By Alexis Wise
As we consider how to create healthy places to live, work, play, and age, an important first step is to distinguish between health and health care. These things are related but not synonymous. Health is about living well and thriving day to day. It’s a measure of how well we are feeling, how closely connected we are to friends and family, and how high our quality of life is. Health care, meanwhile, is typically a response to illness.
Planning and programming designed to support good health is concerned with preventing illness in the first place and enabling people to thrive. Enhancing the health of individuals and communities cannot be the domain of health care service providers or public health professionals alone. Transforming how cities and neighbourhoods support improved health requires participation of a broad set of stakeholders who together adopt health as a shared priority.
While planning for health will improve quality of life for everyone, it is particularly important for more vulnerable populations, including a demographic that is increasing rapidly in cities around the world: older adults. As we age, many of us will experience declining physical and mental health, making us more reliant on local resources to meet our needs and keep us healthy.
In Toronto, as in the rest of Canada, older adults are the most rapidly growing segment of the population and are projected to account for almost a quarter of the population by 2030. Adults over the age of 65 are also the most intensive users of health care services. In Canada, approximately 80 percent of older adults live with one or more chronic conditions. A city’s ability to meet the unique and evolving needs of aging populations is critical to ensuring that older adults remain healthy and independent.
As we prepared our Toronto Tomorrow proposal, we sought to better understand how older people would like to live in cities, and what resources would enable them to live well. To that end, we collaborated with the Futures Team at SE Health, a Canadian social enterprise dedicated to transforming the way that people live and age at home. Part of our work with SE Health involved hosting a half-day workshop, where we met and heard from a group of dynamic, outspoken, and passionate older adults who had a lot to share. You can read the full report here.
We were particularly interested in better understanding senior views on the intersection of housing and health. While of course older adults are not a homogenous group, we did hear some commonly held ideas about what they’re looking for in a community and in the places they call home.
Moving Towards Intergenerational Communities
One point we heard strongly was a desire to live in intergenerational communities. Older people want to be surrounded by people of all ages, including younger people, not segregated to seniors-only communities. The common model for housing and supporting older adults — the retirement or assisted living facility — was created for mostly practical and operational reasons. It wasn’t created to meet a human need or a community goal and most workshop participants were looking for an alternative.
We also heard from the group that their first choice as they age is to live in the home and the community they know. Sometimes this is difficult. Their home or the neighbourhood may not be well suited to aging — it may have too many stairs, for instance, or be far from key amenities, making day-to-day tasks more difficult when older adults retire from driving. And there are often few alternative housing options available in the immediate community for older adults who require additional support. Homes and neighbourhoods that can enable independence into older age are clearly highly valued.
These are the types of challenges we aimed to address with our proposal: envisioning a community that allows adults to age and thrive in place, and where older adults can participate fully in daily life.
Accessibility. As a starting point, our proposal meets existing accessibility requirements, including those set out in the Accessibility for Ontarians with Disabilities Act as well as the World Health Organization’s recommendations for Age Friendly Cities. For example, we proposed designs that include convenient places to sit at regular distances in public areas, so that when someone chooses to go for a walk to the park they can rest periodically on their way there.
We also built on existing guidelines and pushed ourselves to meet higher standards of accessibility: for example, we designed sidewalks wide enough to accommodate two assistive mobility devices like electric scooters or walkers — so that people can be side-by-side while moving around their neighbourhood.
Housing. When it comes to housing, we are committed to ensuring that at least 20 percent of residential units are built with flexible fixtures, such as height-adjustable sinks and countertops, that can be easily modified to the physical needs of older adults. We’re also excited about emerging housing types, such as co-living, where residents share a set of communal amenities like kitchen and dining spaces, fitness facilities or rooftop greenhouses. For some older adults, communal living has a lot of appeal as it can provide more affordable housing options while also offering opportunities for social connection.
Access to services. Housing located close to a range of key services and amenities such as grocery stores or health care services is vital for older adults who rely on the resources that are nearby. We propose a neighbourhood of mixed-use buildings with a significant percentage of ground-floor space allocated to retail and community purposes — such as health care and community services, as well as spaces for community programming — enabling convenient access for all residents.
Since our workshop, one participant’s response has stayed with me. We asked the group what features they’d like to see in their ideal unit or building. Did they want on-site fitness classes, private green space, in-building health services? “I can’t really answer that,” one woman responded, “because it depends on what else is available nearby, in the neighbourhood.” If amenities are close by and easily accessible, for example recreation facilities or a health clinic, there is less need for them to be available in the building.
That answer is a good reminder that we’re not just designing a collection of homes or offices or parks — we’re designing a community. Yes, it is a neighbourhood built from individual parts, but to the resident these aspects must form a seamless whole that can meet the needs of everyone.
We continue to explore how best to build homes and communities where everyone, including older adults, feel they belong, feel supported, and feel they can live independently for longer. The result can lead to desirable and healthy places for older adults to age with independence and dignity.
Alexis Wise is Director of Health and Human Services at Sidewalk Labs, based in Toronto.