Caring for older people is traditionally an area in which many charities are active. In the face of the current demographic shifts, these activities are gaining increasing importance. We are living longer, and the number of older people is growing. This new situation poses a challenge for our whole society.
«Our heart doesn’t lose its memory,» says Beat Hänni, chair of the board of trustees.
For over 15 years, the Humor & Gesundheit («Humour & Health») foundation has been supporting initiatives and projects that use empathetic and respectful humour to increase the quality of life for elderly and disabled people and those suffering from dementia. The board of trustees pursues the principle, rooted in the charity’s purpose, that humour can be a therapeutic tool for increasing people’s physical and mental well-being. Bringing humour to retirement and care homes is a challenging and contentious undertaking. It’s a balancing act: those with all their mental faculties should be able to engage as well as those who have lost some of their mental capacity. The effect of humour on those suffering from dementia should not be underestimated – smiling, laughing and lighting up can make a real difference. «Specially trained “contact clowns” know and have a very precise feel for how to engage with those suffering from dementia. They use speech, touch, music and facial expressions,» explains Hänni. «Hearing and vision can excite emotions. And long-term memories are often still accessible.» This gentle humour allows them to engage with, move and delight people with whom other forms of interaction have become difficult.
A growing group
The question of growing old well is a complex one – the answer to which will become increasingly important for our society. It poses a challenge for the government, science, business, non-profit organisations and charities alike.
There is no place for competitive thinking; we need to focus on complementary engagement. «Above all, I foresee people coming together,» says Maja Nagel Dettling from the Paul Schiller Stiftung.
The charitable institution promotes high-quality care for older people in Switzerland. It is particularly active in areas where the government is not (yet) involved. «We see ourselves as a balancing force. We have financial resources and, compared with the government or private businesses, are an independent entity,» she explains. This allows the foundation to be more flexible. Foundations can identify and define problems and find solutions on their own initiative. This is urgently needed when it comes to the question of ageing. Political reforms have stalled. Demographic change has made it essential to find answers, and soon. According to reference figures from the Federal Statistical Office, a quarter of the population will be over 65 by 2045 – in 2015, this figure was 18 percent. In 1998, a 65-year-old woman could expect to live another 20.6 years on average. By 2018, this had risen to 22.7. According to the Federal Statistical Office, men’s average life expectancy after retirement also climbed to 19.9 years – 3.4 years longer than at the end of the 20th century. Every additional year is, in essence, a gain. But this change brings with it major societal challenges: the increasing demographic imbalance between those of working age and those who are retired is new and uncharted territory.
Antonia Jann, CEO of the Age-Stiftung foundation, explains: «We are entering a situation that is entirely unknown. We are living longer, and the number of older people is increasing. At the same time, people are also remaining independent for longer. There is no historical precedent for this.»
Our perception of society is shaped by structures that no longer exist. However, Jann also sees opportunity alongside the huge challenges ahead: «We need to change the way we think and find new solutions. The solutions we have relied on up to this point will no longer work with the new demographic realities.» The Age-Stiftung is dedicated to the topic of ageing, with a particular focus on accommodation – as was desired by its anonymous English founder. «Where we live matters – and it matters more the older we get,» says Jann. The Age-Stiftung wants to help broaden people’s horizons. «As a foundation, we’re not the ones doing the work ourselves; we function as a kind of fuel for innovation,’ she emphasises. The foundation works on the principle that people who work in the sector have good ideas and know what is needed and what is possible. It aims not only to offer support to those who are implementing the project, but to support projects that can be learned from and that are multipliable. «We don’t just support a single, standard solution but a wide variety of different ideas,» Jann adds. Since it began in 2000, the foundation has helped fund around 300 projects, and it provides support of around 3 million francs each year.
Living situations as key
«People’s living situations have a huge impact on their quality of life, their well-being and their level of satisfaction. This becomes increasingly important as we get older,» says Tatjana Kistler, Head of Media at Pro Senectute.
Pro Senectute is the largest and most influential service organisation for older people and their relatives in Switzerland. Together with Raiffeisen, the foundation recently carried out the «Wohnen im Alter» («Housing in old age») study, which revealed that people’s living situation in later life is something they think about. Almost two thirds of 35- to 44-year-olds have already thought about it. Only ten percent of them have sought advice, however. The survey also showed that tenants» satisfaction increased significantly with age. Among 35- to 44-year-olds, only around 60 percent were satisfied with where they lived, whereas this figure climbed to 90 percent for people aged 65 to 75. But a comfortable living situation is not a given. «In order to be able to live as independently as possible for as long as possible, people need to start planning early and consider certain factors, together with their relatives,» advises Kistler. Pro Senectute offers support with this. «Where you live now is not necessarily the best place to live when you are older,» says Kistler. Certain structural changes can be made to meet some requirements of living in old age – but there are limits. There are some situations that require people to move. This can be a significant sacrifice. It requires leaving behind what is familiar. «For many, moving into accommodation designed for old age means giving up some of their independent lifestyle,» says Kistler.
Home is more than your four walls
The «Wohnen im Alter» study demonstrated the importance of independent living. A large proportion of participants under 75 said they needed no assistance. And if they did, they were helped by family members. It is clear that it is becoming increasingly important to support independent living. And it isn’t just the personal preferences of those directly affected that play a role. Our society has no choice but to invest in housing that enables long-term independent living. Over the next few years, the baby boomers are going to retire. In concrete terms, this means one in five employees in Switzerland is going to leave the conventional labour market. «The government’s policy is to prioritise outpatient over inpatient care. They want people to be able to live independently at home where at all possible – and that is what most people want as well,» says Antonia Jann. People should be able to live in their own homes even at the age of 90. «This is difficult if they are not receiving any help or support, however,» she says. Which is why infrastructure and remuneration models need to be adjusted accordingly. Because demographic change necessitates societal transformation, we need good examples for how to approach the question of housing in old age. There are already services available to support people living at home – such as at-home care, meal deliveries and household help, which is what Pro Senectute offers. But the topic needs to be considered further. «The question of ageing needs to be taken into account from the start of the real estate development process,» says Jann. «And it needs to be a topic that is addressed at a municipal level, not just by private stakeholders.» To offer municipalities support in this, the Age-Stiftung launched the second round of its Socius programme in 2020. The programme aims to gain insight into how regions and municipalities can best deal with demographic change. Ten municipalities are taking part. They are building support systems for older people. According to Jann, regions and municipalities will play a key role in the reorientation of old-age care. They need to make sure there are no substantial gaps in the services provided and ensure that involvement by members of civil society is promoted and carefully maintained.
All old age is not the same
When it comes to the discussion around living arrangements, an exciting new concept is emerging: «Multigenerational living is the magic word,» says Antonia Jann. «Everyone is behind it.» It’s a positive term for older people, who enjoy living alongside the younger generation, and the younger generation don’t mind having older people around. But the term «old» is a difficult one. Nowadays, it seems to cover an age range of around 40 years. It can refer to both a 60-year-old employee and a 100-year-old retiree. So there is really no such thing as being old, just getting older. Jann is convinced that it is not enough to have a single word: «old». She uses the word for «snow» as a comparison. African languages often only have a single word for snow, whereas Inuit languages have many. So we should perhaps be sceptical about the word «old». «When people say, «I’m not old yet,» they mean, «I’m not frail, I can look after myself. I can handle everyday life,» says Jann. «It doesn’t mean they think they are still young. It’s more about expressing their desire to remain independent.»
Living healthily for longer
To make this happen, you need a certain level of health. But the additional number of years people live as life expectancy rises are not necessarily lived in good health. Illness can bring an abrupt end to independent living. To minimise this risk and help people live healthily for longer, ETH Zurich is conducting research in the field of healthy ageing. Longer life needs to be decoupled from chronic diseases as far as possible. In addition to the existing research being carried out by numerous professors at ETH Zurich – who take a variety of different approaches to the topic – the university has created a new professorship in the field. James Mitchell became Professor of Healthy Ageing at the start of 2020. He previously worked as an associate professor at the Harvard School of Public Health in Boston. He explores specific aspects of biological ageing and uses scientific approaches to investigate how this process is influenced. He is also interested in age-related illnesses. The boundary between his work and medical research is a fluid one: he researches molecular mechanisms that delay age-related illnesses and keep people healthier for longer.
«The support of donors and partners has accelerated research into health and healthy ageing,» says Donald Tillman, Managing Director of the ETH Foundation.
More than just medical care
The Paul Schiller Stiftung is also involved in research, though in an area that corresponds to its funding criteria. Its work in the area of ageing focuses more on socio-cultural and psychosocial factors. The significance of these factors is reflected, among other areas, in older people’s daily routines. «As important as medical support and care is, it only accounts for a small portion of people’s daily lives,» observes Maja Nagel Dettling. These areas are generally the top priority in terms of funding and ensuring services. But when it comes to quality of life for older people – particularly those with limited independence – the rest of their day presents a huge challenge. «It is important to define terms here, and science is faced with a difficult task. We need to be promoting dialogue with society as a whole, and with the academic world,» asserts Nagel Dettling. The coronavirus crisis has highlighted the importance of psychological and social support in addition to medical care. The relevant skills, socio-pedagogical expertise and expertise brought by care and activity support specialists are required. And this is where the foundation aims to help. «We want to combat the most common problems faced by older people,» says Nagel Dettling. Based on the Eden Alternative philosophy, these include loneliness, helplessness and boredom. She sees great potential in this holistic view of age. This is an area in which foundations have a lot to contribute. Networking and coordination foster dialogue, as Maja Nagel Dettling is well aware. «We need facts. We need to know what the real challenges are,» she states. Which is why she is also involved in the SwissFoundations working group on age, in which various charities exchange ideas and coordinate on the greatest challenges they face. For Nagel Dettling, it’s important «that we have a holistic view of people and, by association, of age.» It’s not just a question of being healthy or sick; environmental factors like a meaningful daily routine and social contact are equally important.
When it comes to tackling loneliness, simple things like a smile or carefree interaction with children can make a difference. «The first visits from special “contact clowns” began in the 1990s,» says Beat Hänni. But there was often a lack of funding. Founded in 2005, the Humor & Gesundheit («Humour & Health») foundation has enabled 70 such projects by providing partial or seed funding. These include, for example, visits from kindergarten classes to a care home for those with dementia. The children’s carefree interactions enabled them to build light-hearted bridges. In addition to facilitating visits from «contact clowns», the Humor & Gesundheit foundation is also involved in providing humour workshops in retirement and care homes as a form of employee training. This makes interactions with residents of the homes easier and helps people use their own sense of humour as a method for dealing with difficult situations. After all, laughter is a common language that spans the generations.
Dialogue with the older generation has become more difficult during the current crisis. At the same time, it has highlighted the importance of these factors. The coronavirus has left many older people isolated, many of them remaining in their own homes or care homes. But there has also been a lot of positivity and a lot of community engagement. Attention has been drawn to the value of care. There are many initiatives aimed at older people, often offering simple services like shopping. The associated social factor is key, however. «These initiatives have meant people are still in contact with the wider community, despite being isolated,» says Maja Nagel Dettling. Faced with the crisis, many charities have used their skills, reacting fast and in a variety of ways. For example, Pro Senectute collaborated with Migros to offer a free shopping and delivery service for people in quarantine run entirely by volunteers. The initiative sourced almost 30,000 volunteers in a very short space of time. The crisis has shed light on something that normally goes unrecognised: the significance and potential of volunteers. Their work is often undervalued: «It’s actually a huge sector – one in three people is involved in some kind of volunteer work. Volunteers provide a total of around 660 million working hours a year, worth 34 million francs,» says Thomas Hauser, Managing Director of Benevol, the umbrella organisation for volunteer work in Switzerland.
Helping is hard – accepting help is harder
Volunteer work is an essential part of our society. It shapes practically every part of our lives. But the sector has difficulty gaining recognition. «On a small scale, it is often seen as extremely valuable, but it isn’t considered very valuable on a larger scale,» says Thomas Hauser. Small-scale local projects are often run by invisible volunteers. This direct proximity to the people receiving support and the involvement in individual local projects prevents recognition of their overall societal impact. «Volunteer work receives no government funding and isn’t subject to any kind of legal regulation,» says Hauser. However, while he believes better framework conditions would be beneficial, e.g. in the form of available premises, Hauser feels regulations would be counter-productive. You can’t force people to volunteer. «People need to be personally affected. Then the necessary resources often appear very quickly,» Hauser observes. Volunteer work is done by ordinary citizens. And the older generation plays an important part in this. The current crisis has revealed their dual roles: they are recipients and service providers at the same time. The fact that many older people are prevented from carrying out their volunteer work as a result of coronavirus is currently being felt. The «younger» generation has been called upon and has shown huge dedication to helping high-risk groups. Day-to-day life during the crisis has shown how we must, and can, learn the interrelation between helping and being helped. «Helping is hard,» says Hauser, «but accepting help is sometimes even harder.» People who have experience of volunteering often find it easier to accept the help of volunteers. This is particularly key for the older generation. Hauser talks in terms of a third and fourth generation: an active third generation and a fourth that requires support. «If you talk to people, it’s easier to know what to expect in the final stage of life and how you want to live it,» he says. Encouraging the third generation to get involved in volunteer work requires first and foremost attractive opportunities. «Modern volunteer work can’t function if people aren’t invested. People find meaning in it if they feel like they are making a difference. Volunteers want to help influence and be a part of things.» There has been a fundamental shift in volunteering over the last few years. Volunteers today prefer to get involved on a project-by-project basis rather than committing their time for an extended period – even if they go from one project to another and their involvement lasts for years. There is something paradoxical about the individualisation of volunteer work, of course. As Hauser asserts: «You only experience that feeling of doing something meaningful as part of a group.»