indispensable to a successful aging in place experience. • The impact of technological solutions may vary according to the user’s familiarity with, and understanding of how to use, technology. These insights will function as guiding principles and crucial considerations as we design interventions to create desirable, feasible, and viable solutions for those who wish to live and age in place.

Research Report

HELLO AGING TEAM

LJA BOLONGAITA

CHERISH DE MOURA

Lja is a UX Designer with a passion for the startup ecosystem and inclusivity in tech. She is excited to join IwB this year to further her education and work on an exciting challenge with her colleagues.

Cherish De Moura blends design and meaning to create beautiful human-centred results. Cherish has a keen eye for design, is tenacious yet compassionate, and believes that words hold power. This is likely why communications and marketing comes naturally to her.

Coming from a background working in the public sector, her interests gravitated to thinking about the technologies of tomorrow. After graduating, she transitioned into the world of design through helping startups refine their offerings to better align with their users. She now works as the Product Design Lead for a food- tech startup called MyPalate, and volunteers as an in-house mentor at an incubator called The Forge.

Cherish understands her clients and end-users and focuses on making her team shine. Her approach is the x-factor that helps shape positive outcomes and inspires high-quality, high-value products. Cherish has 15+ years of professional experience and was recently awarded for Excellence in Leadership and Outstanding Inspiration. Her legacy will be the positive impact she makes on others and the world.

Interdisciplinary Design Strategy

HELLO AGING TEAM

SAYA KIM

KANIKA KUMAR

Artistically driven and critically engaged with the world, Saya would like to pursue truths, actualize ideas, and design solutions. She has obtained her B.A. Honours at Queen’s University as a Philosophy major and a Political Science minor, along with a Certificate in Business from Smith School of Business in 2017. Upon moving to live and work in South Korea as a teacher for two years, Saya returned to Toronto in 2019 for Art and Design Foundations at George Brown College. Now, amidst all that is 2020, she is looking forward to growing as a designer through the Interdisciplinary Design Strategy Program.

Kanika is an Architect by education who has spent the last 5-years in the spatial and experiential design of spaces. She is seen as a dedicated and highly motivated professional with extensive experience in design, production, and execution of various wellknown events, festivals, and exhibitions of varying scales. Collaborators have described Kanika as someone with “high levels of passion” and “extremely detail-oriented”. Kanika strives hard to keep up with the fresh trends of the industry and the magic that can be created with ephemeral architecture. According to Kanika, “architecture and design are intertwined”. The innate knowledge that comes with understanding the basics of architecture has helped her greatly in becoming an accomplished designer providing her with a sense of space, scale, and style. She has a knack for designing art for the Public as it gives her immense satisfaction and thrill to see a person create moments and experiences with art curated by her. Her dream is to take her creativity to the next level with the Interdisciplinary Design Strategy course at the Institute without Boundaries, George Brown College.

Research Report

HELLO AGING TEAM

CHRISTEL PANG

MARYAM RAZAVI

Christel is a life scientist with a passion for art and design. She enjoys researching and deciphering the theories of science while being inspired by the creative designs and fine artworks of the past.

Maryam Razavi is a Persian freelance Designer with more than 10 years of experience working with different companies. Maryam studied Industrial Design with a remarkable interest in fashion. She was recently working as a textile design manager. In this role, she was responsible for coaching other employees to use new ideas and software. Maryam is a strong team player and uses her positive attitude and tireless energy to encourage others to work hard and succeed. Maryam is inspired daily by communicating with other people and her friends. In her free time, Maryam likes to do yoga and meditation and loves to travel.

During her studies at the University of Toronto, she worked as an after-school program instructor for children of graduate students ages 5-12. She was responsible for designing and executing programs ranging from STEM, fine arts, music, and dance. This experience challenged her creativity and promoted her recognition of diverse perspectives. She wishes to continue positively influencing youth and advocate learning through creative means. In the IDS program, Christel would like to explore strategic thinking while exchanging skillsets with the interdisciplinary students and faculty members. She wishes to contribute to the betterment of current healthcare services through innovative, effectual, and ethical designs.

Interdisciplinary Design Strategy

HELLO AGING TEAM

KIM PAULO TOLEDO Kim Paulo Toledo is a Graphic Designer, originally from the Philippines and currently living in Toronto, Canada. He defines himself as self-motivated, adaptable, confident, well organized and a down to earth person. He enjoys collecting action figures and art toys, watching good movies and attending concerts and photography. Playing video games or doing anything music related. Designing is Kim’s true passion. It is the one thing that can give him a real sense of satisfaction. For Kim, being a designer is a job that dreams are made of fun, flexible and positively overflowing with creativity.

Research Report

TABLE OF CONTENTS

10-13

Executive summary

Meet The Hello Aging Team

21-27

Definition of Aging in Place

Systems Map

130-131

133

Gaps

Conclusion

Interdisciplinary Design Strategy

15-17

18-19

Introduction

Timeline

22-27

116-129

Research methodology

Our Design Intervention

23 24-25 26-27 28-39 40 52-65 66-77 78-89 90-101 102-115

Secondary Research Charrette Primary Research Insight 01 Insight 02 Insight 03 Insight 04 Insight 05 Insight 06 Insight 07

119 121 123 125 127 129

Beyond Home Dear Diary Elements Food Connections The Golden Circle The Heart

135

140-145

Looking Forward

Bibliography

Research Report

Interdisciplinary Design Strategy

INTRODUCTION

The world’s population is rapidly aging. The number of individuals over the age of 60 have doubled since 1980 and is projected to reach 2 billion by 2050 (World Health Organization). In Canada, by 2030, older adults will number over 9 million and make up 23 percent of the total population (Canada). As the population ages, it becomes increasingly evident that aging in place presents considerable challenges to both the individual and social, economic, and political systems in place. Proactive preparations must be made to mitigate risks to older adults. In conjunction with the realities made evident by the COVID-19 pandemic, it is clear that there are gaps and opportunities within the existing systems of our society. These issues would otherwise remain as threats and risks to older adults unless addressed in a strategic and timely manner. Conversely, through careful examination and prudent planning, one can better prepare for future challenges that may arise. This research report will act as a catalogue to reflect work performed to-date by the 2020 Interdisciplinary Design Strategy student cohort. With it, we will share our knowledge with faculty, stakeholders, older adults, and their caregivers. We will present the findings of our research that has been conducted over the past four (4) months, including insights and gaps. Additionally, we will use this report to inspire further research and inform our future design interventions in regard to living and aging in place.

older adults population

Interdisciplinary Design Strategy

Why Living and Aging in Place?

As of July 2020, there are close to 7 million older adults aged 65 and older living in Canada - the fastest-growing age demographic.

By 2030, the number of older adults will reach over 9 million, representing close to one quarter of Canada’s population.

Research Report

TIMELINE HELLO AGING TEAM

Fall Charrette

60 Case Study Analysis

WEEK

Date Visualization

Ecosystem Map & Timeline

Product System & Servic

Communication Module

Semester 2 International Charrette Concepts

WEEK

01 Jan

02FEB

03 MAR

APR

MAY 06

Interdisciplinary Design Strategy

Stakeholder Interviews

User Interviews

Atul Bhatt Dr. Joe Bornstein Diana Cable Dr. Raza Mirza

Caregivers (3)

Stakeholder Interviews

Caregivers (4)

Primary Research & Synthesis

Research Report & Insights Presentation

ce Design

Users Interviews

Glenn Miller Ron Beleno Arlene Etchen Mwarigha Don Fenn

WEEK

Environmental Module

Prototype

Final Deliverables

Research Report

LIVING AND AGING IN PLACE

The deﬁnition of Living and Aging in Place (AIP) is two-fold: 1. What it means to live in a place; and 2. How a place should accommodate one’s aging process. Deﬁning what it means to live in a place explores what it means to have a place to call “home”. Beyond just a space where an individual can eat, sleep, and be sheltered, a home is where one can attain a sense of safety, security, and belonging. It serves as a hub to social supports that connect individuals to larger communities so that one may engage in the place where they live in meaningful ways. A home is connected to a network of infrastructure and amenities that can provide goods and services to satisfy one’s wants and needs. The manifestation of an individual’s sense of safety, security, and belonging vary according to one’s needs, values, the socio-political context, and the resources available. Further, the home may require a number of changes alongside any physiological transitions that an individual experiences as they age, and the home must accommodate one’s changing needs and values accordingly.

Interdisciplinary Design Strategy

SYSTEMS MAP

INDIVIDUAL(PISTIL) • • • •

COMMUNITY (PETALS)

Personal Identity Health Competencies Financial Wealth

Social Network of Support • Family • Friends • Healthcare Providers • Neighbours

SOCIAL SYSTEM (STEM) The Public Sphere • General Public • Social Norms

POLITICAL SYSTEM (ROOTS) • • • •

Public Goods Public Investments Policy and Legislation Civil Participation

ECONOMIC SYSTEM (LEAVES) • • • • • •

Market Human Resources Goods and Services Production Trade Delivery

TECHNOLOGY AND INFRASTRUCTURE (SOIL)

Research Methodology

Interdisciplinary Design Strategy

SECONDARY RESEARCH

Our cohort dove into existing findings to better understand what businesses, public institutions, and researchers have already uncovered about older adults aging in place. In conducting our secondary research, we: • Collected, reviewed, and synthesized a broad range of design inspirations around the world through case studies; • Noted our preliminary insights and continued to add to them as we progressed through our research; • Created our living visual lexicon of Aging in Place - a website where we aimed to capture the concepts we learned from case studies, research reports, and course readings in an engaging way for the public to view; • Honed in on the topic of falls and their risks to older adults aging in place using data visualization and highlighting key statistics; and • Mapped factors which contribute to the well-being of independent older adults aging in place through our system map. Individually, we determined speciﬁc research questions to investigate further for our design research essays. We explored topics spanning from place attachment to digital ethics, and generated insights that helped refine our research and found gaps that we could use to expand our research down the road. Our secondary research would aid us in formulating our primary research questions for the next phases of our research.

Research Report

CHARRETTE

The design charrette is an intensive, collaborative process that brings together design students, industry professionals, stakeholders, and citizens to ideate, synthesize, refine, and ultimately, present a single concept at the end of the charrette. In October 2020, our cohort was divided into two (2) groups. Over the span of five (5) days, each group focused on creating environmental design interventions to support older adults aging in place in private and public spaces. THE GOLDEN CIRCLE (FORMERLY SENIOR’S CORNER) The Golden Circle is an opportunity for older adults to connect with people of all ages in public spaces through a mobile recording pod. It enables them to share their stories, experiences, wisdoms, and leave their legacy for future generations.

KEY TAKEAWAY Older adults want to be heard and they have a great deal of wisdom to share with younger generations. In return, younger generations, from their diverse range of perspectives, experiences, and cultures, can share their knowledge with older adults. The Golden Circle creates a way to connect generations in a meaningful way for wisdom-sharing and storytelling.

Interdisciplinary Design Strategy

BEYOND HOME Beyond Home is a gamified health experience that supports activities of daily living through an immersive and holistic home entertainment system that aims to engage older adult users to draw the outside world in.

KEY TAKEAWAY Beyond Home as a concept was particularly interesting in light of the COVID-19 pandemic, which only further highlighted the inherent importance of staying connected in our current world of enhanced safety measures and social distancing.

Research Report

PRIMARY RESEARCH

After conducting our secondary research, we prepared our initial findings and began planning to conduct primary research to verify and further refine our preliminary insights. Our cohort decided to conduct semi-structured interviews and we decided to conduct our interviewing in three (3) phases, with increasing proximity to the older adult over time. This allowed us to become familiar with conducting and processing qualitative interviews in a way wherein we would be better prepared to interview older adults once it was time. The planned phases were as follows: 1. External Stakeholders 2. Caregivers 3. Older adults

STAKEHOLDERS

We interviewed a total of nine (9) external stakeholders representing various organizations that provide service and/or advocacy for older adults. The goal of interviewing external stakeholders was to confirm whether our research aligned with their industry findings, and to provide us with greater insights and highlight potential gaps that they may have encountered as experts in their field.

Interdisciplinary Design Strategy

The list of external stakeholder interviewees is hereunder: Arlene Etchen, Knowledge Transfer Consultant, Canadian Mortgage and Housing Corporation Atul Bhatt, Advisor, Policy & Innovation, Canadian Mortgage and Housing Corporation Diana Cable, Director, Policy & Advocacy, CanAge Don Fenn, Founder, Home Modifications Canada Glenn Miller, Senior Associate, Research. Canadian Urban Institute Dr. Joe Bornstein, Managing Director, Health Innovations Group Mwarigha, VP, Housing & Homelessness Services, Woodgreen Community Services Dr. Raza Mirza, Network Manager, UofT National Initiative for the Care of the Elderly (Nice) Ron Beleno, Older Adults and Caregiver Advisory Committee Co-chair, Age-Well Inc.

CAREGIVERS

For the next phase of our primary research, we focused on the perspectives of caregivers. These individuals had more direct contact with our older adults than external stakeholders, and provided more personal insights into what it takes to support individuals living and aging in place. We interviewed a total of seven (7) formal and informal caregivers, with a breakdown of two (2) formal and five (5) formal. In the next semester, we look forward to interviewing older adults firsthand, and hearing their lived experiences with regards to living and aging in place. 27

INSIGHT 01

Interdisciplinary Design Strategy

‘‘

Aging in place requires policy solutions that support the process of aging at the individual level.

Research Report

Impact

Policies, and their subsequent narratives, form social norms that impact how society perceives and acts upon matters of aging. Ultimately determining the kinds of solutions available for individuals, policies can either enable or hinder one’s ability to successfully age in place.

Keywords

Policy, Governmental Support, Systematic Solution, Social Norms, Public Goods, Holistic Approach

Systems Map

Relevant parts of the system:

•

Individual

•

Social System

•

Political System

Research

Interdisciplinary Design Strategy

CASE STUDY: 2 STUDENT ESSAY EXCERPT STAKEHOLDER QUOTE: 1 CAREGIVER P.O.V.

Case Study

The Community-Based Integrated Care System in Japan Japan, 2012 - 2015

Description Moving away from the failures and burdens of long-term care, by 2025, the Japanese government aims to establish a Community-based Integrated Care System (CbIC), a medical care and welfare services policy created to balance and integrate the concepts of self-help (Ji-jo), mutual aid (Go-jo), social solidarity care (Kyo-jo), and governmental care (Ko-jo), to tackle the burden of a super-aged society. In doing so, the Japanese government recognizes the need for two major changes. First, a paradigm shift in the delivery of medical care for the elderly toward a holistic approach incorporating physical function, mental care, and environmental modification to meet the demands of disease structure changes. Second, the need to increase the number of personnel engaged in providing comprehensive care to effectively implement the CbIC. Investing in implementing changes through the education system, the aim is to establish a department of gerontology or geriatric medicine, appoint instructors dedicated to medical care for the elderly, and facilitate collaboration with medical, welfare, and nursing facilities in every medical school in Japan by 2025.

https://unsplash.com/photos/tGYrlchfObE

Impact Increasing the number of health care, nursing care professionals, and students who are able to fully understand the physical and mental characteristics of older adults is intended to raise awareness to the urgency of the aging population and promote further research. It allows Japan to develop personnel for the successful implementation of the CbIC policy.

Stakeholders: Older Adults Healthcare providers Nursing care professionals Prospective students Scale: National

Case Study

The National Positive Aging Strategy: Positive Aging Starts Now Ireland, 2014

Stakeholders: Older Adults Department of Health, Republic of Ireland Scale: National

Description Recognizing ageism is a real barrier to be combated in order to modify or adapt existing laws, and formulate a new, non-discriminatory understanding of aging and health in response to the aging population. Ireland’s National Positive Aging Strategy (NPAS) is a cross-departmental policy that aims to paint an image of society that is age-balanced in order to promote intergenerational solidarity and initiatives. A goal of the NPAS is to support and use research to better inform policy

Impact The four national goals outlined in the vision aim to: remove barriers to participation and provide more opportunities for engagement; provide support for maintaining physical, mental health, and wellbeing; enable older adults to age in place for as long as possible with confidence, security, and dignity; and support and use research about people as they age to better inform policy responses.

Student Essay

An excerpt from: “A Critical Look At The Current Narrative Of Aging In Place Under The Neoliberal Lens.” by Saya Kim p. 2 to 4 In any given society, political subjects are primarily shaped by discursive practices, largely mediated through texts and documents, such as academic literature, research, and policies (Rudman 186; Dalmer 42). Specifically within policies, by describing, idealizing, and framing approved ways of being and acting, policies function to inherently legitimize and de-legitimize certain social constructs and narratives (Rudman 186). Social policies then tend to permeate through social norms by presenting the aims of the policies as common knowledge when introduced, from which the narratives within policies are practiced and internalized by individuals (Rudman 186). However, policies are complex texts that combine a number of strategies, solutions, and with morally-laden messages that are designed to shape one’s experiences, behaviours, and reality with a specific agenda (Dalmer 42). Nested within and interconnected with other policies, individuals within a society are often unknowingly influenced by many (Dalmer 42). In so, as individuals manage their personhood and conduct according to the social narratives in existing policies, policies often work to directly influence and shape the way individuals make future social, cultural, and other political decisions (Rudman 186). As a result, there is a need to be critical when examining AIP as a social policy, in the way it is framed and presented, and all the subsequent narrative that follows. For instance, by introducing, and thereby framing international and national policies of AIP using words like “uneasing”, “overwhelming”, and “unmanageable” when describing the demographic change in the rising number of the older population (Dalmer 44), the notion of aging is immediately problematized as a burden to be managed (Rudman 181). As a result, strategies are prescribed and framed to manage the aging population, and addressing the notion of old age (Rudman 181).

‘‘

“Policies are complex texts; they combine a number of strategies and solutions and are nested within a network of other, interconnected policies.”

Student Essay

Yet, at the core of the discourse of AIP, the real pressing issues the policies are attempting to address are that the governments are facing a financial crisis. Related to the rising dependency ratio and the shrinking labour force that either already is, or is anticipated to place a significant burden on publicly funded care services-- like that of specialized care or pension systems-- as governments are finding it increasingly difficult to sustain financially (Dalmer 41).

Dalmer, Nicole K. “A Logic of Choice: Problematizing the Documentary Reality of Canadian Aging in Place Policies.”

Hence, the solution proposed through AIP policy for older adults to remain in their current homes and communities for as long as possible is essentially neoliberal in twofold. First, by shaping the narrative toward favoring deinstitutionalization to justify withdrawing programming and support structures; then, through promotion of individualism which shifts the financial burden from the government to the individual, as it frames the individual as a free agent, solely responsible for their own life decisions (Dalmer 41). Neoliberalism is a political-economic ideology that rises with the decline of the welfare state, as it aims to minimize state dependency (Rudman 186). By emphasizing individual choice and responsibility in order to promote a free market, neoliberal narratives are often masked as promoting agency, and freedom (Rudman 186). In practice, AIP as a neoliberal policy can be said to be “a result of governments’ desire to reduce health spending, and not a reduction in older adults’ needs (Dalmer 41)”. As one that targets the aging population both as a source and the solution of the problem-- in positioning the older population as having to bear the weight of their own solutions (Dalmer 44). As such policies permeate through and transform social norms, deinstitutionalization and individualism are narrated as naturally logical, and desirable solutions to be undertaken. 35

Stakeholder Quotes

“The way to affect change is through policy, coupled with advocacy.” Diana Cable

Director, Policy & Advocacy, CanAge

Stakeholder Quotes

Caregiver Interview

CAREGIVER P.O.V.

“I don’t know if there are supports or things or technology or anything that can help my experience. So far as that, generally speaking, the healthcare system is very deficient when it comes to dealing with these kinds of things, particularly within the household. I don’t think I’ve even explored cause every time I learn or see or understand anything from the health care system, it’s just a disappointment.” - Informal Caregiver “A lot of personal support workers don’t have paid sick leave. And that sucks because you’re kind of forced to go to work while you’re sick, which increases the probability that you get your clients sick. I think that’s number one “ - Formal Caregiver

Caregiving, especially formal caregiving, requires solutions at the policy level to be able to enable solutions at the organizational level, so as to ease the burden at the individual level. Some of the burdens at the individual level are: emotional, physical, lack of financial support, and unequal distribution of resources and labour forces.

Opportunity

Caregiver Interview

How might we challenge the current political narrative on aging in place? How might we connect private needs with public policy? How might we involve more stakeholders to implement changes and solutions with a greater impact at a larger scale

INSIGHT 02

Interdisciplinary Design Strategy

‘‘

There is no o n e - s i ze - f i t s - a l l solution for aging.

Research Report

Impact

Though universal design can help in ensuring creating an accessible and inclusive environment regardless of one’s abilities, aging is ultimately a unique experience that requires co-creation and collaboration with individuals to customize solutions.

Keywords

Universal Design, Inclusion, Participatory Design, Co-creating, Collaboration, Customized Solutions

Systems Map

Relevant parts of the system:

•

Individual

•

Economic System

•

Technology and Infrastructure

Research

Interdisciplinary Design Strategy

CASE STUDY: 4 STAKEHOLDER QUOTE: 1 CAREGIVER P.O.V.

Case Study

The Town of Caledon’s Universal Design Policy Canada, 2017

Stakeholders: Home-buyers Housing developers Municipal government Sales agents Older Adults Persons with disabilities or mobility issues Residents Scale: Local

Description The Town of Caledon has a long-term, community-driven strategy to universally address the needs of their residents over the age of 55, called Adults 55+ Strategic Plan. Within the official plan, the Universal Design Policy mandates any new subdivision housing development applications to follow the universal design principles on at least one floor plan, in order for their draft plan to be approved by the municipality. Some of the features are to ensure accessibility into the dwelling, a main-floor living design with wider hallways and doors, various height countertops, higher plug placements, and a roughed-in area to potentially install a residential lift or an elevator. In addition, the builders are to display and list the universal design options, along with the list of all the available features in their sales office to expand options for potential homebuyers, and for sales agents to direct older buyers to the necessary options. Impact Within the policy, the universal design principles are recognized as being flexible, desirable, and meeting the needs of both the homeowners and developers. Though the policy is still under progress, the impacts would extend beyond older adults by providing accessible homes to all. It would allow ease of movement for everyone in a household, regardless of age or ability, make housing affordable without incurring additional costs to accommodate for age or mobility changes, and add resale value to homes.

Case Study

Photovoicing The Neighbourhood: Understanding The Situated Meaning of Intangible Places for Aging-In-Place

Stakeholders: Older Adults Scale: Local

The Netherlands, 2017

Description During the process of aging, individuals acquire meaning of places through experiences, memories, and history. For those aging in place, there is an intangible attachment to places that may no longer exist. This is a photovoice study of 18 older adults aged 70 to 85 years, who live independently, and 14 professionals (social workers, housing consultants, neighbourhood managers, community workers). Older adults and professionals photographed places that they deemed a requirement for aging in place successfully. It was found that the professionals focused on access to amenities, meeting places, and mobility for successful aging in place. Yet, older adults were more focused on their lived experiences and the attachment they held to intangible places, sometimes places that no longer exist.

Impact Professionals can make more thoughtful decisions to consider the needs of older adults; in turn, may act as an acknowledgement of their lived experiences, history, memories, and place attachment. It may also reduce feelings of loss to a place, helping older adults to retain a sense of purpose, connectedness, belonging, and value. Muraro, Tiago. “Elderly woman taking a snap” Unsplash, January 23, 2015, https://unsplash.com/photos/ pwMds57bapI

Case Study

Age Friendly Neighbourhoods as Civic Participation: Implementation of A.A.P.

Stakeholders: Older Adults District councils Universities and research Institutions Business/private sectors NGOs and other social organizations

Hong Kong, 2013

Scale: Local

Description In response to the active aging policy framework proposed by the World Health Organization in 2002, and age-friendly program plan in 2007, the Hong Kong government has promoted elderly civic participation by constructing a supportive, age-friendly environment. They have do so via an array of government and non-governmental organization volunteer programs and services recognizing the lived experiences and expertise of older adults in their own communities. Older adults had the opportunity to engage in community networking to build a community where their contributions are valued, included, and heard to help to further develop age-friendly neighbourhoods. Florian Wehde Unsplash, https://unsplash.com/photos/DpgujuZ92zE

Impact One example of an initiation promoting civic participation of elders was the “Age-friendly Buses Project” in 2013. With the goal to allow elders within the community to propose a design research and recommendations to enhance the age-friendliness of the buses in their cities, the process was 7-fold: 1) preparation and recruitment of more than 80 elderly volunteers; 2) field visit to real sites for hands-on site experience; 3) participatory workshops; 4) a meeting with facilitated two-way discussion with real stakeholders and district council representatives; 5) presentation of their findings, and a press release; 6) publication of their findings submitted for consideration; and 7) education and exhibition. The elderly volunteers were able to identify gaps in the age-friendliness of their cities through a bottom-up approach of productive involvement, and empowerment. 46

Case Study

Maslow’s Hierarchy of Needs: A Framework for Achieving Human Potential Hospice

Stakeholders: Caregivers Family Frank Hospice care staff Scale: Local

The Netherlands, 2017

Description This case focuses on the application of Maslow’s Hierarchy of Needs to better inform hospice staff of caregiver treatment strategy to focus on a patient’s needs and well-being, particularly in end of life situations. Frank, the focus of this case study, was diagnosed with advanced-stage cancer and enrolled into hospice care. Using Maslow’s Hierarchy of Needs as a framework, the hospice staff and his family were able to collaborate to address his needs systematically as they were discovered: addressing immediate physiological pain due to his disease, addressing his fears of a slow painful death, ensuring the presence of community to support him, listening and allowing him to tell his story, even ultimately achieving closure by being able to revisit places and memories important to him.

Impact Frank survived past his initial prognosis of two months to a full year. He was able to come to terms with his trauma and the experience of dying brought him closer to his family. This case would go forward to being cited in 200+ more studies in the area of understanding human needs in palliative care (amongst other contexts).

Forouzani, Ashkan. “Person in white coat holding face mask and stethoscope with gloves”. Unsplash. 17 March 2020, https://unsplash.com/ photos/ignxm3E1Rg4. 47

Stakeholder Quotes

“Either you do research with a population or you do it for the population, and if you’re doing it for the population, then your end result might not meet their needs. And I think that’s what it really comes down to.” Dr. Raza Mirza

Network Manager, UofT National Initiative for the Care of the Elderly (Nice)

Stakeholder Quotes

Caregiver Interview

CAREGIVER P.O.V.

“The situations for seniors can change in a heartbeat[...]They’ll change depending on the situation, the condition, the medical, their cognitive abilities, their physical abilities. They may lose their ability to do something and maybe gain it back in a different capacity. So what may work and fit right now may not necessarily work or fit six months down the line, or vice versa. You tried something right now and it doesn’t work, but six months down the line it’s like, yeah, this would have been perfect.” - Informal Caregiver “Every client is different. It took me 6 months to build a routine with them [...] It takes time, and you have to know your clients [...] I’ve been trying a lot of different things. You have to observe them to figure out what they like and what their interests are. And eventually, I understood why they refused some things and not others.“ - Formal Caregiver “Of course I know how to build relationships. Of course I know, but it’s also one of those things that you don’t really get while you’re in a classroom. You only really learn while you’re interacting with patients.” - Formal Caregiver There is no one-size-fits all solution for caregiving. Aging is ultimately a unique experience that requires co-creation and collaboration between caregivers and the individuals to provide customized care. Oftentimes, it is through trial and error and constant adaptation for caregivers to meet the changing needs of the aging older adult.

Opportunity

Interdisciplinary Design Strategy

How might we involve older adults in the process of design to create designs that are truly reflective of their individual needs? How might we better collaborate and co-create with older adults in our community?

INSIGHT 03

Interdisciplinary Design Strategy

‘‘

Successful aging in place involves planning and preparedness.

Research Report

Impact

Though there may be unforeseeable challenges with advanced life events, planning ahead can help prepare and ease the transition for older adults and their social networks, including their caregivers; and can be better attained when proactive solutions are available, made accessible, and are advocated through the systems in place.

Keywords

Preparation, Proactive Solution, Transition, Support

Systems Map

Relevant parts of the system:

•

Individual

•

Community

•

Economic System

•

Political System

•

Technology and Infrastructure

Research

Interdisciplinary Design Strategy

CASE STUDY: 3 STAKEHOLDER QUOTE: 2 CAREGIVER P.O.V.

Case Study

Advanced Life Events That Impede Aging in Place Among Older Adults United States, 2016

Description While older adults do acknowledge certain foreseeable life events that may arise in their futures, they are knowingly and willingly unprepared for them. If they wish to have their voices heard, older adults must overcome their unpreparedness. This case study interviewed 68 adults between 65 to 87 years of age. The older adults categorized five Advanced Life Events (ALEs) that may impact their ability to age in place at home. Specifically, hospitalizations, falls, dementia, spousal loss, and home maintenance issues. Numerous older adults remarked that they neither planned for an ALE nor believed an ALE would happen to them. Furthermore, apparent themes began to emerge as to their disregard for planning. Namely: uncertainty over their future; claiming to be either too healthy or too sick; the influence of their offspring; denial and procrastination; perceiving an overwhelming number or perceiving a lack, of options; financial concerns; pride. Older adults need to overcome their preconceived notions and plan for their futures as the next step in giving themselves a voice regarding their future care.

Impact Future planning (prevention strategies, risk mitigation, funding solutions) may better prepare older adults for at least some of the ALE that may arise in their lives. Having plans in place may also offer them a greater peace of mind; in turn, bettering their overall sense of well-being.

Case Study

Stakeholders: Older Adults Scale: National

Image:Wong, Jeremy. “Grandma crying moment during a wedding” Unsplash, June 30, 2017, https://unsplash.com/photos/1iP2NFMaMHU

Case Study

Older People Living in Squalor: Ethical and Practical Dilemmas Australia, 2009

Description When we consider aging in place, the home is a place where services may be provided. When the conditions of these homes are deemed to be in squalor, then access to services may not be rendered. For some, these conditions may be resultant of psychological health issues. Regardless, the homes of older adults aging in place should be in such a condition where they are able to receive access to services. Australia’s Squalor Program aims to facilitate cleanups for those living in squalor. This case study explored the case management of 28 male and 32 female clients, who participated in this program for an average of 15.3 months each. This case study examined two situations in which older adults were living in squalor and highlighted implications for those who work closely with older adults. The several benefits of the Squalor Program included: providing a safe environment for caregivers to access older adults in their homes; connecting older adults with community services; and decreasing external pressures from family, neighbours, and landlords.

Impact Dealing with the conditions of older adults homes so that they may remain aging in place in comfort, is a beneficial and cost-effective way of managing the rising number of older adults who require assistance.

Stakeholders: Older Adults The Benevolent Society, Sydney, New South Wales, Australia Scale: Local

Carman, Haley, “Comfortable armchair in home library” Unsplash, May 23, 2019, https://unsplash.com/photos/c4LpYfizLvw 58

Case Study

Older Adults’ Experience of Home Maintenance Issues and Opportunities to Maintain Aging in Place New Zealand, 2016

Description Home maintenance tasks may be viewed as either an issue or an opportunity for older adults aging in place. This case study interviewed 28 older adults aged 65 to 94 to seek an understanding of older adults experiences regarding home maintenance tasks. Older adults view these tasks negatively if they have financial or mobility constraints, causing them anxiety, stress, and worry. Yet, those who can tend to these tasks on their own feel a positive sense of self and autonomy. With either perspective, their well-being, sense of social legitimacy, and place attachment, are impacted. Ultimately, how home maintenance tasks are viewed by older adults influences their experience of aging in place.

Impact Being able to successfully address home maintenance matters can offer a sense of achievement for older adults. Thus, offering a positive perception of their capabilities, heightening their beliefs of independence, and renewing their perspectives of their ability to age in place.

Stakeholders: Older Adults The University of Auckland, Auckland, New Zealand Image: Vălenaș, Sergiu. “Old window” Unsplash, February 12, 2018, https://unsplash.com/photos/knrpCSJ6XlQ

Scale: Local 59

Stakeholder Quotes

“In order for it to be an effective aging in place experience, we need to be able to incrementally provide those supports that make aging at every point, the best that we can make it for each of the individuals.” Mwarigha

VP, Housing & Homelessness Services, Woodgreen Community Services

Stakeholder Quotes

“The reality is not everyone can age in place because a lot of times homes weren’t built for that. They didn’t have that kind of plan in place; and people financially will have challenges with aging in place not being able to afford extra care.” Arlene Etchen,

Knowledge Transfer Consultant, Canadian Mortgage and Housing Corporation

Caregiver Interview

CAREGIVER P.O.V.

“Sometimes, I think we’re not that prepared. We take it day by day.” - Informal Caregiver “We’re just kind of waiting for her to tell us, I can’t do this or I can’t do that. We observe her just to see how things are going.” - Informal Caregiver “Time will come when I will no longer be able to take care of [my husband], but we can find solutions that are out there when it happens.” - Informal Caregiver

Caregiving is an emotionally straining, time consuming and a costly feat. In order to optimize the utilization of available resources, one may need to prepare and plan ahead. Especially in terms of informal caregiving, planning ahead may require being able to gather and schedule the right people for support, ensuring that the people involved are able to take time off, be knowledgeable of, and have access to necessary resources and equipment, such as assistive technology, to be able to provide proper care. However, 3 out of 5 informal caregivers have alluded that they are reluctant to plan ahead

Opportunity

Interdisciplinary Design Strategy

How might we help older adults ease the feelings of uncertainty in their later years? How might we normalize and facilitate more conversations about aging and advanced life events? How might we motivate people to start preparing for their advanced life events?

INSIGHT 04

Interdisciplinary Design Strategy

‘‘

Having access to information empowers older adults’ ability to make informed choices.

Research Report

Impact

One should have options available to choose from, and able to easily access information, and solutions such as programs, products, and services; so as to be able to make better informed decisions according to their own needs and preferences.

Keywords

Choice, Access to Information, Informed Decision Making, Judgement, Independence, Equity

Systems Map

Relevant parts of the system:

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Individual

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Community

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Social System

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Economic System

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Political System

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Technology and Infrastructure

Research

Interdisciplinary Design Strategy

CASE STUDY: 3 STAKEHOLDER QUOTE: 1 CAREGIVER P.O.V.

Case Study

Skill Mix Change Between General Practitioners, Nurse Practitioners, Physician Assistants and Nurses in Primary Healthcare for Older People Netherlands, 2018

Description Quality of care to older adults can be optimized to include a diverse skill mix of health care practitioners. This case study interviewed 34 primary healthcare providers, including general practitioners, nurse practitioners, physician assistants, and nurses. An interview study was conducted on fourteen individuals and five focus groups in a general practice care and community care environments. Nurse practitioners and physician assistants can act as substitutes for physicians to treat older adult-patients living at home. Treatment includes the ability to diagnose and prescribe medications. The results of physician substitution have proven to be on par, or better, than when older adults receive care and treatment by physicians. The reasoning can be attributed to greater accessibility, amount of time, and attention, being allotted to older adult-patients; thus, offering a more holistic view, and proactive approach, of their care and treatment.

Impact

Stakeholders: Older Adults General Practitioners Nurse Practitioners Physician Assistants Nurses in primary healthcare Scale: National 70

More thorough and personalized health care with quicker access to treatment can offer a greater sense of therapeutic alliance between older adult-patients and healthcare providers. Competencies and legal boundaries must be clearly defined, understood, and respected between the skill mixes, with collaborative relationships based in trust, constant communication, and shared goals.

Case Study

Strategy for Swiss Aging Policies Switzerland, 2007

Description The strategy for Swiss aging policies is an approach presented by the Swiss federal government in 2007 in order to help the aging population live long, independent, and healthy lives in their own homes. The policy focuses on meeting the needs of older adults by providing accessible resources and necessary care. It acknowledges the needs of older adults, such as autonomy, active social engagement, and civil participation. It also recognizes their contributions to their communities. The policy also includes guidelines on various age-related topics such as health and care, social security, employment, mobility, pensions, and engagement. These guidelines have also adapted to meet the specific needs of regional and local municipalities.

Impact Demonstrating a top-down approach to policy implementation, the Swiss government was able to adopt a federal policy plan based on the framework proposed by the World Health Organization on Global Strategy and Action Plan on Aging and Health. By considering the existing socio-political pre-conditions for taking action, and outlining potential options to address specifically challenges, the federal guideline was then adapted to meet regional and local requirements.

Stakeholders: Swiss Federal Council Older Adults Scale: National 71

Case Study

Feed It Forward Canada, 2014 - Present

Description Feed It Forward is a charity that focuses on tackling the issues of Canadian food insecurity and food waste. Operating mainly in the Greater Toronto Area (GTA), it is involved in a variety of initiatives, most notably in operating North America’s first pay-what-you-can grocery store, bakery, and coffee shop. Shoppers are restricted to a family’s worth of daily needs to ensure enough food can be shared amongst people in need. Additionally, the charity distributes nutritious meals throughout the GTA with their mobile food truck initiative. Feed It Forward was launched by formerMarine-turned-Chef Jagger Gordon in 2014, focusing his approach on rescuing unsold food from places like restaurants and grocery stores otherwise destined for the landfill.

https://unsplash.com/photos/y3ZY6qFln_g 72

Case Study

Impact As of May 2020, Feed It Forward has served 654,236 meals, and saved 1,114,200 lbs of food from landfills. Feed it Forward distributes approximately 1,600 meals per week through their mobile food truck initiative. Winner of the 2019 City of Toronto Volunteer Legacy Award.

https://unsplash.com/photos/A4Ax1ApccfA

Stakeholders: Volunteers Jagger Gordon Recipients Donors Food partners Sponsors Scale: Local

Stakeholder Quotes

“It’s simply about the choices that we want. That we value what’s important to us individually and how, as we age, some of those choices either get reduced or completely removed.” Ron Beleno

Older Adults and Caregiver Advisory Committee Co-chair, Age-Well Inc.

Stakeholder Quotes

Caregiver Interview

CAREGIVER P.O.V.

“[My grandmother] has been living with me ever since [she fell]. In fact, the house that I bought right now, the reason I bought it, was for her, it was very difficult in Toronto to find a three bedroom house on the same floor [..] There are limited bungalows and most bungalows are smaller in size. It’s really hard to find at least three bedrooms that are on the same floor, where I could have the space for her without stairs.” - Informal Caregiver “I’ve basically taken [caregiving] into my own hands and dealt with it the best way I can. Are there additional supports? Maybe there are, I can’t tell you, I haven’t looked for them. I’ve been in moments of crisis, and if necessary, I do resort to physical restraints...and the physical restraints that I use, have always been personal, physical, restraints. Just holding her, maybe for hours “ - Informal Caregiver There’s still a lot of things to be done and made [in terms of providing care]. And every day I find things– either I read it on the internet, or people offer suggestions. But you’re like, okay, it doesn’t apply to me. - Informal Caregiver In our case, we’re very lucky. It’s not a matter of money. It’s just a matter of actually deciding it and valuing it as a priority. Because it’s not my house. I can’t just make these changes. - Informal Caregiver Access to readily available and relevant information and a comprehensive understanding of options can empower caregivers to make informed decisions about providing care for older adults. However, such decisions are also dependent on the availability and affordability of resources, its applicability to individual circumstances, and motivation to enhance care.

Opportunity

Interdisciplinary Design Strategy

How might we optimize information access for older adults? How might we better communicate the value of our solutions to our users? How might we empower older adults make better informed decisions?

INSIGHT 05

Interdisciplinary Design Strategy

‘‘

Aging in place should accommodate for different needs in order to provide equitable solutions for older adults.

Research Report

Impact

This can be achieved by providing alternative solutions that account for differences in culture/language, finance, health, socio-political identity, and abilities of individual.

Keywords

Alternative Solutions, Diversity, Identity, Equity, Individually

Systems Map

Relevant parts of the system:

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Individual

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Social System

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Economic System

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Political System

Research

Interdisciplinary Design Strategy

CASE STUDY: 3 STAKEHOLDER QUOTE: 1 CAREGIVER P.O.V.

Case Study

Walkways of Life | Dementia Sensory Garden United Kingdom, 2014

Description The Dementia Garden was designed with many features to initiate physical, cognitive, social and psychological benefits to patients with dementia. The carefully designed, figure eight pathway was created with no dead ends, linking all areas of the garden to a central line forming a safe environment for the residents. The planting scheme was designed on a colour wheel to help residents identify different areas of the garden. Multiple seating areas were placed around the garden to ensure the safety of the patients and a place to relax and chat with family and friends. An activity area for no-bend vegetable growing and workshops for painting and small craftwork was also built into the design. Other items that offer stimulation and psychological benefits were strategically placed such as metal sculptures with flowering roses trained over to denote entrances and exits, a postbox and bus-stop to trigger memories and water features to create areas of tranquility and reflection. The garden has been described as a national example of excellence in dementia care.

https://www.houzz.com/hznb/photos/walkway-to-a-long-life-sensory-gardenwestcliff-on-sea-essex-contemporary-landscape-essex-phvw-vp~40343882

Case Study

Stakeholders: Dementia patients St Martin’s Residential Care Home Scale: National

Impact Sensory experiences can awaken the memory centers of the brain and engage residents in responses that are both emotional and physical. Features of the garden help trigger memories, and stimulate the senses with floral fragrances and colours.

https://www.pexels.com/photo/woman-standing-near-yellow-petaled-flower-2050994/

Case Study

Exploring Aging-In-Place Among Chinese and Korean Older Adults in British Columbia, Canada Canada, 2008

Description

Impact

For years, there has been a constant migration of Chinese, and increasingly steady migration of Koreans, to Canada. Occurring now is a demographic trend that reveals the influx of older adult immigrants aged 65 and older. Canada’s provincial and municipal governments should prepare for these trends and subsequent impacts.

Korean community partners are looking into a similar model that will allow Korean older adults to age in place independently, within their own communities, and with familiar resources.

This case study compares different housing needs, neighborhood characteristics, and the use of local amenities of these two populations through interviews of 50 Chinese and 49 Korean older adults. Upon arrival in Canada and living with their adult-children, Chinese and Korean older adults faced adjustment issues regarding head of household changes. In turn, these older adults sought relief from the stresses by finding independent living arrangements. The number of Chinese older adults who moved to independent housing was significantly higher than those of Korean older adults due to Chinese community partners who received provincial funding to develop assisted living homes for low-income older adults.

Stakeholders: Older Adults Scale: Local

https://www.pexels.com/photo/smiling-man-andwoman-wearing-jackets-1642883/

Case Study

Loree Erickson’s Care Collective in Toronto, Canada Canada, approx. 2002 - ongoing

Stakeholders: Loree Erickson Care Collective Social and community networks Scale: Local

Description Loree Erickson is a radical disability justice and anti-oppressive scholar, community activist, and porn star, who requires personal care assistance multiple times per day. Unable to access formal funding to pay for this care work as a Canadian immigrant without Citizenship, Loree developed an alternative system of care. To meet her care needs, Loree organizes a volunteer care collective promoting disability-focused and anti-oppressive community building. The Care Collective is a careshifting community developed resource which has been operating for over eighteen years, comprised of volunteers who commit to personal care shifts. Loree and her existing Collective members and colleagues circulate open calls for Care Collective volunteers on an as-needed basis, through professional and social networks, often via social media circulation, to maintain the collective of approximately 20 volunteers. No previous experience is required to volunteer in the Collective, however, Loree maintains community with likeminded people and seeks volunteers with similar values and disability justice politics.

Impact The Care Collective is very strategically and directly impactful for Loree Erickson and its members. Through the maintenance of an active Collective, which emphasizes tangible forms of recognizing care labour and engaging in labour exchange, Loree meets her care needs without the exchange of monetary wages. Particularly with such longevity, the significance of this care model cannot be understated as a strategic design approach. 85

Stakeholder Quotes

“We have to be culturally sensitive when we’re coming up with policies to meet the needs of older adults, particularly older adults who may not have the same cultural norms that the majority of the population has.” Glenn Miller Senior Associate, Research. Canadian Urban Institute

Stakeholder Quotes

Caregiver Interview

CAREGIVER P.O.V.

“Every client is different because the culture is different. I’ve worked with an Italian couple, a Canadian one, and others. [Providing care] is really different, every client and every case; it’s a case-by-case basis.” - Formal Caregiver “I know for sure that our children will not leave us. They will help take care of us as much as possible. Even if it’s not a hundred percent, at least they’re to guide us or to see if anything happens to us.” - Informal Caregiver “My grandmother has never been a very warm person in general, when she was a warm person, she would be kind and thoughtful and even charming sometimes. But for sure...You would need to be a male. Seriously, I’m not exaggerating. No, my brother is like a perfect child, he can’t do anything wrong... she respects him way more. She’s less vocal when she is with me... She expected tons for me. She didn’t have a lot of caring, warm...comments or love for me.” - Informal Caregiver In accounting for the discrepancies between older adults and their caregivers; different cultures, along with their norms and expectations, are associated with varying problems that demand for different approaches to solutions. For instance, in providing customized care, informal caregivers may be providing care for a close relative as a result of cultural expectations; whereas, for formal caregivers, it may require adjusting and accommodating to a client’s cultural lifestyles and preferences 88

Opportunity

Interdisciplinary Design Strategy

How might we create flexible and dynamic solutions that can be adaptable and customized? How might we better communicate the value of our solutions to our users? How might we create alternative solutions to deliver the same quality of goods and services for people with diverse needs?

INSIGHT 06

Interdisciplinary Design Strategy

‘‘

A social support network is indispensable to a successful aging in place experience.

Research Report

Impact

A social support an older adult can rely on can help maintain one’s physical, mental, cognitive, and emotional well-being.

Keywords

Social Support, Network, Well-Being, Community

Systems Map

Relevant parts of the system:

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Individual

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Community

Research

Interdisciplinary Design Strategy

CASE STUDY: 3 STAKEHOLDER QUOTE: 1 CAREGIVER P.O.V.

Case Study

Aging In Place and The Place of Aging: A Longitudinal Study United Kingdom, 2020

Description The places where people age may change over time, as do the people aging within them. This means that the relationship between the people who are aging and the place where they are changing are in constant flux. This can often be a challenge for those aging in place. This case study examined four White working class older adults over four years through interviews that established the circumstances of the older adults themselves, as well as their respective neighbourhood communities. Aging in place is an ideal outcome for people, yet, little consideration has been paid to how people’s neighbourhoods age alongside them. Some older adults identified that population turnover within their communities challenged their sense of home causing them to feel alienated or excluded. Alternatively, others were able to successfully adapt to the change, building on their sense of identity and belonging.

Stakeholders: Older Adults Scale: National

Case Study

Impact As older adults and neighbourhood communities change over time so must the relationship between the individual aging in place and their place of aging. older adults may benefit from social supports as new populations are introduced into their communities. This may make them feel that their opinions and needs are accounted for as changes occur. Image: Sheldon, Jeff. “Old man reading newspaper with tea” Unsplash, November 5, 2014, https://unsplash.com/photos/4vr9a_sdJ78

Case Study

Receipt of Formal and Informal Help with Specific Care Tasks Older People Living In Their Home. National Trends Over Two Decades. Sweden, 2018

Stakeholders: Older Adults Swedish government Scale: National

Description As people age, they require varying levels of support in relation to their ability to perform daily living tasks. This case study examined older adults living independently aged 77 and above. It focused on two common tasks, house cleaning and food shopping, in relation to the following factors: gender, living alone, having children, and socio-economic position. In Sweden, formal care (institutional care), is available to all citizens aged 65 and above on an as-needed basis. However, due to changes in recent decades, significant reductions have been made causing older adults to rely more heavily on informal care from family and friends for personal care and practical living support. Resultantly, there has been a trend of “re-familialization” of care, where older adults become increasingly dependent on others; thereby, threatening their autonomy. As women typically enter widowhood later than men, they have especially been affected as living alone is the most influential driver compelling the receipt of care. Women tended to rely on formal care for house cleaning and food shopping, while men relied more on informal care. Impact Continued reductions in Swedish legislated supports will mean greater onus on older adults to rely on informal care to perform their daily living tasks.

Centers for Disease Control and Prevention, “Elderly woman teaching her grandson how to Unsplash, February 13, 2020, https://unsplash.com/photos/E9BR0lNMiQE

Case Study

Toronto Homeshare Program Canada, 2019

o safely use a knife to peel potatoes”

Stakeholders: The National Initiative for the Care of the Elderly (NICE) Ontario Ministry of Seniors Affairs City of Toronto Older Adult International Students Students Scale: Global

Description The intergenerational co-housing project partners the aging population with youth to create a dynamic solution for providing care for older adults wishing to age in place, in alleviating their financial burden, decreasing social isolation on one hand, and offering post-secondary students and international students with reduced living costs ($400-600 rent) amidst a housing crisis, in return for up to 7 hours of companionship or assistance. Facilitated by dedicated social workers for careful screening, safety inspection of homes, providing ongoing support with regular follow-ups, any necessary medication, and conflict resolution services. Officially launched in Toronto as a City of Toronto program in partnership with the National Initiative for the Care of the Elderly (NICE) as an initiated created as a direct result of the Toronto’s older adults Strategy Accountability Table in May 2018.

Impact A direct result from the implementation of a recommendation that arose out of Toronto’s older adults strategy 2.0, the HomeShare program in Toronto has matched 12 older adults with students through their pilot program as of April 2019, and had aims to connect 200 more throughout the new academic year (prior to COVID-19 pandemic breakout -- progress since then is unknown).

Stakeholder Quotes

“Like anything in life, everything works better when you’ve got a lot of players. When you’ve got a team, you’ve got alternative solutions.” Don Fenn

Founder, Home Modifications Canada

Stakeholder Quotes

Caregiver Interview

CAREGIVER P.O.V.

“I guess that goes back to this social piece. I think that it takes a village to raise a child, and having someone aging at a home is not really that different. And the difference is that they don’t grow, they get worse, they get younger.” - Informal Caregiver “There’s other aspects to caregiving that go beyond just caregiving for someone. At least to me, caregiving means you need [the older adult] to live in a clean environment. For that you need to mop. You need to clean, you need to wash dishes. She spilled something, you need to clean it up. I don’t know. Maybe, some people only care for the person and then leave all the things dirty. But that’s not the case for me. [...] We’re also five people here [helping grandma]. We’ll try to do our best. As I say this, I’m watching my dad go take out the garbage, and everybody’s trying, but it’s an imperfect system.” - Informal Caregiver “There is no actual quote un-quote downtime until I’m out of this apartment. When I’m in my own space or out with my friends or walking my dog. [...] So it feels like [my caregiving task has] ended, and I’m doing something else. Then I’ll come back. And I think that makes a difference when you’re caregiving full time.” - Informal Caregiver

A social support network team of multiple members is indispensable to the well-being of an older adult, as providing care includes many aspects such as: transportation, companionship, assistance with basic activities of daily living, household chores, grocery shopping, etc. that may be overwhelming without a team of people to distribute the responsibilities. In addition, caregivers also rely on a social support network to be able to maintain their well-being outside of their caregiving duties, often through personal leisure activities to alleviate stress associated with long hours of caregiving.

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Opportunity

Interdisciplinary Design Strategy

How might we facilitate more meaningful interactions within communities? How might we enable people to seek out support when they need it?

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INSIGHT 07

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Interdisciplinary Design Strategy

‘‘

The impact of technological solutions may vary according to the user’s familiarity with, and understanding of how to use technology.

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Research Report

Impact

There is great potential in technology for those who are socialized and acclimated to technology; otherwise, technology without proper support for engagement may further isolate, depersonalize, and demotivate older adults

Keywords

Technology, Assistive Technology, Interaction, Human to Human

Systems Map

Relevant parts of the system:

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•

Individual

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Community

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Technology and Infrastructure

Research

Interdisciplinary Design Strategy

CASE STUDY: 3 STUDENT ESSAY EXCERPT: 1 STAKEHOLDER QUOTE: 1 CAREGIVER P.O.V.

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Case Study

Motum United States, 2020

Description

Impact

Motum offers smart mobility aids and ambient monitoring services. Through their service, Motum proactively informs older adults and their care network about health, wellness, and mobility changes that may negatively impact their lives.

These innovative products and services enhance independence, security, confidence and quality of life for older adults.

Motum uses machine learning analytics and advanced assistive technologies. Their mobility products feature a cellular safety button with twoway voice and location tracking. When an emergency call is launched, it is immediately routed to the older adults selected caregiver. At the same time, the call is supported by a call centre professional. Motum’s technologies constantly monitor the older adults wellness, allowing trends to be identified and shared with caregivers.

Stakeholders: Older Adults Family Caregivers Scale: National 106

Case Study

ELLIQ

Stakeholders: Older Adults Users

United States & Israel, 2017

Scale: National

Description Loneliness and lack of social activity among older adults is one of the biggest issues in the future. ElliQ is an example of how technology can appear less complex and less intimidating to this specific population. ElliQ, designed by Yves Behar and Intuition Robotics, is a voice-controlled tabletop assistantive technology that encourages active and healthy lifestyle. ElliQ was specially designed to assist older adults in managing and improving their health and wellness while keeping them entertained.

Impact ElliQ is designed to proactively engage with its users. It is an emotionally intelligent robotic companion, intended to help the aging population connect with technology and continue learning in later life and fill their loneliness. https://www.therobotreport.com/wp-content/uploads/2020/05/Screen-Shot-2020-05-11-at-10.57.12-AM.png

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Case Study

Successful Cognitive Aging France, United States & Japan, 2009

Description A scientific study proposes to use a systematic approach to slow the decline of natural cognitive aging through the means of cognitive remediation. Cognitive mediation maintains, improves, and mitigates the loss of cognitive capacity in older adults. The purpose of this study is to provide a synthesis of cognitive remediation for future practice and research on improving relationship between cognitive ability and age. These cognitive remediation strategies include Posit Science, a self-administered training program to practice and perform six visual and auditory tasks at consistent daily increments, and Brain Age, a Nintendo DS game designed to train the brain for 10 minutes a day.

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Case Study

Impact The recognition of plasticity in the brain puts emphasis on preserving cognitive ability as a mean of successful aging at a preventative stage. However, a crucial gap to this implementation is found at the level of caregiver-to-patient relationship. In order to facilitate successful cognitive aging, caregivers must also function in the role of an educator and advocate to apply cognitive remediation computer programs to the daily habits of the patient.

Stakeholders: Journal of Gerontological Nursing School of Nursing University of Alabama at Birmingham Scale: Local

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Student Essay

An excerpt from: “Tech for Good? A Critical Analysis of the Ethics of Tech” by LJA Bolongaita The Paro robot is a robotic pet in the shape of a baby seal designed to facilitate communication and stress management primarily in patients with cognitive decline. It is meant to be a safer, more sanitary, and easily reproducible alternative to live care animals and/or humans. The author builds from other prominent individuals in the space (Tergesen and Inada) and states the following: “Although Paro was not designed as a replacement for social interaction with people, one still might observe that, during actual occasions when it becomes the focus of attention for elder humans, it often may be substituting human-robot interaction for human-human interaction” (Calo et al.). The author brings to attention the question of the possibility of further giving older adults means to isolate themselves through the appearance of connection instead of encouraging them to reach out to their community.

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Student Essay

Aside from the Paro, there are other functional robots that are also generating questions about the role of robots in an aging world. There are robots that can simulate social interaction; and some that can aid in personal tasks such as feeding and bathing. The biggest take-away, however, is the cautionary tale that is painted, “human contact is [...] in danger of becoming a luxury good as we create robots to more cheaply do the work of people” and “robots may violate human dignity because it can be demeaning and objectifying to have a machine wash or move you” (Samuel).

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Stakeholder Quotes

“[With technology, we’re] finding new ways of solving old problems, problems that old methods haven’t solved effectively.” Atul Bhatt

Advisor, Policy & Innovation, Canadian Mortgage and Housing Corporation

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Stakeholder Quotes

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Caregiver Interview

CAREGIVER P.O.V. “Some houses will have a lift if the client can afford it. But usually it’s just you and maybe you’ll have another PSW working with you. If it’s a heavy patient, and there are no lifts, you’ll just have to find someone to help you. [...] Sometimes when you’re by yourself, you might make stupid decisions because you’re right there and you just want to help– but the wise decision would be to be able to call someone to help you lift the person back to bed.” - Formal Caregiver “We’re trying to find practical solutions. We bought this bar that you can install on the bed frame, but it’s not a clinical bed. But [my grandma] figured out how to get around it. She’s like a grown child, think about it this way. Except she’s much stronger and she could pull [the bars] out, she can move it. And so if you put her in her own bed with these new bars, she knows how to push them to the side or slide down. She knows how to squish everywhere. It’s crazy. It’s not a solution.” - Informal Caregiver “In terms of cleaning. I can see the value of something automatic that can help vacuum a little bit. But again, when you were sleeping and eating and sitting all day in one space, light cleaning in my point of view is not enough. You need to clean up, and clean up well and deeply as much as you can. And I think an old person can’t do it on their own and you need to move the furniture and you need to organize the things as much as possible.” - Informal Caregiver [My grandmother] needs a walk-in shower with proper handles, with ideally movable shower heads. All those little things make a world of a difference in trying to shower her three times a week, it’s much safer. I would also change the toilet. It’s too low. It takes effort for [my grandmother] to squat down and make sure that she’s sitting in the right position. Little things like that. Call them technology, call them perks, I don’t know. But I think those are very important aspects of making everything a little bit easier.” - Informal Caregiver Caregiving relies heavily on human capabilities to be able to provide customized, compassionate care, which depends on the caregiver’s physical and emotional capabilities. Although all 7 interviewees have mentioned using some form of assistive technology, they were all hesitant to say that they rely on any technology in assisting them to provide care. 114

Opportunity

Interdisciplinary Design Strategy

How might we better support human to human interactions through technology? How might we remove barriers to technology to enhance its impact?

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LOOKING FORWARD

To-date, we have conceptualized six (6) design interventions, namely: 1. 2. 3. 4. 5. 6.

Beyond Home Dear Diary Elements Food Connections The Golden Circle (formerly known as Seniors’ Corner) The Heart

In the upcoming months, we expect to continue expanding our views on what it means to live and age in place in Canada. We hope to tangibly create a prototype for Beyond Home, Elements, and The Golden Circle, as our contributions to older adults that may shape their future ways of living.

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Beyond Home Beyond Home is a gamified health experience that supports activities of daily living through an immersive and holistic home entertainment system that aims to engage older adult users to draw the outside world in.

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Dear Diary Dear Diary offers women a new opportunity to express and understand their emotions, interact with others in a meaningful way, and is simple and convenient, offering them a sense of connection, bringing a sense of hope and purpose into their lives.

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Our Design Interventions

Elements For Elements, we designed an environment that enhances the experience of aging while engaging older adult’s mental, physical, and emotional well-being by focusing on the elements of the mind, body, and spirit because we believe that as humans age, the need for these connections is critical to our well-being.

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Our Design Interventions

Food Connections Food Connections is an end-to-end dietary support that allows users to make incremental changes to their diet while being relevant to their cultural and health contexts. This is done through a model of learn - connect - support, wherein we involve grocery stores, caregivers, community members, third party deliverers, dietitians, chefs, and health care providers to join in supporting the user through their transitionary time.

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The Golden Circle The Golden Circle (formerly known as Seniors’ Corner) is an opportunity for older adults to connect with people of all ages in public spaces through a mobile recording pod. It enables them to share their stories, experiences, wisdoms, and leave their legacy for future generations.

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The Heart The Heart is the only virtual assistant technology designed specifically for older adults with a built in projector for a hands free, immersive experience of the online world. Specifically designed to tackle digital barriers, The Heart can filter external apps and services through our app, applying universal UI design to render any external user interface to one that is more age-friendly.

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Research Report

Gaps in Context 1. What are the challenges of sustainability and what are the environmental impacts of current, popular existing products, systems, and services? 2. How do we address the challenges of the pandemic and exploring resilient design? 3. What are the accessibility challenges related to the connectivity and affordability of technology? 4. What are the challenges for aging in place in rural and remote communities?

Gaps in User Group 1. What behavioural studies of our user groups exist? 2. What are the intersectional identities, experiences, and challenges of our user groups and how do they affect their perspectives on aging in place? 3. What are the necessary products, systems, and services available for our user groups given different limitations and barriers?

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Gaps in Alternative Solutions 1. How might we contrast the aging experience in long-term care facilities? 2. What alternatives exist beyond aging in place? 3. How might we design solutions for older adults aging in place with reduced levels of ability?

Gaps in Current Market 1. How do we forecast and measure the long-term impacts of new solutions developed to address the needs of the aging population, ex. social, technology, infrastructure? 2. How might we ensure equitable access to existing systems and services for older adults? 3. How might we provide customizable solutions that meet individual needs on a mass scale? 4. Why do intervention programs not guarantee adoption?

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CONCLUSION

The population of Canada is aging rapidly, exposing the need for systemic changes to accommodate this changing demographic. Given that, there is a growing interest from governments, private organizations, and community stakeholders for design interventions that contend with the various challenges that older adults face as they live and age in place. In support of this, our cohort determined seven (7) key insights that will guide us to create desirable, feasible, and viable solutions. They are: • Aging in place requires policy solutions that support the process of aging at the individual level. • There is no one-size-fits-all solution for aging. • Successful aging in place involves planning and preparedness. • Having access to information empowers older adults’ ability to make informed choices. • Aging in place should accommodate for different needs in order to provide equitable solutions for older adults. • A social support network is indispensable to a successful aging in place experience. • The impact of technological solutions may vary according to the user’s familiarity with, and understanding of how to use, technology. These insights were uncovered through our secondary and primary research gathered and conducted thus far. The end goal of these insights is that they will be used to help inform the design interventions our cohort prototypes during the next semester.

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RECOGNITION The Hello Aging Team would like to thank all of the Faculty and Advisors for their support and guidance over the past few months while we explored the subject of living and aging in place.

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Aging is inevitable, 138

we’re all in this together. 139

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