The making of ageing-in-place Citation for published version (APA): van Hees, S. V. (2017). The making of ageing-in-place: Perspectives on a Dutch social policy towards lifecycle-robust neighbourhoods. Maastricht University. https://doi.org/10.26481/dis.20171219svh Document status and date: Published: 01/01/2017 DOI: 10.26481/dis.20171219svh Document Version: Publisher's PDF, also known as Version of record Please check the document version of this publication: • A submitted manuscript is the version of the article upon submission and before peer-review. There can be important differences between the submitted version and the official published version of record. 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If the publication is distributed under the terms of Article 25fa of the Dutch Copyright Act, indicated by the “Taverne” license above, please follow below link for the End User Agreement: www.umlib.nl/taverne-license Take down policy If you believe that this document breaches copyright please contact us at: [email protected] providing details and we will investigate your claim. Download date: 05 Oct. 2021 The making of ageing-in-place Perspectives on a Dutch social policy towards lifecycle-robust neighbourhoods Susan van Hees The research presented in this dissertation was conducted at the Care and Public Health Research Institute (CAPHRI), Department of Health Services Research, Maastricht University. CAPHRI participates in the Netherlands School of Primary Care Research (CaRe), which has been acknowledged by the Royal Netherlands Acad- emy of Science (KNAW). Funding for the research of this dissertation was provided by The Netherlands Organisation for Health Research and Development (ZonMw), grant 314070201. Printing of this thesis was financially supported by the Netherlands Graduate Research School of Science, Technology and Modern Culture (WTMC). © Susan van Hees, Breda 2017 ISBN: 978-94-6233-766-4 Lay-out and Cover design: Evelien Jagtman (www.evelienjagtman.com) Printing: Gildeprint Enschede All rights reserved. No part of this thesis may be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopying, recording or any information storage or retrieval system, without prior written permission of the holder of the copyright. The making of ageing-in-place Perspectives on a Dutch social policy towards lifecycle-robust neighbourhoods PROEFSCHRIFT ter verkrijging van de graad van doctor aan de Universiteit Maastricht op gezag van de Rector Magnificus, Prof. dr. Rianne M. Letschert, volgens het besluit van het College van Decanen, in het openbaar te verdedigen op 19 december om 12.00 uur door Susan Vivette van Hees Promotores Prof. dr. D. Ruwaard Prof. dr. K. Horstman Prof. dr. M. Jansen Beoordelingscommissie Prof. dr. G. Kempen (voorzitter) Dr. M. Knibbe Dr. L. Neven (Avans University of Applied Sciences Breda) Prof. dr. G. Roets (Ghent University) Prof. dr. T. Swierstra Table of contents Chapter 1 Introduction 7 Chapter 2 Conflicting notions of citizenship in old age. 23 An analysis of an activation practice Chapter 3 How does an ageing policy translate into professional practices? 51 An analysis of kitchen table conversations in the Netherlands Chapter 4 Meanings of ‘lifecycle-robust neighbourhoods’. 69 Constructing versus attaching to places Chapter 5 Photovoicing the neighbourhood. 95 Understanding the situated meaning of intangible places for ageing- in-place Chapter 6 Discussion 119 Summary 141 Samenvatting 149 Valorisation 159 Dankwoord 171 About the author 179 List of publications 183 Chapter 1 Introduction Introduction 1.1. Reforming care in ageing societies 1 An ageing population and associated public health-care expenditure has caused an increasing number of Western welfare states to shift more and more of their health- care responsibilities to individual citizens (Bond et al. 2007; Dunn 2005). Activation policies are used within these care reforms as a strategy to maintain an affordable and sustainable health-care and welfare system. Simultaneously, these states are decen- tralising welfare and care functions from national to local governments (Hacker 2009; Kroneman, Cardol and Friele 2012; Nowak et al. 2015; Singh 2008). Partici- pation is an important element within these developments. Governments promote deinstitutionalisation, and to achieve this they do not only emphasise individuals’ own responsibilities for their health and well-being, but also aim to activate people to help each other (Rudman 2015; Lamb 2014; Newman and Tonkens 2011). Increasing people’s options to remain living in their own place independently for longer are part of such individualisation strategies. To meet the needs of an ageing population, the World Health Organization (WHO) developed policy frameworks to encourage ageing-in-place. These frameworks were created to stimulate and enable active ageing and the development of age-friendly places (WHO 2015). With these frameworks, the WHO intends to provide govern- ments with guidelines to help them develop new policies. In line with these ideals, the Dutch government aims to enable ageing-in-place, and emphasises the importance of encouraging independence and individual responsibility in an activation policy (Newman and Tonkens 2011). In 2007, the Social Support Act (Wet maatschappelijke ondersteuning) was implemented. One of its aims was – and still is – to encourage older adults to live independently for longer. This Act has been continuously adjusted since its introduction and other reforms have been introduced to further facilitate a shift towards a more participatory society. The Dutch policy is further informed by current discussions on ‘positive health’, a notion introduced by Huber et al. (2011). They argue that modern societies need a more positive conceptualisation of health than the WHO definition of health as a ‘state of complete physical, mental and social well-being’, namely as ‘the ability to adapt and to self-manage, in the face of social, physical and emotional challenges’. In this view, health is primarily related to individual abilities and not just to physical and mental health status. To understand the abilities relevant to positive health, the environment in which people live plays a pivotal role, especially for older adults, as they often spend a growing amount of time in their own home and neighbourhood (Andrews et al. 2013; Beard et al. 2009; Ottoni et al. 2016). To improve our understanding of how this activation policy functions, we studied one innovative public care initiative in particular. In this initiative, the main aim was ‘to encourage and enable ageing-in-place’, by understanding and developing neighbourhoods as ageing technologies, as mediators of ageing-in-place. Instead of a traditional evaluation study, in which outcomes and effects are monitored to evaluate 9 Chapter 1 the quality and success of a policy, we aimed to understand the meanings given to the ‘making of ageing-in-place’ and how meanings change, by observing this policy in practice. To achieve this, we used a social-constructivist approach. In this chapter, ageing-in-place is first introduced as part of the broader category of activation policies. Next, we describe the innovative public care initiative ‘Voor Elkaar in Parkstad’ (literally For Each Other in Parkstad, but also meaning ‘getting things done’ or ‘all well’), which we used as a case to study the development of an ageing-in-place policy. And finally, we discuss the theoretical approach, our main research questions and the methodological approach we used to study this initiative. An outline of the various chapters that are part of this thesis is included at the end of this chapter. 1.2. Ageing-in-place: Places as ageing technologies Place is increasingly considered to be an important facilitator (or mediator) of ageing-in-place. It is argued that ageing-in-place should be given preference over ageing in institutional settings, as it is presumed to enhance people’s choices in live. According to Gilleard and Higgs (1998), Higgs (1995) and Persson and Berg (2008), being able to move in the own home and neighbourhood is important, not only to remain independent, but also to maintain one’s status as a citizen, as a participative member of society. The ability to participate in social activities is considered ele- mentary in remaining independent. The place where one lives is thus assumed to play an important role in maintaining one’s status as a citizen (Sixsmith et al. 2014) and in preventing institutionalisation in accordance with most people’s preferences (Wiles et al. 2011). Social constructivists such as Gieryn (2000) emphasise that it is not so much a particular place in itself that is important, but mainly the way in which place mediates social life, because it is the emotional or social relations in and historical associations of a place that people are really attached to. Lamont and Molnár (2002) demonstrated that places become meaningful through the way they reflect and constitute social relations. In the Dutch activation policy, which is part of care reforms aimed at cre- ating a more participatory society, care and welfare professionals play a pivotal role in optimising places as age-friendly.