Quarterly Brief 1
Age Integration Aging Society ISSN 2586-5692(Online)
The 6th issue Issue Date. 2019. 04.30 Publisher. Soondool Chung
Ewha Institute for Age Integration Research / Room No. 504-1. SK Telecom Center. 52, Ewhayeodae-gil, Seodaemun-gu, Seoul 03760 / TEL.02.3277.2235
Issue report I
Creating a physical environment for an aged society: Korea’s experience
Eun-ha JEONG
Team Manager, Research and Development Team Policy Research Department Seoul Welfare Foundation
The most crucial contribution made by the Global Network of Age-friendly Cities and Communities, a World Health Organization (WHO) initiative launched in 2010, is the government- led endeavors on reminding the global community of the need to develop policies in preparation for an aged society. It is particularly notable that the initiative puts cities and communities as the main agent of policy-making, enabling substantial changes that are relevant to citizens on the ground. The eight domains of an age-friendly community under the initiative cover the aspects of physical living environment, such as outdoor spaces and facilities, transportation, and housing, along with the issues related to the physical environment. This feature helped policy-makers expand and diversify their areas of interest in their efforts to prepare for population aging. Given the limited mobility in an old age, the lives of elderly people largely revolve around their decades-long residence and their community. The local community is therefore the backbone of their social relationships, enabling interactions with residents of various age groups and assistance for one another. This warrants attention to local communities as a spatial scope of activity where older citizens lead their everyday lives while maintaining various forms of social bonds. The elements of their physical environment should be the basis of this interest in pursuing the age- friendly values, including “aging in place” and “active aging.” This article explores a variety of policies implemented by Korean municipalities, including Seoul City, in relation to this physical environment aspect. The examples of policies in Seoul, those specifically executed by the Seoul Metropolitan Quarterly Brief 2
Government or by the autonomous district authorities under its jurisdiction, fall into the following three categories: public housing projects for the elderly population; renovation of senior welfare facilities; and creation of age-friendly outdoor infrastructure for senior citizens, such as parks and streets. There is a number of other examples related to mobility, such as subway fare exemption for elderly passengers, introduction of low-floor buses, and renovation of bus stops and subway stations. However, these measures were either implemented out of political motivations a long time ago or aimed more at enhancing convenience of the general public rather than the older population in specific. So the mobility-related examples are thus excluded from the present article. First of all, the Borin Housing project in Geumcheon District warrants a particular attention in terms of public housing for senior citizens. This affordable housing initiative combines studio apartments that guarantee an independent space for elderly residents and communal spaces that promote a community spirit among them and encourage interactions between the residents and the local community. A total of four housing units were built in the district under this scheme throughout the year of 2015 and 2016. They look no different from any other low-lying studio buildings in their appearance, but the idea behind this model was not only new but also appropriate, given the lack of consideration for elderly inhabitants under previous public housing initiatives. The Borin Housing model is currently being adopted by other district authorities, which is expected to be the starting point for future advances in the housing policies for the elderly population. The efforts on improving the physical environment of senior welfare facilities have a relatively longer history than senior affordable housing. This approach is based on the concept of universal design, where the concept of making facilities accessible to everyone is not only compatible with the objectives of age-friendly cities but also embodies the value of social inclusiveness beyond the mere focus on the aesthetics of the design. Starting with the guidelines applicable to daycare centers in 2010, Seoul City has published guidelines on implementing this concept of universal design in various types of facilities, such as senior community centers, senior welfare centers, senior welfare housing units, and long-term care facilities in 2011. These guidelines are being embraced in some new facilities although they fall short of general implementation. These attempts contribute to spreading the recognition that senior welfare facilities primarily serving older population should take their needs into consideration in designing and managing the buildings. The application of the age-friendly design should by no means be confined to senior welfare facilities; this approach gains even further relevance in residential buildings where elderly people lead their everyday lives. Potential increases in the prevalence of dementia, driven by population aging, warrant consideration for elderly residents with cognitive impairments. In this light, the Design Policy Division of the Seoul Metropolitan Government launched the so-called “cognitive health design” initiative in 2014 in Yeongdeungpo District, Yangcheon District, and Nowon District. The initiative introduced age-friendly, and easily recognizable design features with the aim of improving elderly residents’ cognitive health conditions in the areas with heavy presence of public lental housing that have been rented out to low-income citizens under the affordable housing schemes. More specifically, the initiative involved colorful paintings or markings to make apartment entrances, mailboxes, floors, and key passageways more easily recognizable, and installing elements that stimulates human’s five physical senses throughout neighborhoods, so that elderly residents can better recall their memories. Given the dominance of high-rise apartment-centered housing environment in Korea, it will be imperative to further expand this approach. Autonomous district authorities in Seoul have a long history of working toward an age-friendly environment, with the focus on neighborhood parks. For example, Yangcheon District created an Quarterly Brief 3
age-friendly Forest Trail Silver Park in 2005, and Seongbuk District installed a range of exercise equipments, specifically designed for elderly visitors, in Cheongnyang Neighborhood Park in 2008. These relatively larger-scale examples are also accompanied by a more recent, smaller-scale Ssamji [literally “small pouch”; here “small pockets of land in the middle of urbanized neighborhoods”] Playground initiative. Launched by Gangdong District in 2016, the purpose of the initiative is to transform small parks and children’s playgrounds across communities into communal spaces for elderly people. The district has created nine such places by 2018 with its plans to establish four more in 2019. These small-sized public spaces are expected to have better access to elderly residents compared to the larger-scale parks. So far, the efforts to improve the physical environment to enhance age-friendliness has been highly fragmented, with the emphasis on individual residential buildings, public facilities, parks, and etc. However, the recent trend involves an comprehensive community improvement project combined with the ultimate objective of building and promoting local communities. The best- practice examples in this regard are found in Busan, Gyeonggi Province, and Seoul. First, Busan is set to initiate an urban regeneration project this year in Geumsa Industrial Complex, Geumjeong District, with the aim of serving both the younger- and the older-generation populace. The area will be filled with affordable housing for the young population, age-friendly villages, community centers aimed at promoting the sense of community, and a food park that will jump-start the economy and create jobs in the area. The outcome is yet to be seen, but an age-friendly community project as part of a wider urban regeneration initiative, rather than a standalone, piecemeal measure solely for a specific age group, certainly has many implications for future age-friendly initiatives. For the past three years, Gyeonggi Province has been sponsoring a community-level elderly welfare project, dubbed “Carnation Village” Under this scheme, the Gyeonggi Provincial Government selects one community every year, through the process of receiving and reviewing applications from cities and counties under its jurisdiction. In 2017, Sanseong-dong in Sujeong District, Seongnam benefited under this project, and carried out a job creation project for senior citizens. The successful candidate in the following year was Wonmi 1-dong, Bucheon, where the endeavors were directed at elderly care and health. This year, the Province choose Yuljeon-dong in Jangan District, Suwon for a variety of projects, which includes creating a laundromat for elderly single residents, providing air purifiers, installing LED lights that shine at night at crosswalks, and forming a senior music ensemble, all of which are anticipated to ensure the safe and pleasurable life for elderly residents in the area. The Carnation Village project carries particular significance, as it offers the communities in Gyeonggi Province an opportunity to cover the eight domains of the age- friendly city, and, , to accumulate an experience in collaboration with various resources at the local level. Seoul City is also exploring the potential application of an age-friendly themed village project, targeted at small-scale residential areas. A case in point is a pilot project dubbed “Orae Orae Shop” in 2017, where the municipal government recognized the popularity of the age-friendly business model outside Korea and adopted it into the context of local communities in Seoul. The project elps small-scale businesses understand the needs of the elderly population and embrace age-friendly practices through training, consulting, and interactions with residents including elderly people, in their community. This project took place in Seongdae Market (Dongjak District), Eungam Market (Eunpyeong District), and Nakhui Street (Jongno District), with 38 businesses selected as the “Orae Orae Shop”. In 2018, the city further pursued another pilot project toward creating an elderly care community, with the emphasis on improving housing conditions for the older population. Five run-down neighborhoods with heavy presence of elderly residents not only Quarterly Brief 4
benefited from better housing conditions under this project, but also received care services that assisted in elderly people’s everyday lives, including mobility and nutritional support as well as neighbors’ visits. These endeavors were made possible through collaboration between various stakeholders, such as domiciliary senior citizen support centers, integrated elderly care centers, housing welfare centers, social cooperatives, residents’ solidarity organizations, and community businesses. Despite the short duration (3–4 months), the project received positive feedbacks from participants and yielded visible outcomes, albeit only to a limited extent. In summary, recent endeavors in Korea toward an age-friendly environment emphasize harmonization and collaboration between different age groups and residents to integrate elderly residents into the local community, even though the projects may focus on specific geographical or demographic targets. This is in line with the value that age-friendly city supports, i.e., pursuit of a suitable environment for all generations, including the elderly, to age with dignity and lead a decent life. Thus, it is fair to say that the endeavors to promote age-friendliness in various Korean municipalities and communities are well-conceived and are in positive direction. When it comes to the future approach in addressing the physical environment, not only the aspect of elderly healthcare, social activities (e.g. job related) but the social environmental factors, including smooth communications, and social respect should be taken into consideration. In order to yield tangible outcomes, the present author recommends a more comprehensive, and integrative approach on creating age-friendly physical environment.
References
Song, I., 2018, A study on community-based housing services for the elderly population, Seoul Welfare Foundation. Lee, Y., 2017, Envisioning and implementing an age-friendly village initiative: Policy recommendations for Busan Metropolitan Government, Busan Welfare Issue Report, Vol. 26. Chung, E. et al., 2015, Creating an age-friendly city: An overview of international best practices, Seoul Welfare Foundation. Chung, E., 2017, Age-friendly village pilot project: An implementation report, Seoul Welfare Foundation. Hwang, G. and Park, S., 2015, Basic research on the establishment of an age-friendly village in Gyeonggi Province. Gyeonggi Research Institute. Seoul Metropolitan Government, 2010–2011, Universal Design Guideline for Senior Welfare Facilities. The Asia Business Daily, September 21, 2018, Age-friendly design enhances senior residents’ cognitive health. The Asia Today, December 20, 2017, Seoul picks 38 age-friendly businesses. The Aju Business Daily, November 21, 2017, Age-friendly design reduces cognitive disorders in older residents. Yonhap News Agency, September 2, 2018, Busan to redevelop run-down industrial complex. The Hankook Ilbo. February 24, 2019, Gyeonggi to pursue age-friendly village initiative in Suwon. Korea Housing Journal, November 2016, Borin House, a brand-new shared housing project for old and lonely residents. https://extranet.who.int/agefriendlyworld/ Quarterly Brief 5
Issue ReportⅡ
Building an age-friendly physical environment in super-aged Japan
Tae-il KIM
Professor, Faculty of Architecture Jeju National University
1. Population aging in Japan Statistical data show that 84% of the elderly Japanese population are living in relatively good health, whereas the remaining 16% require long-term care and/or assistance (Figure 1). This warrants a suitable housing environment for healthy senior residents through a range of endeavors, such as renovating existing homes, diversifying senior housing options available for elderly residents in their community, and enhancing welfare services available at home or at specialized residential facilities. Effective geriatric care solutions are also imperative for those requiring assistance. In terms of the types of residence, 96% of the elderly Japanese live in residential units, with the remaining 4% accommodated at care facilities. It is also notable that the rapid rise in single elderly dwellers has contributed to the surge of the so-called Kodokushi (孤独 死, “lonely death”) phenomenon, where people die alone and remain undiscovered for a long time. Single elderly residents often find themselves in complete isolation with no social interactions whatsoever and no one to come to their aid even in emergency. Tackling this problem is an emerging concern in Japan.
Figure 1. Distribution of residency types in the Japanese elderly population (Source: 衆議院調査局国土交通調査室、「高齢者等の安心な住 まいについて」2014年2月, p12). Quarterly Brief 6
2. Key housing and elderly care issues in super-aged Japan Japan has separate statutory codes that govern senior care facilities and housing units, respectively, both of which include different types of houses and welfare facilities with varying features, functions, and target users. They are intended to accommodate demands for specific functions and facilities as well as to allow for a wide range of options that elderly people and their families can choose from, depending on their needs and circumstances. Instances include: intensive care homes and fee-based homes for the elderly (特別養護老人ホーム) (有料老人ホーム) under the Act on Social Welfare for the Elderly ; long-term care health facilities ( (老人福祉法) 介護 ) under the Long-Term Care Insurance Act ; and serviced homes for the 老人保健施設 (介護保険法) elderly under the Act on Securement of Stable Supply of Elderly (サービス付き高齢者向け住宅) Persons' Housing . (高齢者の居住の安定確保に関する法律) By function, these homes can be divided into welfare institutions and housing units. The former is primarily supplied by the Ministry of Health, Labor and Welfare and the latter by the Ministry of Land, Infrastructure, Transport and Tourism, both pursuant to relevant statutory regulations (see Figure 3). Each facility that falls into either of the two categories finds its legal basis in the Long- Term Care Insurance Act, the Act on Social Welfare for the Elderly, the Social Welfare Act (社会 , or the Act on Securement of Stable Supply of Elderly Persons' Housing, all aimed at 福祉法) fulfilling welfare needs and/or provide residential services. The diversity of features, functions, and managing authorities that hallmarks this housing system represents Japan’s commitment to addressing diverse needs arising from different health conditions (from healthy to bed-ridden) in providing facilities and services for the elderly population. One notable point is that, while a variety of options are available for elderly residents depending on their income, capacity to lead an independent life, and their need for assistance and/or long- term care, an increasing number of welfare facilities put emphasis on their residential functions. Also, enhanced residential functions have led to the expansion of welfare institutions that combine elements of care homes and ordinary residences, rather than mere increases in the types and numbers of housing units (Figure 2). This trend, which can be dubbed “de-institutionalization,” represents a shift from the previous focus on receiving and managing elderly residents at care facilities to the emphasis on making them feel at home as much as possible even as the residents, no longer capable of leading an independent life at their own home, become institutionalized and accept group life.
[Figure 2.] Categories of welfare institutions and residential units by income and function. Quarterly Brief 7
Another key issue is the introduction of the long-term care insurance system. Japan is experiencing demographic changes that call for appropriate long-term care services, including a rapid surge in the population aged 75 or over and the aging of the baby boom generation who, born around the end of World War II, joined the elderly population in 2015. The country also needed a well-conceived social insurance structure that can easily win public support and consensus through clear definition of costs and benefits. Additionally, in the long run, the existing top-down structure needed reforms to allow beneficiaries the right to choose from a range of healthcare and welfare services from various providers. All of these considerations gave rise to today’s long-term care insurance program. The expression “three facilities under the long-term care insurance scheme” is an umbrella term for facilities covered by public aid providing long-term care to the elderly (介 , long-term care health facilities , and medical long-term care 護老人福祉施設) (介護老人保健施設) sanatoriums , all dictated in the country’s Long-Term Care Insurance Act. (介護療養型医療施設) However, the insurance program has been plagued by numerous problems, such as a rapid surge in subscribers, cost overruns, increasing financial strains on the system, snowballing payouts driven by increasing demand for the long-term care services, excessive focus on treatment in the services under the scheme, and the out-of-control spread of long-term care facilities covered by the scheme. The upshot is a transition in the system toward more emphasis on support related to the living environment, especially that of the elderly beneficiaries.
3. Transition in Japan’s elderly housing and welfare policies: Toward a better physical environment and more tangible support
Japan has a history of systematizing and integrating geriatric care facilities through the introduction of a long-term care insurance program. After trial and error, it is now moving toward new elderly housing and welfare policies that stress assistance for elderly people in their everyday lives, especially in relation to a better physical environment, as the country becomes a super-aged society. Below is the summary of the specifics of this transition.
(1) Community-based comprehensive care package The 2005 amendment of the Long-Term Care Insurance Act, which originally went into effect in 2005, proposed the introduction of community-based services and comprehensive community support centers. Then, the 2011 amendment called for in-home, long-term care based on periodic visits and on-demand services as well as integrated service models, leading to discussions on further improvements in existing facilities. In other words, the new system aims to provide comprehensive services at the community level that ensure not only medical assistance and care services but also seamless preventive action, residential support, and assistance with daily activities.
(2) Multifunctional long-term care in a small group home (小規模多機能型居宅介護) This new long-term care model, introduced in 2006 under the Long-Term Care Insurance Act, involves welfare workers’ periodic visits and short stays, primarily through daily commuting, according to beneficiaries’ conditions and preferences.
(3) Regional comprehensive care system: Leveraging strengths of city centers This policy has been proposed by a review board established by the Ministry of Health, Labor and Welfare after discussions that began in 2013. City centers are tightly-knit communities, Quarterly Brief 8
featuring a variety of housing models, people from all walks of life, pre-established living infrastructure, and enterprises, all within a small, densely populated area. This care model leverages the strengths of this environment to respond to the needs of a society marked by a low birthrate and a super-aged population. The following key recommendations from the review board also deserve attention: First, be cautious about improving intensive care homes in municipalities outside the capital with the expectation—possibly unfounded—that the facilities will attract numerous, unspecified urban dwellers to their communities; Second, supply more serviced elderly homes; Third, in the event elderly residents move into serviced homes in other municipalities, the upkeep for their long-term care should be covered by the autonomous authorities with jurisdiction over their previous area of residence; and Fourth, make use of empty houses in urban areas and former schools.
(3) Reverse mortgage program (Japan Trans-Housing Institute) This project, spearheaded by the Japan Trans-Housing Institute (JTI, 移住·住み替え支援機 ), connects senior homeowners aged 50 or older with younger people looking for rented 構 accommodation. The homeowners can sublet their property for as long as they want—until their death, if they wish—in return for moving into a smaller property and receiving pensions from the JTI. This scheme has many advantages. For example, the homeowners are entitled to the minimal rental payments even in case of vacancy; the tenancy lasts three years, so homeowners have the option to move back into their place; and the process involves no direct interactions between homeowners and tenants since it is the JTI, not the homeowners, that arranges tenancy and subletting.
(4) Stable housing for elderly residents, people with disabilities, and families with children This program is aimed at promoting and supporting residential stability for senior citizens, people with disabilities, and families with children, where the state prioritizes and spearheads the endeavors with highest importance under a set of tangible and intangible criteria. The government also subsidizes projects under this scheme without actually taking the lead. Government subsidy involves the following criteria: - Houses and facilities aimed at providing stable housing for elderly people (Subsidy covers one-tenth of the upkeep for newly built houses and communal facilities for elderly people and two-thirds for renovated houses and facilities) (Subsidy covers two-thirds of design costs) - Validation of technologies relevant to ensuring residential stability for elderly people (Subsidy covers two-thirds of the costs for validating technologies, e.g., experiments involving residents or social experiments) - Provision and dissemination of information on stable housing for elderly people (Subsidy covers two-thirds of the costs for providing and disseminating information in this respect, e.g., maintaining show houses and creating miniature models for display)
(5) Lifetime tenancy scheme (終身建物賃貸借制度) This program, stipulated under Article 5 of the Act on Securement of Stable Supply of Elderly Persons' Housing, involves lifelong tenancy arrangements for elderly single dwellers and married Quarterly Brief 9
couples, aged 60 or above, where tenants are eligible for lifetime tenancy and the contract terminates only upon the tenant’s death, superseding the provisions of the Act on Land and Building Leases , if the rented property satisfies certain criteria, there is a permission (借地借家法) from the governor of higher administrative authorities (i.e., prefectures [ ]), and the 都道府県 tenancy contract was formed through notarized documents. The tenant’s death does not prejudice his/her spouse’s right to continued tenancy.
(6) The Urban Renaissance Agency’s age-friendly housing renovation In terms of community building and urban planning, collective housing complexes will play a key role in ensuring a safe living environment for elderly dwellers. Japan’s Urban Renaissance Agency (locally also known as “UR”) is renovating its pre-established residential complexes as part of its effort to address emerging challenges in a super-aged society (Figure 3).
(7) Earthquake resilience and other safety issues at elderly housing
[Figure 3.] An Urban Renaissance Agency apartment complex, renovated to address the needs of the super-aged Japanese population (Source: 衆議院調査局国土交通調査室、「高齢者等の安心な住まいについて」2014年2月, p71).
Japan is well known for frequent natural disasters, especially earthquakes, but many of the elderly housing units and facilities are at risk of high casualties in case seismic shocks affect the building. This has led to significant budgetary commitment to making the structures seismic- resistant. Another latest trend in Japan’s elderly housing is the emphasis on improving the facilities for fire prevention, such as installing sprinklers, motivated by casualties associated with fire or other contingencies in recent years.
References
Kim, T., 2008, Dwelling space in an aging society, Bogosa Publishing. Presidential Committee on Aging and Future Society, 2005, Comprehensive measures on housing support in an aged society. 2014, 2 ,71 衆議院調査局国土交通調査室、 「高齢者等の安心な住まいについて」 月号 Quarterly Brief 10
Policy & Law
Recommendations on legal and regulatory reforms toward an age-friendly urban environment 1)
Ko, Youngho
Manager of Research Coordination team Architecture & Urban Research Institute
Korea has one of the world’s fastest-aging population, but it is largely preoccupied with healthcare and welfare in its policies and programs that are meant to tackle the challenges of this demographic shift. In contrast, the World Health Organization (WHO), through its Global Age- Friendly Cities: A Guide (hereafter “the WHO Guide”), presented three physical features (outdoor spaces and buildings, transportation, and housing) and five non-physical features (respect and social inclusion, social participation [including recreation], civic participation and employment, communication and information, and community support and health services) of an age-friendly environment (WHO, 2007). Achieving better physical and mental health in the older population and, ultimately, building an age-friendly society require improvements in both the physical and non- physical environment. However, Korea’s national and municipal-level plans on population aging lacks concrete considerations on the physical aspects of the challenge, such as the outdoor space and urban landscape. The country’s Framework Act on Low Birth Rate in an Aging Society mandates the state to ensure a decent and safe environment (Article 13) through policy measures. The same statutory code also requires the government to develop “basic plans on low birth rates in an aging society” every five years and local authorities to devise annual implementation plans. However, the second basic plan, when compared with the WHO Guide, demonstrated shortcomings in preparing an age-friendly physical environment, such as access to green space (e.g., parks) and outdoor facilities (Chung & Eo, 2012). The third basic plan envisioned an additional “policy roadmap on low birth rates in an aging society” (Presidential Committee on Aging Society and Population Policy, 2018) that stressed local communities’ leading role in elderly care to address inadequate outcomes vis-à-vis budgetary commitment while enhancing effectiveness of the tasks under the plan. Meanwhile, the first-phase implementation plan of the Seoul Metropolitan Government faced criticism for insufficient consideration on the actions toward a pleasant living environment (Chung, 2014). All these drawbacks signify gaping holes in the physical environment that will support the welfare policies at the central and local government levels, including health promotion, access to healthcare services, and encouragement of recreational activities and socio-cultural engagement, in preparation for the challenges of an aged society.
1) This article is a partially revised and edited version of the author’s previous publication titled Measuring the Age- friendliness of Urban Environment for Preparing Ageing Society (Architecture & Urban Research Institute, 2018). Quarterly Brief 11
The outdoor landscape in urban areas and communities have a tangible, significant impact on elderly citizens’ physical health as well as their social interactions and engagement. It has been established through a number of previous studies that a community with an enabling environment in its outdoor spaces, such as good accessibility to walkways, parks, and shops, is closely associated with a physically more active old-age population, while, simultaneously, safety and connectivity of such environment are associated with elderly people spending a longer time on outdoor activities (Joseph & Zimring, 2007; Nagel et al., 2008; Gomez et al., 2010). The outdoor environment provides a backdrop for this age group to spend time together with their family, friends, and neighbors, promoting their social interactions and alleviating social isolation (Pinquart & Sorensen, 2001). A walkable outdoor space has particular relevance in enhancing elderly people’s independence and social interactions (Frank et al., 2010). The outdoor landscape has a crucial impact on their activities and may also determine their quality of life (WHO, 2007).