Apartments for Life: Humanitas Rotterdam

Project Selection

The project may contain a number of the following features but it has been identified by the Steering Committee specifically because it:

The following project description is an edited version of the report: “Apartments for Life in Australia Lessons for Australia from Humanitas in the Netherlands June 2009” prepared by the Benevolent Society and available at www.bensoc.org.au.

Project Overview

Under the leadership of Dr Hans Becker, Chair of the Humanitas Foundation, the first Apartments for Life complex opened in the mid 1990s. Today there are seventeen Apartments for Life complexes in Rotterdam with several thousand older people as residents.

Why it is an innovative project

As its name suggests, a key feature of the Apartments for Life model is that it offers older people a chance to remain in their own home, throughout older age and to avoid having to move home when their health declines and they require increasing levels of care and support. Apartments for Life challenges the oft-held assumption of the inevitability of a move to a nursing home in later old age.

However, Humanitas’ Apartments for Life is about more than just enabling older people to live in the one place until the end of life. It is about supporting older people’s control over their own lives and their continued activity and participation in community life.

The Built Environment

The apartments are designed to be ‘age-proof’, that is, to be liveable for people of any age. Where possible, apartments are configured or adapted to the needs and preferences of individual residents. There is an average of 240 apartments in each complex and they are all high rise – because of the pressure on space in densely populated Holland.

The design of individual apartments promotes residents’ abilities to do as much as possible for themselves and to continue living there as normally as possible even when their health deteriorates and they need intensive assistance. They are designed to be attractive to people in good health who live completely independently and for those who need intensive assistance.

Each apartment has its own lockable front door. They have their own private space into which others can come only by invitation, not just a room with an ensuite or a shared room. Care workers cannot enter an apartment uninvited.

The apartments are accessible for people who use wheelchairs and also have enough space to move a person on a stretcher. Wide doors and the absence of thresholds are standard as are lever taps, smoke detectors, adjustable sink units, easy to use door and window fastenings, computerised door keys, lockable letterboxes, a large bathroom, easy access to the balcony and meters that can be read at wheelchair height.

The minimum floor space is 70 sq m. Newer complexes have apartments ranging in sizes up to 300 sq m, with residents paying more for larger apartments. Future developments will feature new technological developments in communication, with a view to maximizing the independence of residents.

In the past four years, Humanitas has constructed nine units for people with dementia. Residents may live until the end of their lives in an Apartment for Life, but if they consider the burden it might lay on the ‘healthy’ spouse too great, Humanitas offers a solution. Living with a partner with dementia even when 24-hour care is available can be exhausting so the option of living in one of these units allows residents to stay in the Apartment for Life community without compromising their care.

The Dementia units are situated within existing buildings and are comprised of a small cluster of studios for 6-8 people around a living room and open kitchen. Daily life consists of shopping, preparing meals and doing any tasks of which residents are capable and a sense of community is maintained by continuing to give residents access to the ‘village square’.

Each Apartments for Life complex has a ‘village square’ at ground level with a range of services and facilities. Typically the village squares include a covered atrium with comfortable seating, restaurant, bar and cafe, internet cafe and open space with art, sculpture and large colourful murals.  These are critical to creating an ambience in which apartment residents are, and are seen by others as, part of the world around them. The aim is to counter the sense of older people being excluded from the mainstream of community life because they no longer work nor look after children or because they are in poor health.

Humanitas works hard to create a warm, stimulating and inviting atmosphere where apartment residents, their friends and family and residents of the local neighbourhood are attracted to come to use the spaces, facilities and services and to interact with each other. The facilities are chosen and designed with family members and neighbours in mind, as well as apartment residents, being careful to ensure that all areas are accessible by people who use wheelchairs.

Apartments for Life complexes may also include:

an ATM

a fitness centre, hairdresser, beauty salon

a physiotherapist

gardens, fish pond, aviaries, animal park

a supermarket or store

a reminiscence museum with everyday objects, pictures, sounds and scents from the last century to provide fun for young and old and especially for people with dementia

art and craft studios

a multi-faith prayer/meditation centre with, for example, Roman Catholic stained glass window, Islamic prayer mat and statue of Buddha.

These facilities create a neighbourhood atmosphere by offering services that local residents will want to come and use as well as creating opportunities for social interaction and adding a level of interest and excitement to residents’ lives. The latter is especially important for those in poor health or with depression so that they ‘have something to talk and dwell upon about other than their own personal afflictions’.

Humanitas believes that people are more able to cope with negative things happening such as illness or death of partners and friends if there are positives happening around them as well.
Health and care services needed by residents are also located in offices and clinics in the village square, being careful not to dominate or present an institutional front. Thus, there are no white coats, jungle of signs, or abundance of rules and regulations evident in the village square.

Service Model

When residents need health and care services, they can obtain them from the Humanitas care organisation or are free to organise care services from other organisations if they wish. Residents have access to personal care, nursing care, psychologist, social worker, dietician, speech therapist, GP and other health and care services. Typically these are based among the ground floor facilities.

The Apartments for Life philosophy has four basic values which underpin the business model and are a key to the organisation’s success. The values are:

Be boss of your own life.  All but those who no longer have the mental capacity are entitled to be self-determining, or as Humanitas puts it, to be ‘boss of your own life’. This means the minimum of rules, no one telling you what you should and should not do and how you should live your life, unless you have asked for their advice.

Use it or lose it. Skills are quickly lost if not used and this includes social skills and confidence as well as physical abilities. Residents, their families and the staff are encouraged to focus on people’s strengths, what they can do rather than what they cannot do. Residents are also given opportunities to do new things, learn new skills, take up new hobbies and so on.

An extended family approach. The Apartments for Life philosophy recognises that everyone has something to offer of benefit to others, whether it is professional skills, years of experience living with a particular condition, local history, lost skills or knowledge and so on. Divisions between staff and clients are minimised.

A positive attitude or ‘yes’ culture. This means that nothing is automatically dismissed as being out of the question or too difficult. Staff are expected to ‘start with yes’ and then explore the situation further to work out a solution. The yes culture means that everyone will have a positive attitude towards residents’ wishes, questions or demands.

Key elements

The four basic values of the Humanitas vision underpin every aspect of the Apartments for Life model. The key elements are:

A clearly articulated philosophy

A carefully designed apartment that is ‘a place of your own’

A ‘village square’ with services and facilities open to the neighbourhood as well as to residents

Events and activities

A mix of people, mixed in terms of health, social and cultural background and tenure

Separate arrangements for housing and care

The management and staff culture.

Who the project serves

In each complex, Humanitas aims that at least a third of residents should be people in good health without significant disabilities and who are able to live independently. There is a deliberate mixing of residents, in terms of health status and socio-economic status. Their inclusion is seen as an important element in avoiding an ‘institutional’ feel, a tendency common in places where people who are dependant are all clustered together. Residents in good health are encouraged to act as volunteers, become involved in organising activities and in the management of the complex.

Dr Becker reports that in practice the apartments are mostly purchased or rented by people in their middle years or in older age who are attracted by the concept and the future availability of care services. The apartments tend to be a bit more expensive than equivalent apartments elsewhere in Rotterdam and so are less attractive to much younger people.

Funding Sources

Humanitas has separated the care elements from the housing elements. Each are provided and paid for separately whether by the resident or through a government or insurance scheme.

Residents rent or purchase their housing as they would in any other apartment complex. Residents can buy or rent under a variety of arrangements, from affordable rental social housing, through to renting or buying (through the equivalent of strata or leasehold in Australia) apartments of varying sizes at market prices. This also ensures a socio-economic mix.
Rules governing who can purchase or rent apartments are kept to a minimum. Lower age limits rarely need to be enforced, and if one member of a couple dies, his or her partner remains entitled to stay regardless of their age or state of health.

Humanitas typically retains ownership of at least 51% of the apartments in each complex. Dr Becker reports that, over the long term, Humanitas generates profits from the sale and rent of the apartments, and ploughs the profits back into the organisation.

Project Auspice

Humanitas is a long established non-government organisation in The Netherlands.

Today, Humanitas caters for some 8,700 residents and elderly using their home care and specialised services. Their 17 Apartments for Life house an average of 280 residents with another 4 under construction that will have almost double the average capacity. It has 3,500 employees, over 1,000 volunteers and an annual turn-over of over 100 million euro ($AUD 142 million)

Humanitas has not built a nursing home for many years and has demolished some that were sitting empty as Rotterdam’s older people have instead chosen to move into ‘age proof’ Apartments for Life.