Growing old in the country – Challenges and opportunities

The German healthcare system is great. Despite some of its current battles, that’s something that needs to be pointed out and should be remembered. However, it faces one big challenge - demographic change. While there are more and more community housing projects in cities aimed at making neighborhoods more accessible, sparsely populated areas in Germany are confronted with major infrastructural problems. This also affects the typically older residents in these regions.

Our German cities are growing, the rents are exploding, the so-called rent price brake isn’t working and finding accessible living accommodations is nearly impossible. "We are already experiencing a shortage of nearly 2 million age-appropriate and accessible housing accommodations and this number is steadily increasing," explained Jens Kaffenberger, Director of the Social Association VdK Germany (Sozialverband VdK Deutschland) during the Alternative Housing Summit on September 20-21 in Berlin. But that's not all. "Only five percent of all senior households are age-appropriate, yet one in four older adults suffers from motor impairments. Creating accessible and age-appropriate living spaces is one of the most urgent tasks in an aging society,” adds Kaffenberg.

Meanwhile, the demographic change has a very different impact on rural areas. While the young people are moving to the cities, entire stretches of land are aging in the wake. Even though it’s difficult to find accessible and affordable housing in cities, outpatient care services or transport connectivity and the resulting mobility for older adults are easier to obtain. It’s an entirely different situation when it comes to countryside living. Rents are low or people own residential property but there are infrastructural concerns such as public transport connectivity or a lack of shopping options and medical care provided by physicians or pharmacies. And yet, people living in cities are not much different from those living in rural areas: all of them want to be able to live an independent and self-determined life in their own home for as long as possible.

In other words, communities outside of our cities face a different set of problems when it comes to demographic change. And here things sound so idyllic: someday you buy a countryside cottage or move into the house you grew up in, buy some land, enjoy closeness to nature, peace and quiet and a nice neighborly community.

People depend on their car in rural areas. What’s more, the number of chronic conditions increases with age. Who will drive you to doctor’s visits in the nearest city? Who will shop for you or work on your house or property if you are no longer able to do it yourself? Those are some of the worries of elderly adults in Germany and with good reason. One-third of the nearly three million people in need of care today are cared for by a family member. Yet many of these relatives live in the cities because that’s where they work. That means, it is far more difficult for these caregivers to accomplish this than it is for those who live in the same city as the person in need of care. The institutionalization of care is already a concern today and will become an even bigger one in the future.

Due to cost reasons, the creed of the federal government clearly states "outpatient versus inpatient care”. Needless to say, this also happens to coincide with the wishes of the older population. However, the shortage of healthcare workers unfortunately also affects outpatient care services. According to the Federal Employment Agency, nearly 36,000 positions in health and elderly care remained vacant in July. And this number is expected to increase, as is the number of people who are in need of care. Added to this is the fact that every minute counts in outpatient care settings. It’s "quality over quantity" to be economically feasible. Meanwhile, this makes the provision of health care more problematic in rural areas since care services often have to travel long distances between patients. It swallows time that does not fit in the budget.

So far, things might look pretty dire when it comes to care settings in old age - or even old age in general. Meanwhile, commercials often hint at sprightly seniors, who are active in old age. The truth usually lies somewhere in the middle. Fact is, the incidence of chronic conditions is higher in older adults. "The older you get, the higher the likelihood of you being in need of rehabilitation measures," explained Dr. Helga Seel, Managing Director of the Federal Association for Rehabilitation (Bundesarbeitsgemeinschaft Rehabilitation (BAR)) e.V. in Frankfurt in an interview with REHACARE.com. Our Topic of the Month May highlighted modern rehabilitation. In the field of ​​rehabilitation, the objective is to get people healthy and fit for everyday life after their hospital stay. Having said that, sometimes people need some additional help. That’s also why the Marienkrankenhaus St. Wendel hospital implemented "Paten mit Herz", which loosely translates into "Caring Mentor". The project looks for volunteers who assist older adults with doctor’s office visits, shopping trips and visits to public services. But the helpers should also be willing and able to lend an ear and chat if needed.

The Federal Ministry of Food and Agriculture (Bundesministerium für Ernährung und Landwirtschaft, BMEL) promotes these types of projects and ideas to strengthen regional value chains and safeguard services for the public. The pilot project titled Land (auf) Schwung, which also gave way to the Paten mit Herz project, reveals several great examples of peripheral rural area development.

This type of support doesn’t always come in the form of projects. Residents in rural areas tend to foster great relationships, where everyone helps each other out. Oftentimes, community spirit tends to be more pronounced here versus in the cities. As part of the German Ageing Survey 2014 (DEAS), more than 6,000 people between the ages of 40 and 85 were surveyed on issues of living, living surroundings, neighborhood, and community. People between the ages of 75 and 85, who live in more rural (56 percent) and sparsely populated rural areas (51 percent), more often indicated they were in close contact with their neighbors than people who live in big cities (45 percent).

There are certainly benefits to country living: participation and involvement, for example. It comes as no surprise that most of the nearly 220 Senior Citizen Cooperatives are predominantly active in rural areas. The majority of volunteers working in neighborhood services are over the age of 65. One reason for this is that people between the ages of 65 and 85 today feel nearly ten years younger than their actual age would suggest (Generali Altersstudie 2013). Most of these older adults are active in their communities and do volunteer work. The rural areas of Germany, in particular, depend on their social capital.

Needless to say, there are limits to how much volunteer work, neighborhood cooperatives, and multi-generational approaches can accomplish. Very few people who already use one or more auxiliary aids or services to assist with everyday tasks are living in accessible accommodations. Yet it would be easy to adapt your personal living space to your changing living conditions before it’s far too late. Which brings us back to the opening statement made by Jens Kaffenberg. However, it’s not just the government that is tasked with doing more to tackle this issue. And maybe it doesn’t necessarily have to be building measures that need to be taken.

In addition to accessible renovations, so-called Ambient Assisted Living Systems (AAL) offer opportunities to stay independent and mobile in your own home even as you get older. Based on the smart home concept, these assistive systems are specifically designed for older and mobility impaired adults. The solutions range from motion sensors lights, fall detection sensors that automatically alert the rescue coordination center once triggered, all the way to a smart home network that is connected with family members’ various devices so that they can be notified in case of unusual activities.

In Germany, the Federal Ministry of Education and Research (BMBF) is committed to this topic. The BMBF introduces its current projects under the header "Bringing technology to the people" at mtidw.de. This also includes projects that emphasize AAL systems. Having said that, the demand for these types of systems is still low. Right now, skepticism and a distrust of the unknown are still big obstacles. Added to this is the issue of usability, another reason for older adults to reject everyday technological aids. Of course, cost also plays a major role.

Demographic change will be an ongoing issue in Germany. The same applies to the subjects of care and housing. We won’t be able to do without the notion of a "caring community", i.e., a community of committed individuals and socially active and responsible companies or social institutions. The government only steps in when families or communities are no longer in a position to help. Meanwhile, to prevent this from happening, private involvement and arrangements can also be effective and helpful. After all, "no matter how healthy we are at the moment, everything can change in an instant," as Dr. Seel pointed out in the Topic of the Month May interview.