The desirable scale: Weighing social quality of assisted living facilities

Abstract

Purpose In order to age-in-place, Dutch older adults have been housed in Assisted Living Facilities (ALFs) for over 25 years. Here they live independently but can rely on services and care facilities. The size of these ALFs ranges from 30 up to 300 residents. They are often considered to be outdated. Nevertheless, they continue to be built but their character is changing by housing a greater mix of people. In contrast with the field of housing and care for dementia, the impact of scale on social quality of housing has not yet been explored. This paper discusses the relationship between scale, social interaction, the facilities offered to the tenants, and the perceived quality of living conditions. Method We reviewed the literature on concepts of scale, mix of functions and groups, and quality of social environment of housing for the elderly. After this desk research, a strategic selection was made from the database of the Expertise Centre Housing-Care. This paper presents the results from the multiple case study of the selected 24 projects. Observations were made on each of them. Around 196 inhabitants, 48 initiators, and 48 professionals were interviewed using a narrative method, qualitatively analysed in ATLAS ti. Results & Discussion The projects were far more mixed than presumed, resulting in two contra-dictory findings: a positive influence on social interaction and informal care but a negative influence on perceptions of confronting a more care-demanding future. Government and initiators intentionally presume informal care: healthy elderly support other groups. This is directly related to the mix of the independency among inhabitants. Where present, this mix encourages social interaction and quality. However, due to reductions by government and changing demands for hous-ing, more people can age at home. This results in more limited mutual informal care and so undermines the concept of Assisted Living Facilities. Depending on the situating, scale influences this precarious balance directly: small-scale pro-jects are more appreciated in villages, large-scale projects in cities. Safety experience -an important social quality of housing- is better assured at small scale. Regarding social interaction, in villages there is more informal contact and social cohesion; this social control has both positive and negative effects. In city environments however, the lack of the negative aspects of social control are a major factor in appreciating the large scale. Moreover, a good mix of people is more easily obtained in a large scale setting: diversity, liveliness, and activity are all more appreciated in cities. Ulti-mately, aggression within social relations has a strong negative influence on social activity and bonding: elderly avoid communal activities within the ALFs. The influence of scale on relational aggression will be analysed in the final phase of this research during the first half year of 2012.