WHAT DO THE ELDERLY DEMAND? A study of the living environment in -, and municipality

Victoria Scherbakova

Magister Thesis in Human Geography, 15 hp Master’s Programme in Human Geography with specialization in Geographical Information Systems (GIS) 60 hp Spring term 2021

ABSTRACT ...... 3 1. Introduction ...... 4 1.1. Aim and research questions ...... 5 1.2. Limitations ...... 5 1.3. Study Area ...... 6 1.3.1. Housing for elderly people in ...... 8 1.3.2 Housing for elderly people in ...... 9 1.3.3. Housing for elderly people in ...... 9 1.3.4. Elderly plan in Västerbotten 2013-2020 ...... 9 2. Background ...... 10 2.1. Types of elderly care ...... 11 2.2. The organization in elderly care ...... 13 3. Theory and previous studies ...... 13 3.1. Theoretical framework ...... 13 3.2. Previous studies ...... 14 4. Method ...... 16 4.1. Interviews ...... 16 4.2. Thematic analysis ...... 16 4.3. Selection ...... 16 4.4. Processing of empirical data ...... 17 4.5. Ethical considerations ...... 18 4.6. Method discussion ...... 18 5. Results ...... 19 5.1. Thematic analysis of interviews with the elderly ...... 19 5.1.1. Well-being and security in the living environment ...... 19 5.1.2. The lack of natural meeting places ...... 21 5.1.3. Relationship between health, place and future change of residence ...... 22 5.2. Thematic analysis of interviews with the municipalities ...... 23 5.2.1. Varying housing supply ...... 24 5.2.2. Popular accommodations in demand by the elderly ...... 25 5.2.3. Older housing supply as a challenge ...... 26 6. Discussion ...... 27 6.1. Proposals for further research ...... 29 6.2. Conclusion ...... 30 7. References ...... 31

Appendix 1. Consent form ...... 37 Appendix 2. Interview template for the elderly ...... 38 Appendix 3. Interview template for the municipalities ...... 39

2 ABSTRACT

In sparsely populated municipalities, there is a large increase of elderly people in relation to people of working age. This will entail a great need for housing for the elderly, and at the same time resources for the care of the elderly. The aim for this study is to examine how older people within Storuman-, Sorsele and Vilhelmina municipality perceive their current housing and other forms of housing for the future, and also to analyze how the housing demand is met now or in the plans for future development within the municipalities. Interviews have been conducted with both elderly but also with people who work with housing issues within the municipalities. There are incentives that the demand of shared housing will increase. The elderly feel a lack of meeting places and they prefer shared forms of housing over regular apartments. The municipalities have different challenges and different housing supply and therefore they have different approaches and plans to cope with the future housing demand for elderly.

Key words: Elderly, Living environment, Meeting places, Rural areas, Retirement home, Home care, Apartments, Västerbotten county, Storuman municipality, Sorsele municipality, Vilhelmina municipality

3 1. Introduction The Swedish population is expected to increase with one million people from the years 2017-2028 and the age group that is expected to increase the most is elderly people that are 80 years and older, with 50% (Statistics , 2018A). Although, in recent decades, the reality has consistently exceeded the population forecasts (Paulsson, 2008). In Sweden, the proportion of older people relative to the population in working age is one of the highest in the world (SOU 2015:101). Since the so-called dependency ratio, i.e., how many people are of working age in relation to those who are to be supported, will increase throughout the country, it will be a problem for many of the country's municipalities. The Swedish government has an equalization system that will compensate for this, but on the other hand if there is a rapid increase of elderly people it must be possible to support them by, for example, building homes for the elderly (SVT, 2019). On the other hand, newly built housing usually entails a higher cost not only for the municipalities, but also for the tenants. This causes a financial burden for sparsely populated municipalities (ibid).

Historically, the housing supply has been a problem in the urban areas in Sweden (Lundmark, 2020). The Swedish government created a reform with the goal to build 1 million residences (The 1 million program) between 1965-1974 to keep up with the urbanization process, although the supply of housing is still a problem. The consequence of this is that the rural areas have been forgotten in this matter (ibid). Furthermore, there is a concentration of elderly people in the more peripheral parts of the country, which is thus a result of urbanization (SOU 2015:101). The aging population affects different parts of the country in different ways. Since most municipal services collect funds through income taxation, the functioning of the labor market is crucial for the municipal economy (ibid). The national economy, the availability of staff in the home care service, etc. will not increase with the aging population (Paulsson, 2008). The municipal home care service must concentrate its efforts on the elderly who have the greatest needs, which means that a large part of the elderly population must increasingly manage on their own or arrange help, support and services on their own through children, relatives, friends, other seniors, voluntary organizations and companies in the service sector. For the vast majority of elderly people, disabilities and illnesses as well as insecurity, loneliness and lack of meaningful activity must be addressed and managed in the ordinary living and social environment. Society largely consists of older environments with poor accessibility, and a large part of the elderly people live in these environments. As the construction sector is a slow sector, there must be long-term and short-term considerations (ibid).

4 More and more elderly people are staying in the ordinary housing market, and in parallel with the increasing age, the demands on housing can come to change in order for the elderly to continue to live alone independently and feel safe in their home (Abramsson, et al., 2018). A varied range of housing is a basis for elderly people to find a home to age well in. In smaller municipalities, where the proportion of elderly people is usually the greatest and there is a limited variation in both newly built homes and older housing supply, it will be a challenge to satisfy the needs of the elderly (ibid).

1.1. Aim and research questions The aim of this study is to examine how older people within Storuman-, Sorsele and Vilhelmina municipality perceive their current housing and other forms of housing for the future. The second aim is to analyze how the housing demand is met now or in the plans for future development within the municipalities. To achieve these aims, the following questions will be answered:

What do the interviewed elderly in the study area demand in their living environment, and how do they experience aging at home?

What does people who work with housing in the municipalities describe is the challenges of providing housing for the interviewed elderly and their demands?

1.2. Limitations In this work, I have chosen to limit the thesis to permanent forms of housing because the purpose does not include sudden events that cause the elderly people to move to short-term housing, dementia housing or other alternative housing. Thus, the essay will only focus on permanent forms of housing, which are also explained more clearly in the following section 2.1. - Types of elderly care.

The delimitation has also been performed in the age group 65 years and older, as this is the age group that is often used to describe the elderly and because this age group usually is retired and thus is not of working age, except for certain exceptions.

5 1.3. Study Area

Figure 1. Map showing the study areas location within Västerbotten and Sweden.

Västerbotten is Sweden's second largest county, and the area is slightly larger than one eighth of the country’s total land area (Regionfakta A, 2021). There are 15 municipalities in Västerbotten and the county had 273 192 inhabitants on December 31st 2020 (Regionfakta B, 2021). The study area for this thesis is the sparsely populated municipalities of Vilhelmina, Storuman and Sorsele. These municipalities are some of Sweden's most sparsely populated municipalities, as Sorsele municipality is the third most sparsely populated municipality, Storuman municipality is sixth and Vilhelmina is seventh (Statistics Sweden, 2019). All of the municipalities are decreasing in population and have been since 1970 which can be seen in figure 2.

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Figure 2. Data source: Statistics Sweden (2020). Population by region, marital status, age and sex. Year 1968 - 2020.

Figure 3. Data source: Statistics Sweden (2020). Municipalities in numbers.

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Figure 4. Data source: Statistics Sweden (2020). Population by region, marital status, age and sex. Year 1968 - 2020.

1.3.1. Housing for elderly people in Sorsele Municipality The municipality has only one form of housing, which is special housing, with 50 places and two departments focusing on dementia. Since there have been vacancies in the housing forms in particular, there are more available apartments than there is a need for (Sorsele municipality, 2020). In 2020, the social services investigated the possibility of closing down eight housing units in special housing as well as new forms of housing within the municipality due to the financial deficit. The municipal board has proposed closing one of the residences and two places to be reintroduced in another recidence that has previously been closed. This means eight fewer places in total (ibid). In the annual housing market survey, the municipality has stated that there are 42 homes in special housing for elderly people during 2021 (The National Board of Housing, Building and Planning, 2021). Furthermore, Sorsele municipality has stated that they will have a housing deficit for elderly people in 2021, after 4 years of balance (ibid).

The municipality has no housing that is a middle ground - either the elderly people live at home, with or without home care, or in special housing (Sorsele municipality, 2020). Therefore, the municipality has opened up the possibility of a new form of housing, which is sheltered housing. The accommodation will be staffed with a hostess during the day who will be able to offer support and help with social activities. The municipality writes that the sheltered housing will be assessed for development assistance. Furthermore, they write that people who currently lives in special housing

8 may be suitable to live in secure housing, and that there is a possibility that those who require a lot of home care would be eligible to live in sheltered housing. The outcome of a new form of housing is still unknown and the municipal board will evaluate this (ibid).

1.3.2 Housing for elderly people in Storuman Municipality There are three retirement homes in the municipality, and they are located in Storuman, and Tärnaby (Storuman municipality, 2021). There are two special homes that also function as dementia homes. One is located in Stensele, an urban area 3 kilometers from Storuman, and the other is in Tärnaby (Storuman municipality, 2020). Storuman municipality states that there is and has been a balance for the elderly the past 4 years (The National Board of Housing, Building and Planning, 2021).

1.3.3. Housing for elderly people in Vilhelmina Municipality In the municipality, there are two retirement homes (Vilhelmina municipality, 2021) and one sheltered housing (Vilhelmina municipality, 2020) in the municipal center and one retirement home in the village Saxnäs. There is also an assisted living facility in the village Dikanäs (Vilhelmina municipality, 2021). There are 102 apartments in special housing in the municipality (The National Board of Housing, Building and Planning, 2021). Vilhelmina municipality states that they will have a deficit in housing for elderly in 2021, after having a balance in 2020 and a deficit in 2019 and 2018 (ibid).

1.3.4. Elderly plan in Västerbotten 2013-2020 Region Västerbotten has set up an elderly plan, Elderly plan in Västerbotten 2013-2020 with an outlook to 2040 (2016), with the purpose to describe the joint mission as the municipalities and the county council has for the population of Västerbotten. The plan is developed in consultation between the region and the county’s municipalities (Umeå kommun. 2018).

It is mentioned in the plan that experience shows there are four areas that are important for the health of the elderly. These areas are called for the four cornerstones for good aging and includes; Social community, Participation/meaningfulness, Feeling needed and Physical activity and good eating habits. The plan includes strategies such as conducting health- promoting urban planning that creates a community that is adapted for all people in terms of service, communications, meeting places, housing and living environment. Furthermore, in order to make elderly people stay in their home as long as they feel safe, they conducted a strategy to adapt the homes after the elderly’s needs. In addition to housing adaptation, they promote access and accessibility to public transport and services as well as

9 supportive environments for physical and cultural activities. One effort that should promote security is a varied range of housing that is adapted for the elderly. Furthermore, the plan includes the importance of increasing the accessibility of the existing housing supply and to design outdoor environments and homes for redevelopment or new construction so that they become attractive and adapted for the elderly and disabled. The region’s strategy is to, among others, create opportunities to stay at home, to develop new forms of home distribution of goods and services and plan housing and other initiatives in collaboration with pensioners’ representatives.

2. Background With the growing population, the group that will increase the most is elderly people that are 80 years and older, which will increase with 50 percent (Statistics Sweden, 2018). In numbers it’s an increase from approximately half a million people to 750 000 (Senior 2005, 2003). One cause to this is that people born in the 40’s are a large group that are turning 80 in the 2020’s while people born in the 30’s are a small group in comparison (Statistics Sweden, 2018A). The number of people over 65 years will be 23% in 2030, compared to today’s number of 17% (Senior 2005, 2003). The share and the number of elderly people will be even greater in another couple of decades (Senior 2005, 2003). Furthermore, the estimated life expectancy will increase for both women and men until 2050, although the life expectancy for men is expected to increase. Until the middle of the 2000’s, the surplus of women is expected to decrease, both in the group of 65-79 years and in the group of 80 years and older (ibid).

As more people reach a higher age as the probability of moving to a tenancy increases, it can be assumed that the need for housing in that sector increases (Abramsson, 2015). With only 5% of the population over the age of 65 in special housing, most elderly people are in the ordinary housing market because that is where they have their accommodation (ibid). There has been a gradual reduction over a long period of time in the number of residences in special housing for the elderly (Swedish national board of Housing, Building and Planning, 2020). At the same time, the demand and need for these forms of housing has decreased, which is a result of improved public health. It is also a matter of policy on the part of society, to steer towards remaining residents through opportunities for housing adaptation and home care (ibid).

In the governmental official report Bostäder att bo kvar i, or Housing to stay in, the conclusion is that elderly people in general is satisfied with their housing and that there is an increased interest among the elderly in forms

10 of housing based on a community. The accessibility needs to be improved, as for instance, there is no lift for half of the people living in apartment buildings. Also, there is a need for a greater diversity of housing that is suitable for older people (SOU: 2015:85).

Abramsson and Hagberg (2019) writes that the depopulation in Swedish rural areas is connected to expanded urban areas, where younger people often move to pursue higher education and opportunities. Further, the outmigration together with increased life expectancy results in an aging population in the rural areas. The consequences of this are a bigger importance of elderly people’s needs in terms of housing and care which also is a part of the political agenda (ibid). Furthermore, the population change sets high demands on the municipalities to provide care for the elderly. In any case, it is hard to make an assessment of how many homes, including special housing, are needed in the future partly due to the lack of information of the needs from the individuals (Socialstyrelsen, 2021). According to Region Västerbotten (2019), when the housing supply does not meet the demand there will be consequences for businesses that want to recruit, opportunities to attract new residents and opportunities to get residents who thrive and want to stay. A central part of the challenge is to ensure basic societal functions but also to be able to provide opportunities for cultural life and community involvement. Social environments need to be designed to meet the needs of different groups in society (ibid).

The result of the ageing population is an increased burden on the welfare system and the providing section of the population (SOU 2015:101). There are discussions about how to handle the labor supply and the municipal finances, where the possibilities are an earlier entry and later exit from the labor market, increased employment rate within groups with a weaker connection to the labor market and immigration. The demographic change has a geographic dimension that results in that the able-bodied population is unevenly distributed, which can be seen in global population changes and migration flows, but just as well in regional or local differences (ibid).

2.1. Types of elderly care When a person needs help in the accommodation or needs help to move to an accommodation with help, the person can apply for needs assessment to the municipality (The Swedish National Board of Health and Welfare, 2016). The application will be needs-tested by an administrator who will investigate and assess the person’s need for help and decide what support the person will receive. The person can thus not demand a specific help or care, however, the person has the right to apply for a specific help. The administrator can grant or reject the person’s wishes. A person can thus not

11 receive some help if the investigation shows that the need does not exist (ibid). In the Social Services Act, chapter 4 § it’s written;

"Anyone who is unable to meet his or her own needs or can have them met in another way is entitled to assistance from the social welfare board for his or her support (maintenance support) and for his or her way of life in general."

Special housing is a collective term for different types of housing for the elderly, such as retirement homes or assisted living facilities (The Swedish National Board of Health and Welfare, 2016). Special housing is a means- tested form of housing according to the Social Services act (SFS 2001:453.). In Chapter 5, §5, the municipalities are obliged to provide special forms of housing with services and care for the elderly who need support.

A retirement home is a form of housing for the elderly who are unable to live on their own. One can get a place in a retirement home if there is a need for care and the need is lasting. People who live in retirement homes have a need for care that cannot be met by home care. There is often a nurse and other healthcare workers that are available around the clock. The retirement homes, and other special housing, is supposed to be adapted to the tenants needs of safety, community and freedom. Another form of housing is assisted living facilities where the tenants have their own apartments where there is access to staff who can give the residents support. Service housing is an option for those who need a little less support and help. There are usually common rooms where the residents can socialize with each other or with staff (ibid).

People who are unable to perform everyday chores can apply for home care, where the staff comes home to the resident to help, for instance grocery shopping, cleaning and other household chores. Home care enables people to stay at home and live an independent life (The Swedish National Board of Health and Welfare, 2016). For people who are too healthy for retirement homes but want to live safely, there is another alternative - safe housing. Safe housing has nothing to do with elderly care and no assistance decision is required to live in secure housing (Skellefteå kommun, 2021). The tenant rents their home on their own initiative and lives in their own apartment. The difference from ordinary apartment buildings is the common areas and activities. The goal of the form of housing is to create opportunities for community between the tenants and to participate in joint activities, to counteract the loneliness that many older people live with today (ibid).

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2.2. The organization in elderly care During the 1960s, Sweden was in a phase of prosperity and welfare developed as a result after the war when a number of social reforms were made possible, which coincided with a rapid increase in the elderly (Thorslund, 2010 A). During the 1960s, Sweden was high internationally in terms of elderly people's access to care and nursing. There were nursing homes and old people's homes, and during the 60s, 70s and 80s, the number of elderly people living in these institutions increased. Furthermore, new service houses and special group homes were built until the end of the 1980s. After 1980, the gap between needs and resources began to widen. The number of places in special housing stopped increasing and stopped, which has further decreased by a fifth during the 2000s. This is partly due to the service houses being converted into ordinary housing but for the elderly, also called senior housing, which was also further converted into secure housing after 2009 (ibid).

Then the age group 65–79 years was halved in both home care and special housing since 1980 (Thorslund, 2010 A). During this year, more than 60% of the population aged 80 and over lived in special housing or had home care. This figure dropped to 37% in 2008. At present, there is no indicator of a major improvement in health among the elderly. Good healthcare and a developed welfare society have contributed to more people surviving to old age with their illnesses (ibid). Based on an unchanged level of health in the elderly population, publicly funded care for the elderly will need to be strengthened by around 60% in order to maintain care with the same level of ambition as today and to be able to support the increased proportion of the elderly population (Thorslund, 2010 B).

3. Theory and previous studies 3.1. Theoretical framework Aging in place is a common term, often used in studies of elderly peope. The U.S. Centers for Disease Control and Prevention’s (2009) definition of aging in place is;

“The ability to live in one’s own home and community safely, independently, and comfortably, regardless of age, income, or ability level”

From a Swedish historical perspective, aging in place has been a theme that has led to most social reforms with the aim of improving the living conditions of the elderly citizens in their homes (Edebalk, 1990). Furthermore, with the principle of aging in place, there are financial

13 incentives for the municipalities, as in 2004, the cost of care in the home was half as large as for care in special housing (Svenska kommunförbundet, 2004). In 2017, the cost for the municipalities for homecare was almost 40% less than the cost for special housing (Statistics Sweden, 2018B).

J.L Wiles, et al. made a study, “Meaning of “Aging in Place” to older people” (2011) which includes how the term “aging in place” is described by different researchers, one of whom, Callahan (1993), means that we all are always aging in place, although two factors have caused aging in place to emerge as a concern for gerontological policy makers. The first factor is the big growth of homeownership after World War II, while the other is that a large number of elderly people have been moving into nursing homes when they can and should stay in their own homes. Callahan further claims that aging in place enables elderly people to maintain independence and connections to social support. According to Davey, Nana, de Joux & Arcus (2004), the term “aging in place” is defined as “remaining living in the community, with some level of independence, rather than in residential care”. The World health organization (2007) emphasizes that the costs of institutional care can be avoided for as long people remain in their own homes. Therefore, it is favored by, besides the elderly people themselves, policy makers and health providers (ibid).

Sandstedt and Abramsson (2012) wrote about aging in place, and according to the authors, it concerns people’s right to stay at home, which by getting help in the home enables the residents to stay, and also by designing the homes to provide opportunities to stay if their health gets worse. There has been a shift in the concept of ageing in place, to also include a change in residence, for instance in the same building but a more suitable home (Johansson, et al. 1983). Granbom (2014) argues that instead of talking about aging in place, one should instead talk about ageing in the best possible place. Granbom further explains that elderly people should have the opportunity to choose between housing options that the society should make it easier for the elderly to move when they still can (ibid).

3.2. Previous studies Marianne Abramsson is a swedish researcher that has written a report with the title Äldres bostadsval och preferenser (2015), or Elderly housing choices and preferences translated to english. This report is a summary of current research about elderly people’s living preferences. She emphasizes that there has been a political goal for many years in Sweden to be allowed to age in the home you have lived in for a long time, even when the health is getting worse. This has been made possible through an expanded home care service and home health care. Although, in recent years, the Swedish

14 elderly housing delegation’s final report (SOU 2018:113) have shown that some elderly people feel alone and unsafe in their own home. It can be elderly that have a hard time getting outside, elderly that have illnesses or elderly that live alone without family and friends near. The Swedish elderly housing delegation has suggested an expansion of sheltered housing, which now exists in some municipalities in Sweden with 4000 residences and is expected to increase (ibid).

Abramsson, Elmquist and Magnusson Turner (2014) has written the report Äldres flyttningar och motiv till att flytta eller bo kvar, translated into Elderly movements and motives to move or stay in english. The study follows statistics for around 1,5 million elderly people (over 65 years) over a time frame of ten and eight years, respectively, along with interviews from 74 households and their reasons to move or to stay, patterns in settlements and the residential mobility. The study shows that several of the interviewed people that didn’t live in special housing, didn’t plan to move at all. The interviewees thrived in their residences and the living environment, even though some people lived in more isolated places far away from public transport. Some of the interviewees had lived in the same place for a long time and their main activities were linked to the living environment, which was a decisive factor to not move. The men often performed activities that were connected to the home, such as in hobby rooms and garages, along with heavier activities to maintain the home.

In a study made by Charlotte Löfqvist, Marianne Granbom, Ines Himmelsbach, Susanne Iwarsson, Frank Oswald and Maria Haak (2013), 80 elderly people aged between 80-89 years were interviewed in Germany and Sweden regarding moving and motives for moving. The study shows that the elderly reflect on the reasons for future moves is mainly loneliness due to friends and family who have passed away, not having the same social network anymore, a partner that has passed away and an increased environmental pressure. The study also shows that the elderly felt a pressure from their surroundings to move due to their age. Overall, the interviewed elderly did not want to move and had a great desire to continue living in their current home. The reasons for not moving are mainly economic reasons, that it would be expensive to move, and that there is an emotional connection to the current home – such as a good neighborhood, having a social life and being close to friends and family, having a good home and good public spaces nearby. The study also examined how elderly people feel about aging in place, and overall, there is a fear of not being able to continue living as they do now and have the same routines if they had to move. A move to a nursing home has been described as the last resort

15 in a negative and emotional way. Lastly, there is a fear of losing freedom and privacy if a move to a nursing home would be relevant.

4. Method 4.1. Interviews Interviews are a useful method to reach knowledge about experiences and other meanings that cannot be received by other methods. In addition, interviews allow the respondent to have a more profound reflection about his or her own experiences in the subject (Hay, 2016). The strength of interviewing is that it can fill a gap of data that cannot be received by other methods such as observations or census data. Interviews are used to examine complex behaviors and motivations and also gather a diversity of different opinions and experiences (ibid). Furthermore, there are three methods of interviews, of which I have chosen to use semi-structured interviews. This is a method between structured interviews and unstructured interviews, as the researcher has a template with questions, but the interviewer is not restricted by asking these questions depending on what the respondent answers (Hay, 2016). The advantage with semi- structured interviews is that the researcher can obtain as much qualitative data as possible (Patel & Davidson, 2011).

4.2. Thematic analysis Thematic analysis is one of the most common approaches when analyzing qualitative data. The purpose of this method is to organize data by identifying key themes in terms of repetitions, similarities, differences, categories, metaphors, transitions, missing data or theory-related material (Bryman, 2011). Furthermore, Saldana (2015) writes that a code is often a word or a phrase which is an attribute and a part of a language-based data. Saldana believes that coding allows the researcher to organize and group similar codes into categories that share certain characteristics. A category is a word or a phrase that describes a segment of the data that is distinct, while a theme is a phrase or a sentence that describes more subtle and implicit processes. Saldana also considers the frequency of words and sentences and their order, along with things that happen in relation to each other to be a pattern (ibid).

4.3. Selection To achieve my first aim, I've chosen to interview elderly people above 65 years within the study area. I found 6 interviewees via local Facebook groups, of which two I got in touch via younger family members in the group, and the rest were contacted in person. The interest was varied, as for example, the interest was greater in Vilhelmina municipality than in Sorsele municipality. In the beginning, my idea was to also include

16 municipality in the study area, however, there was no interest in interviews, so I had to delimit the study area. I focused on reaching out to elderly people who are willing to participate, regardless of age group, gender and variation in where they live within the municipalities. This is because the current covid-19 pandemic makes it difficult to travel to the study area and reach a diverse population, and also because the older generation may not be as active on social media as the younger generations, which I had to adapt to.

Six people participated of which three live in Vilhelmina municipality, two in Storuman municipality and one in Sorsele municipality. Half of the participants are women and half are men. The participants live geographically dispersed, as 2 live in the municipal center within their municipality, one of whom lives in an institutional home and one in a rental apartment, and the remaining four live in other villages. The ages varied among the participants who were between 65-83 years old. Five of the participants were interviewed over the phone and I took notes on the computer in the meantime. I suggested recording the interviews, but the respondents did not feel comfortable with this. I sent out the interview questions via email to one of the participants because this person has a hearing impairment which would make the interview more difficult if it were done by phone. The person was also willing to answer follow-up questions via email, which facilitated the purpose of the study. To achieve my last aim, I have interviewed three people in total who work more or less with housing in each of the three municipalities. To reach them, I called each municipality’s customer service and was forwarded to the interviewees. These interviews were not recorded so I took notes on my computer.

4.4. Processing of empirical data After the interviews, the data was transcribed directly after the interviews to be as accurate as possible. Parts that are considered irrelevant to the study were removed and I anonymized the data since certain details that can be linked to the individuals appeared. I made a document to compile the answers, which later was printed out in paper form to facilitate the thematic analysis. An inductive approach has been used in the method as the thematization is based on the respondents answers and not in previous studies. The empirical data was divided into different codes which were later sorted based on the content. The similar codes were grouped to create overall themes. The themes will be presented further in the results section, which also is sorted after them.

17 4.5. Ethical considerations Using a qualitative method to receive data may invade the respondent’s privacy (Hay, 2016). The questions asked can be considered private for some people and therefore the researcher should ensure that the research doesn’t enable others to identify the respondents (ibid). For this reason, I have chosen to anonymize all respondents as far as possible. In the previous section, I have mentioned the age range among the elderly and whether they live in their own home or in an institutional home. In the result section I have written about the elderly living in towns or in the countryside. I have done this to show the range in the selection, and also to distinguish between housing preferences between living in towns versus in rural areas. However, this information should not be linked to the individuals in question. For the respondents who work with housing issues, I have chosen to fully anonymize the persons by not stating their professional title, gender or anything else that may reveal them. Since it is sparsely populated municipalities, it may be that gender can more or less reveal the individuals. For this reason, I will refer to them as the municipality in question.

Before the interviews began, I informed the respondents about my purpose with the study and what the material would be used for. Furthermore, I informed them about their anonymity, their right not to have to answer everything and their right to terminate the interviews without having to state any reason. Because I could not meet them in person, they could not sign a consent form. Thus, there was oral consent. The consent form that was read out to the interviewees can be found in Appendix 1.

4.6. Method discussion It would have been preferable to record the conversations, but the respondents were not comfortable with this. However, the disadvantage of taking notes is that the conversation does not become as natural because writing notes takes time, and the interviewer may feel unprepared for the next question (Hay, 2016). In addition, note-taking can miss important body language and expressions which can be an important part of the analysis. On the other hand, recording the interviews can cause the respondent, in some cases, feel vulnerable knowing that their voice is being recorded, if the recording would end up getting public. In addition, a recording can remind that the situation is a formality which can affect the interview answers (ibid). Also, it would have been desirable to get fold of the elderly in a different way than via social media because it can exclude elderly people who are not fit and alert enough to use technology as younger generations do. Although, two of the participants was contacted through their younger family members that used Facebook, which may have included a wider group of elderly.

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An attempt was made to email the municipality, where the advantage is that I can be referred to someone who has a deeper knowledge of my questions, to book a time for a further phone interview without any time pressure. However, I didn’t get an answer within a reasonable time, so I chose to go another way by calling the municipalities. This resulted in me, in some cases, being referred to people who could not answer my questions. Due to this, I had to call back the customer service and ask for someone else. This also resulted in unprepared calls for the respondents. I wanted to have the opportunity to ask the questions in peace and quiet, but since the calls were sudden, I had to adapt to the respondents' schedule. One respondent had a meeting within 10 minutes from the time I called, which didn’t give me the opportunity to ask all the questions as I planned.

In the interviews with the informants from the municipalities, the questions were asked in ways about how the work takes place at the municipal level, to avoid answers about personal thoughts and opinions. Even if it felt implied, it may be that the informants did not perceive this in some cases. Since personal thoughts and opinions is not relevant for the study, I redirected the questions so that the person could answer as an official that works for the municipality.

5. Results Two different thematic analyses have been carried out and therefore the results section is divided, one with the thematic analysis for the elderly, and one with the thematic analysis for the municipalities. Thus, different themes have been identified from the different analyzes.

5.1. Thematic analysis of interviews with the elderly To answer the study's first research question: What do elderly in the study area demand in their living environment, and how do they experience aging at home? the collected empirical data on the housing preferences of the elderly is described in the following section. From the thematic analysis, three themes have been identified. The themes are Well-being and security in the living environment, The lack of natural meeting places, Relationship between health, place and future residence.

5.1.1. Well-being and security in the living environment After interviewing and asking what the elderly appreciate the most in their current living environment, a recurring theme has been mentioned, which is a good neighborhood which entails a well-being and a security in the living environment. The respondents that live in the periphery highlight that the neighbors help and take care of each other, which creates a sense of

19 security and is especially important when living in sparsely populated areas and feeling that there is a trust between the neighbors. Having a good neighborhood applies to both the 4 who live in small villages in the periphery, who believe that there is a good cohesion between the neighbors, but also the two who live in municipal centers who believe that the neighbors respect each other by not being loud. One of the respondents explains;

“I live in a quiet home and have quiet neighbors, no one bothers so I am very happy. There is a lawn outside where the neighborhood usually sets out tables and stuff. There are usually a few meets and socializes there during the summer”

Furthermore, one of the respondents points out that there is no real need for a larger house and yard today as it did before, and mentions that a more comfortable accommodation would be suitable;

“I would like to live in an apartment with a patio and a lawn in the major town. It would be nice to have close to everything when you get older”.

The accommodation should be accessible, and it is important, says one of the respondents who lives in an apartment in one of the municipal centers. Furthermore, the person expresses;

“I enjoy living on the 1st floor, which means I do not have to go upstairs, which is also a security”.

Later in the interview, the same person mentions that there are some high- rise buildings in the town that do not have elevators. This is described as a problem since there are elderly people living in these houses. It has been presented to the property owner, without success.

“There are three high-rise buildings in the center. However, there are no elevators in the houses. I have been a little familiar with elderly care to make an impact, but it is not possible to get elevators in those houses. I am worried of the elderly who live on the top floor. After having contact with the landlords, they said that the elevators could not be arranged at all. You would have to rebuild the one-bedroom apartments and replace them to an elevator shaft”

20 5.1.2. The lack of natural meeting places All respondents have raised natural meeting places in one way or another. One respondent feels no major lack of a meeting place as there is one outside the home where the person lives. Another person also does not lack meeting places, but the person is voluntary antisocial and is comfortable living in loneliness. For the remaining four respondents, a lack of meeting places is described in different ways. The person living in the special housing feels a lack of a meeting place in the current accommodation, while the villagers lack something in the town centers. One of the respondents perceives and creates meeting places in connection with errands, and times it according to the time of day that other people do errands. The lack of meeting places is something that, according to most of the respondents, is something that is based on loneliness. Loneliness at home, loneliness in the villages that the neighborhood cannot do much about. Two respondents that live in smaller villages describe the loneliness that can arise;

“I would have liked to hang out with people, have coffee with some friends. I miss having something to pick up from someone, discuss a book or so. I can get to the municipal center, but not now during the pandemic. I miss connection with other people. Discussing with yourself is tedious”

“I miss a place to spontaneously meet people”

Another respondent, currently living in the periphery, used to live in the municipal center. He later moved into the village that he’s currently living in, as he did not thrive in the municipal center;

“I have worked a lot in the urban area and lived there for a few years, but never enjoyed it because it was lively during the day, but in the evenings, it was dead when no people were outside. There were so few public meeting places. The hotels were closed in the evening, and there were no pubs or anything. But during the day there was little life in the pharmacies, the liquor store and grocery store, libraries, etc.”

He further emphasizes the lack of natural meeting places and due to that, he makes his everyday chores into an activity to meet people since these places are the natural meeting places to him;

“I have some errands in the town sometimes and usually plan to go during lunchtime because then there are usually people to talk to. Since I live alone, it becomes even more lonely, especially during the

21 corona pandemic. It feels important to do errands for the social part as well. I also sometimes go to another nearby town to see and meet people at a lunch restaurant or so”

The only respondent who lives in special housing believes that there are shortcomings from the property owners in creating a community between the residents by not providing with rather cheap materials to be able to create an own natural meeting place, which can increase the everyday joy of many of the residents who live in loneliness;

“Last year, there were discussions at the accommodation that they wanted a little more flowers and a barbecue area. The residents wanted as little as portal barbecues. We got nothing from it, except a flower box that we could have been without. When you live like that, you are not allowed to do anything yourself. What is most lacking are natural meeting places. Many of the tenants is handicapped and lonely. We can arrange the activities ourselves, as long as there is space and time. I am active in an association myself and have been participating in activities. Elsewhere in the village, however, there are meeting places such as the community house within walking distance, but no matter how it is in the living environment, it would need a little shake-up”

5.1.3. Relationship between health, place and future change of residence A common theme throughout the interviews is the relationship between health, place and future change of residence. Within this theme, the respondents describe their housing in relation to the location to the urban area. At the same time, there are fears of moving due to the location and car dependence. Therefore, these themes go hand in hand. Car dependence is something that all respondents who live in the periphery describe as something important. Most of them mentioned that if their health would get worse, so much that they cannot drive a car, there are often fears of having to move to different types of housing. One of the respondents mentioned that he will most likely move back to his hometown, which is located in another part of Sweden, when he will no longer be able to use the car;

“The only downside with living here is the day I will not be able to drive, then I will probably move back to my hometown. Partly because I have social connections there, partly because I lived and worked there for many years”

Another respondent expresses that the car is something he depends on to be able to do everyday chores;

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“It is important to me that I have access to a car. I have never tried to be without a car, but I think it would be quite tricky if I need to go grocery shopping and do errands in the urban area and not have a car. Sure, there is bus traffic that goes through my village but then it should fit with the times, as I do not want to wait for several hours to take the bus home”

There are also thoughts and wishes to move to a town to avoid having a car-dependency;

“Sure, it feels okay to live and age here but I prefer to live in a town in the future, where it is close to everything, and you do not have to be dependent on the car”

There are different views on alternative forms of housing. For some it would make everyday life easier to live in a special accommodation, while for others there is a fear of moving away from home. However, most of the respondents seem to be more interested in special housing because there is often a community between the residents. It also appears that there is another reason for this because of the security that comes with being able to get help;

“A good retirement home is located in the urban area. I think I would feel safe there. If a move would be relevant, I would prefer an assisted living facility where I can be myself by having my own apartment but still have access to service. I would rather stay than move to my own apartment”

“I really do not want to move into a retirement home. At the moment I have home care, but do not need much more than that. I would much rather stay than move to a retirement home. But at the same time, I would rather move to a retirement home than to an apartment, because of the lack of community. It would feel difficult to leave my home.”

5.2. Thematic analysis of interviews with the municipalities To answer the study's second research question: In what ways do people who work with housing in the municipalities describe the challenges of providing housing for the elderly and their demands? the collected empirical data on the work and challenges with housing for elderly people is described in the following section. From the thematic analysis, three

23 themes have been identified. The themes are: Varying housing supply, Popular accommodations in demand by the elderly, Older housing supply as a challenge.

5.2.1. Varying housing supply In the interviews, it appears that the three municipalities have different supplies of housing for the elderly. Vilhelmina municipality believes that they suffer from too many homes that must be filled, Sorsele municipality have a reasonable supply and do not consider it a problem to fill empty apartments, however, Storuman municipality has a deficit of housing for the elderly.

Storuman municipality; “There is a long waiting time for the elderly in the municipality as we have a housing deficit. We only have special housing within the municipality. We also opened a sheltered housing last autumn with 11 apartments. Only 9 of the apartments are filled”

Sorsele municipality; “We have a fairly decent housing supply. There are many who are in the housing queue, but some do not want to move now due to various circumstances such as it being close to summer, then it is also covid. Emergency situations arise”

Vilhelmina municipality; “We have all kinds of accommodations. There are around 700 apartments, of which the elderly live everywhere in the housing supply. It is almost as if we have difficulty filling all the apartments”.

Furthermore, Sorsele municipality mentions that there was previously a problem with long queues, but they solved it by using the existing supply;

“We had problems with queuing before. We have a large building that has recently been housing for unaccompanied refugees. When the Migration Board terminated the agreement, we were left with an empty building. Then it was decided to build 10 senior apartments, but in the end, there were 5 senior apartments and 5 LSS housing (housing for people with disabilities) because this was also in demand”

24 5.2.2. Popular accommodations in demand by the elderly There are various demands in housing types between the municipalities. Although, one common theme is that there is no greater demand among the elderly to live in regular apartments. Instead, there is an increased demand in shared accommodations and housing adaptations. Vilhelmina municipality explains that they try to make housing adaptations as far as possible;

“There is one sheltered accommodation that is very popular here. There are also quite often requests for adjustments in the home. We want to try to treat and care for people in the home as far as possible. Some adjustments can be made, and some not”

Sorsele municipality emphasizes that it is important for the elderly to have the opportunity to move into a shared accommodation. Furthermore, they also believe that ordinary apartments will contribute to isolation for the elderly;

“Most people are interested in senior apartments and they are very popular. Since it’s a large municipality, there are many people living in villages, so it’s important that they get to move into a shared accommodation. If they were to move into their own apartment, they would still be isolated. When they live in senior housing, they can join activities and it will not be a barrier to get to places. This is also why there are many who have been queuing for many years, even though they are not interested in moving now”

However, when I asked the municipality if there is a different demand in different parts of the municipality, the demand seems to be the same. The municipality also emphasizes that people want to stay as long as possible and in general, the elderly usually prefer to move into ordinary apartments rather than care facilities. It doesn’t emerge in the interviews with Storuman municipality what kind of housing is in demand from the elderly, although they mentioned that they are open to newer types of housing;

“There is a need to find some kind of middle ground between home care and retirement homes. It is partly about adjusting, but also about opening up to new forms. It is also about dimensioning this right. For example, a higher proportion of men become lonely and older. However, we do not really know if it is the same pattern that women have. In addition, a large proportion of the elderly move from the municipality”

25 Storuman municipality continues to explain that there are questions, for example that they do not know what the migration pattern looks like for the elderly, that they do not know where the elderly is moving. There is an aging population in the villages as well, but then there will be further questions about home care and such.

5.2.3. Older housing supply as a challenge Both Vilhelmina- and Storuman municipalities have a common challenge. It’s about being able to restructure existing buildings to turn these into apartments in the future, which entails a large cost for the municipalities. Sorsele municipality did not mention that they have any major challenges, but that they believe that in the event of an emergency, it will be solved since it will be a collective problem for both staff and residents.

Vilhelmina municipality says that there are financial challenges in renovating the existing supply;

“To a greater extent, we must be more alert to renovation and keep the asset aspect in mind. Our challenge will be to meet this. We have a relatively old housing supply, which will be very expensive to renovate. Renovations can’t be considered as investments because it is rough on the housing companies' finances. It will thus not be optimal to rebuild a 60-year-old house”

Storuman municipality; “Our challenge is the big question. The proportion of older people is increasing. We have structures that are not built according to the needs that exist, which will be the big challenge”

In general, it appears from the interviews that the existing supply becomes difficult to adapt for elderly due to economic aspects. Storuman municipality is open to new types of housing as they have a shortage of housing for elderly, and at the same time, Vilhelmina municipality has a different variety of housing supply and has no difficulties in filling the apartments. Sorsele municipality does not have any long-term strategies for the housing situation of the elderly.

26 6. Discussion It emerged in the interviews with the elderly that the biggest shortage in both living environments but also urban environments, are meeting places. In the living environment, there is a demand for outdoor spaces with the possibility for elderly to socialize, while in the city there seems to be a demand for gardens and spontaneous places to meet people. Since living environments are to a large extent something that is the landlord's responsibility, it will in many cases be the municipality's responsibility to provide these. In some cases, it can be a cost issue, as a large part of the supply is municipal owned, for the municipalities that have a limited economy. At the same time, as one respondent pointed out, the residents did not receive cheap accessories to be able to create their own meeting place. This can also be based on the budget for the well-being of the elderly and what the priorities are.

Furthermore, according to the Västerbotten region elderly plan, they believe that it is a challenge to create a community, and at the same time emphasizing that it is important to create environments adapted for different groups in society. As previously mentioned, most respondents have not experienced many such environments. Creating meeting places can therefore affect the well-being of the elderly and the social dimension can be improved overall.

Many respondents believe that they prefer common forms of housing rather than ordinary apartments and the municipalities seem to have the same perception on this. In particular Vilhelmina municipality highlights the possibilities of adapting housing to accessibility, which enables the elderly to stay. However, this was not something that was mentioned from Storuman municipality, which may be due to various things, such as that they do not see such a need, that the municipality does not actively work with it or that the person interviewed does not have broader knowledge of these issues. Sorsele municipality did not raise this issue either but points out that they have knowledge that the elderly wants to stay in their homes. In summary, it is not perceived that Storuman and Sorsele municipality work with this issue actively, but rather focus on apartments in different forms, while Vilhelmina municipality has a focus on adapting homes to a large extent, even if they have difficulty filling the existing apartments.

To connect it to the aging in place principle, which has led to social reforms to make it easier for the elderly to stay home, the cost for the society can be postponed by enabling elderly to live at home as long as it's possible. It will not only be a profit for the municipal economy, but also in this case it will be a profit for the elderly who in these interviews have a desire to stay

27 in their current housing. Furthermore, when the elderly moves to municipal housing that requires care staff, it becomes a cost to society, especially in the affected municipalities that have a limited budget. Since home care services are generally a smaller cost for the municipalities than retirement for the elderly, it is possible to discuss if the municipalities prioritize this, or whether it is possible to make some kind of community through home care to make it more attractive for the elderly. This could save costs in building different types of housing and at the same time counteract the isolation that some people feel.

To make a comparison with the analysis of the interviews and Callahan's claim that aging at place enables the elderly to maintain their contacts, there is another aspect that may be worth discussing, especially since Callahan's perspective may not have been from the inland of or other rural areas that are declining in population. In places like the study area, where the municipalities are decreasing in population to nearby growing municipalities such as Skellefteå and Umeå, it is the case that the elderly have already lost many contacts. As it emerged in the interviews, some older people, who originally came from these municipalities, had moved to other places earlier in life and then returned. While they lived in other places, some of their children had stayed while the interviewees moved back. Thus, some older people do not have this network of contacts, especially people who have had contacts who have passed away due to age and health. This can be a contributing reason why older people request meeting places. Furthermore, Paulsson mentioned (see the introduction) that municipal home care will need to prioritize the elderly with the greatest needs in the future which might result in elderly that need to arrange help and support on their own. This might be a problem for people that live in the periphery, don't necessarily need much help and want to stay at home for as long as possible. These people might eventually become a forgotten group in the society.

There are some similarities between the answers in these interviews and the ones in the study by Löfbom, et al. (2013). For instance, the elderly thrives in their current housing, not least with the neighborhood. There is also a fear among the elderly to not keeping their freedom in connection with a move to a nursing home. What distinguishes the studies is that in this study, the respondents are between 65-83 years old, while the respondents are 80- 89 years old in Löfbom, et al.’s study. Something that many respondents in Löfbom’s study descried, but which was not mentioned in the interviews in this study, is that there is a pressure from the surroundings to move to a special accommodation.

28 Vilhelmina municipality and Storuman municipality believe that their challenges are obstacles in adapting housing and renovating the existing housing supply. This was something that one respondent pointed out, that there are buildings without elevators even though elderly live in them. The municipalities believe that it is the costs that prevent them from renovating and adapting the housing. In the introduction, I included a paragraph, where Paulsson believes that it is important to have long- and short-term plans regarding buildings because the construction sector is slow. This was not mentioned by any of the municipalities, and no documents were found on the municipalities' website. However, there is a possibility that the municipalities have plans that aren’t published on the websites, but at the same time one might think that if that was the case, it would have been mentioned in the interviews.

6.1. Proposals for further research What distinguishes this specific place, which is depopulated rural municipalities, from increasing municipalities, in this matter is the deficit of people of working age in relation to those who are to be supported. The problem formulation aims at this and in order to be able to provide for the elderly, it is also about either getting people to stay, or having a strategy to attract people. Such a study will be able to examine the other side of the problem.

Furthermore, it emerges in the interviews that it will be a cost issue to renovate the existing supply because it is not seen as an investment. Therefore, a study dealing with profitable new constructions or accessibility adaptations would have been of interest, as it may not be seen as an economic investment, but rather an investment in social sustainability.

The interviews also revealed how the car plays a role in their future plans to move. We also know that the municipalities are declining in population to larger growing municipalities. Therefore, it is possible to discuss whether there is another type of "urbanization" within sparsely populated municipalities, if home care and accommodation should not be prioritized in similar municipalities. Such a study, which delves into the role of home care in rural areas, could raise this issue even more.

29 6.2. Conclusion As a result of an aging population, not least in Swedish rural municipalities, the need for housing will increase. There are incentives that the need for shared housing types will increase instead of ordinary apartments. While the aging population will increase, the able-bodied population will not be as large in proportion to the elderly as it is today. This means that the tax revenue, which is used to support the elderly, will be a problem in the future. The purpose of the study is to investigate what older people in the municipalities of Storuman, Sorsele and Vilhelmina demand in their living environments, and what the municipalities have plans to provide for the elderly and make them feel comfortable. To achieve the purpose, interviews with both older and municipal employees were conducted. The analysis has linked the results to previous studies and theories. The results showed that there is a great need for natural meeting places, both in the living environment but also in the towns and the public places. Many of the interviewees lived in loneliness, which contributed to the meeting places being an important factor. They also want to live in the home for as long as possible. There is a varied housing supply between the municipalities, and the municipalities seems to realize that it will be a challenge to provide housing for the elderly. Storuman municipality seems to have a greater concern for this as they have a deficit in housing at the moment, while Sorsele has a reasonable supply and Vilhelmina seems to have difficulties filling the empty apartments they currently have. The municipalities have different attitudes and plans to solve the future problems. Among other things, Storuman believes that they are open to new types of housing, while Vilhelmina currently has a larger range of different types of housing. Vilhelmina works to try to get the elderly to stay as long as possible through accessibility adaptation. But the big challenge for the municipalities is to adapt the current housing supply by renovating to accessibility, which is becoming an economic issue. Since renovating the existing housing supply is not seen as an investment from an economic point of view, this will be a future challenge.

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34 https://www.boverket.se/sv/samhallsplanering/bostadsmarknad/olika- grupper/aldre/ (Downloaded 2021-04-30)

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Appendix 1. Consent form Jag heter Victoria Scherbakova och jag skriver i nuläget min magisteruppsats inom kulturgeografi. Studiens syfte är att undersöka vad äldre inom Storuman-, Sorsele- och Vilhelmina kommun efterfrågar i sin boendemiljö, hur äldre inom studieområdet känner om att åldras i sitt nuvarande boende samt vad kommunerna planerar för att möta den åldrande befolkningens efterfrågan av boende och vilka utmaningar kommunerna har.

Intervjuerna beräknas ta ca 15 minuter och anteckningar kommer föras under tiden om inspelning av samtalet inte godkänns. Dina svar kommer att behandlas konfidentiellt vilket betyder att du kommer vara anonym och ingen utöver mig och min handledare kommer att få tillgång till materialet fram tills dess att uppsatsen är färdig. I intervjun behöver inte som deltagare svara på alla frågor och du får avbryta din medverkan när som helst utan att ange någon orsak. Om frågor skulle uppstå så är du välkommen att kontakta mig i efterhand.

/

My name is Victoria Scherbakova and I am currently writing my magister's thesis in human geography. The purpose of the study is to investigate what older people in Storuman, Sorsele and Vilhelmina municipalities demand in their living environment, how elderly people in the study area feel about aging in their current housing and what the municipalities plan to meet the aging population's demand for housing and what challenges they have.

The interviews are estimated to take about 15 minutes and notes will be kept in the meantime if the recording of the call is not approved. Your answers will be treated confidentially, which means that you will be anonymous and no one other than me and my supervisor will have access to the material until the essay is completed. In the interview, the participant does not have to answer all the questions and you can cancel your participation at any time without stating any reason. If any questions would arise, you are welcome to contact me.

Victoria Scherbakova Supervisor: Emma Lundholm

37 Appendix 2. Interview template for the elderly

Can you explain the place where you live?

How long have you lived at the place?

Do you thrive?

What do you appreciate in your living environment?

Is there something you are missing in your living environment?

Is there anything you like less about your living environment?

How do you feel about aging in the place you live?

Has the living or housing preferences changed with the age? And what do you consider important/less important now, which you may not have considered before?

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Appendix 3. Interview template for the municipalities

What does the housing supply look like for the elderly?

Is there a difference in demand between different types of housing?

Do you see any difference in the demand for the elderly depending on where in the municipality they live?

Do you think that you will succeed in meeting the needs that exist?

Do you have any challenges in providing housing for the elderly?

How do you work to make the elderly thrive?

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