The Brown Sisters, New Canaan, Connecticut, 1975 | © Nicholas Nixon, courtesy Fraenkel Gallery, San Francisco

How old is old?

More time together

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.

Extract from The Philanthropist, issue 2/2020

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.

Coro­na­vi­rus crisis

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.»

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