German Health Care System

Housing and Care Concepts Integrated Service Areas

Holger Stolarzhousing and care concepts in residential areas

Bonn, Germany

PLATFORM31, 3 September 2013, Den HaagEUKN Policy Lab Netherlands ‘Housing and Care’

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� Population is ageing

� Higher demand for careservices due to increasing

life expectancy.

� Increasing number of peopleliving alone and decreasingnumber of relatives who cangive support

� Changes in housing preferences

Future challenges in the support of the elderly

Future challenges

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Demographic Change 2004-2050plus 7 million „old“ versus minus over 14 million „middle/young“

0

+6,8

+6,2

0

1

2

3

4

5

6

7

8

9

10

15,4 Mio.

21,6 Mio.

22,2 Mio.

„old“ people aged 65 years and over

+6.8million

2004 2030 2050 2004 2030 2050

0

-1,1

-4,3

-10

-9

-8

-7

-6

-5

-4

-3

-2

-1

0

28,5 Mio

27,4 Mio

24,2 Mio.

0,0

2,4

+5,5

0,0

1,0

2,0

3,0

4,0

5,0

6,0

7,0

8,0

9,0

10,0

3,6 Mio.

6,0 Mio.

9,1 Mio.

2004 2030 2050

0

-6,4

-9,9-10

-9

-8

-7

-6

-5

-4

-3

-2

-1

0

38,6 Mio.

32,2 Mio.

28,7 Mio.

2004 2030 2050

„young“ people aged up to 40 years

-9.9million

„Very old“ people aged 80 years and over

(+5.5million)

„middle“ aged people between 40 and 65 years

-4.3millionmillionpeople

millionpeople

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Typical Features of the Housing and Care-System in Germany

Housing: owner occupied 40 % (low)(number of flats) private tenants 35 % (high)

housing company 25 %

Care providers Home care (2007) In-patient care (2005)Welfare organisations 53% 55%Private care providers: 45% 38%Public care providers: 2% 7%

Type of care Number of persons

Home care with professional services 470,000 (23 %)

Care in nursing homes 650,000 (32 %)

Home care without professional services 930,000 (45 %)

Total 2,050,000

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Kuratorium Deutsche AltershilfeTypical features of the care-system

in Germany

Social financing system

Insurance Tax Payments according to..

means tested

Pensions X contribution - Unemployment benefit

X contribution -

Health insurance X need (no limit) - Nursing care insurance

X need (limited) -

Social benefit X need (limited) X

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Forms of Housing for the Elderly

Source: Bundesverband Freier Immobilien- und Wohnungsunternehmen (BFW)

2008: BFW – Research, Berlin

Normal

residences

93%

Self-organized

communal

Housing

<1%Nursing home

5%

Assisted

Housing with

service

provisions

2%

Group living

arrangements

<1%

Percental distribution

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Basic Ideas of Integrated Service Areas

Structural changes in the care of older people

Change from a provision oriented to a participation oriented care

Small scale and interlinked structure of care within residential areas

� Economically necessary

� Serves the needs and wishesof older people

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5 Strategies to meet future needs

Strategy 1: Strengthening the possibilities for normal

independent living in one’s own home

Strategy 2: Spread and development of new alternative forms of independent housing

Strategy 3: Spread and development of self-determined

group living arrangements for older people in the need of nursing care

Strategy 4: Small-scale and decentralized organisation of housing and care provision for the elderly

Strategy 5: Strengthening individual initiatives and

encouraging mutual help and social networks

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Structural Features of “Integrated Service Areas” (Quartierskonzept)

Small-ScaleResidential Area

Building Blocks of SupplyHousing, Social Support, Nursing Care

Means of Implementation:Cooperation,ParticipationSomebody “who minds”

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„Small-Scale“What does it mean?

� Residential Living Projects can vary in their size. They can be implemented in all types of housing areas: residential quarter, housing settlement, a small community orvillage

� The people who live in such a residential area must recognizeit as their familiar surrounding

� Up to 10,000 – 15,000 inhabitants seems to be a sensible size

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The Building Blocks of Integrated Service Areas

� Housing Adaptation

� Barrier-Free Housing

and Surroundings

and Infrastructure

� Forms of Housing

for Self-reliant Living

(e.g. communal

housing)

� Counselling,

Coordination,

Home Help

� Social Integration

and Mutual Help

(e.g. meeting places)

� Domestic Care linked

to the Area

� Forms of Housing

with Care Provision

(e.g. group living)

� Integration of

Nursing Homes, Short-

term -and Day-Care

Fields of Supply

Housing Social Support Nursing Care

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Implementation of the Integrated Service Areas

Residential Participation Professional Cooperation

The building blocks of supply can be established step by step

Involvement

� in the planning and implementation of the project

� as helpers, providers of services (paid/unpaid)

� as cooperation-partners

� as initiators and organizers

Cross-Linking

� Housing corporations

� Welfare organisations

� Private care providers

� Municipalities

� other organisations (e.g. churches, associations)

Main Means of Implementation

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Means of Implementation: Cooperation Main Actors in “Integrated Service Areas”

Implementation:Participation of Citizens

� Delivering care within families

� Counselling, support services, neighbourhood help (payed/ unpayed)

� Citizen’s associations, organising activities

� financing/sponsoring (as for housing coop.)

� Taking the role of initiator or director (as for example in Eching)

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Implementation:Cooperation and changing roles of Players

� Municipality: sometimes director as well as provider of finance, mostly supporting and moderating partner

� Welfare Organisations: important partner but also competitors, taking responsibility for the local area, cooperation with citizens

� Housing Enterprises: Both housing (investment, organisation) and (increasingly) social serviceprovision, cooperation with care services

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Example 1 Eching Service Centre for Older People (ASZ)

Centre of the Municipality with Service Centre

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Example Eching

ASZ Eching Building

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Example Eching

Courtyard ASZ Eching Building

Example Eching: Second Building with Residential Care Group and Assisted Housing

Top floors:Assisted

housing

Ground floor:

Residential

Care group

for dementia sufferers

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Example Eching: Second Building (Ground Floor) Residential Care Group for Dementia Sufferers

garden

common room

private rooms

bathrooms

technical rooms

hallway

Floor plan

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Example Eching: Second Building

Residential care group on ground floor, Dementia garden

Eching Service Centre for Older PeopleFactsheet of the Project

Provisions

�Eching: population ca.13,600, start of project: 1995 (planning mid 1980ies)

�Housing: 60 flats assisted housing: 22 Eching Centre, 30 new building (2007), 8 Eching Centre (2010),

�Infrastructure: shops, technical aids, physiotherapy

�Social support: Cultural centre for all citizens, advice, area management, home help

�Nursing care: domiciliary care, day and short-term care (axed 2008), care group 8 residents 2007)

Implementation

�Provider: Citizen’s association “Getting Older in Eching” (500) Aim: complete local care chain but without nursing home

�Cooperation: municipality + all local players are board members

�Participation: planning +running of services, volunteers in community centre (110) and home help (25)

�Cost: 14 full-time jobs, 1.5 million Euros overall expenditure

�Financing: 0.5 million pays municipality (social support and management), rest is refinanced by fees. 22

Eching Service Centre for Older peopleDiscussion of the Concept

Advantageous conditions

�Residential area makes up a whole municipality (decision-making power)

�Municipality supported the concept politically and was able to finance social support

�High level of cooperation andcitizen’s participation

�Provisions for all Generations

Disadvantageous conditions

�Small scale provision of nursing care was undermined by external county authorities (finance)

Conclusions:

�Overall care and financing systems must enhance local solutions (decision-power) as well as:

�Cooperation of providers

�Participation of old and young citizens

�Financing of social support(residential management)

�Variety of housing and care solutions

�Integration of services into small scale areas

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Example 2„Bielefeld Model“: Housing Projects in Bielefeld

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“Bielefeld Model”

Example: Heinrich Street Project

Providers: Bielefelder Wohnungsgesellschaft mbH(not-for-profit Housing corporation) and“Old and Young” (Provider of domestic nursing care)

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Example „Bielefeld Model“

Housing Project Heinrichstraße, Bielefeld

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Example „Bielefeld Model“Heinrich Street Project

Situation Plan, Heinrich Street

Ground Plan „Wohncafé“

(residential café)

Example „Bielefeld Model“Vennhof Avenue Project (Sennestadt)

“Bielefeld Model”: Vennhof Avenue Project Residential Café (Wohncafé)

“Bielefeld Model”: Vennhof Avenue Project Position within the Residential Development

“Bielefeld Model”: Structure of the Housing Project Residents (Old and Young)

� Age group

� under 40

� 40-65 years

� 65-80 years

� 80 and above

�

� Total

� Care need (levels1-3)

� Number of tenants

� Heinrich Street Vennhof Avenue

� 2 -

� 7 (21 %) 4 (29 %)

� 15 (36 %) 7 (50 %)

� 18 (43 %) 3 (21 %)

�

� 42 14

� 12 (29 %) 6 (43 %)

� (3 Mieter are 48–60)

Main features of the Bielefeld Model

Provision:

� Housing Project: Care in self-sufficient flats, old and young, no extra service charge

� Residential Area: Guaranteed Care in the near surroundings, 24 h

� Residential Café: Social centre for both housing project and residential area

Implementation:

� Cooperation: Housing association, care service, municipality, regional authority as well as other cost carriers

� Participation: Citizens in the residential area (partly in project)

� Minder: Strong role of housing association, housing adaptation in the area

� Flexible Care Service: Working hours (free lancers), broad range of tasks, care and social support in one hand

� Financing: social support, community work, low threshold provisions

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Example 3 Housing Cooperative in Bielefeld

•Community Centre „Meinolfstrasse“ - Pioneering projectFreie Scholle Bielefeld (Housing Cooperative „Free Land“)

Provisionof all three

building blocks

� Housing

new accessible

housing for old and

young

� Social Support

community centre

for old and young

� Nursing Care

small group living

but no nursing

home

Strategies

� Coordination:

Freie Scholle

Housing Cooperative

(„Caretaker“)

� financed by all- old and young -

residents

� Resident‘s Association

organizes home help

und mutual help

� Intensive cooperation

and participation in thecreation as well as

running of the project

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Financing of the „Minder“and the Provision of Social Support

Common financing

�Municipality (e.g. Eching)

�All residents of the area (e.g. housing cooperatives)

�Public social fund, provided by different partners including citizens of the area.

�Some funding by special public programs

Financing by the users or providers

�Only the users of services (fee, e.g. Assisted housing at home)

�Service fee apportioned to the rent or paid additionally by the residents of an Assisted Housing project.

�Contributions from housing providers

�Individual social benefit recipients (e.g. Bielefeld Model)

Wine Making Village Eichstetten near Freiburg

Praxisbeispiel: Bürgergemeinschaft Eichstetten e.V.

Meeting space for the

whole village (1998)

16 flats asststed housing

at Schwanenhof (1998)

Citizen‘s office at

Schwanenhof (1999))

Qualifying of helpers for

dayly activities (2010)

Café for integration

„Together“ („Mitnander“)Residential care group

„Adlergarten“ (2008)

Day care for older and disabled

people at Schwanenhof (2006)

Citizen‘s initiative with mayor: implementation step by step

Citizen‘s assocciation(Bürgergemeinschaft) Eichstetten e.V. (ca. 3.500 Einw.)

Example 4 „Integrated Service Area“ in a Village: Eichstetten

ISA Website: International Platform for Integrated Service Areas

� Content of the platform: for each country

national context and project examples (town + country)

� Original members: Netherlands, Switzerland, Germany, Denmark

� New member of the network: Sweden

� Overseas cooperation: Japan, United States

(Association with “SYSTED”)

� Perspective: more examples, more countries, systematic comparison between countries, networking between

projects, international congresses37

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