Embracing Housing Alternatives for the Enhancement of Wellbeing in the Aging Population: A Qualitative Study

,


Introduction
The population of Bangladesh is on the brink of significant aging, with the proportion of individuals aged over 65 standing at seven percent.According to recent statistical projections, this transformation is expected to occur as early as 2030 [1].Remarkably, Bangladesh is undergoing this transition from an aging to an aged nation in just 25 years, a stark contrast to the 115 years it took France to traverse a similar demographic shift [2].
It is imperative for the nation to address this issue with utmost seriousness, particularly considering the escalating needs of the elderly population, especially in terms of their healthcare requirements.Furthermore, this concern must be integrated into the broader context of the country's development.Presently, many elderly individuals experience loneliness and isolation as their children grow older and become engrossed in their own schedules.A significant portion of the elderly population faces their daily routines in solitude, which can pose risks to their well-being.Additionally, there has been a concerning rise in incidents of violence and neglect directed towards the elderly.
Given the continuous growth of the aging population and the associated challenges, there is a pressing need for the establishment of comfortable and secure environments for the elderly.Such environments are essential to ensure their safety and well-being, allowing them to embrace positive aging throughout their lives.

Methodology
The study titled " Embracing Housing Alternatives for the Enhancement of Wellbeing in the Aging Population: A Qualitative Study" aims to assess the housing requirements of senior citizens by considering their current living situations and lifestyles.It proposes various improvements, including the implementation of residential support facilities, to facilitate seniors in obtaining necessities, accessing services, and staying close to their family and friends.The ultimate goal is to create a supportive environment that ensures the well-being of the elderly and addresses their housing needs for independent living in their later years.
To conduct this research, qualitative approaches and librarybased research methods were employed, which involved content analysis of relevant documents and literature reviews.Through these analyses, the perspectives of different researchers who have studied this subject and related issues were brought to light.
The study's findings revealed four primary types of housing arrangements for senior citizens: family homes, care centers, health facilities, and retirement homes.The choice of housing option depends on the comfort and adaptability of the elderly individuals, enabling them to make informed decisions regarding their living arrangements.

Concerns and Approaches Regarding the Aging Populations
Bangladesh's first National Policy for the Elderly was introduced in 2013.The Plan and Action for the inter-sectoral national policy, a National Advisory and Consultative Council for the Elderly was established, under the Ministry of Social Welfare.In 2008, the Ministry of Health developed a National Health Policy for Older Persons to strategize the human and physical resources needed to meet the healthcare needs of a rapidly ageing society.Under the Town Planning Department, a guideline was developed to assist in the physical planning of facilities for the elderly in 2012.
Under the National Blue Ocean Strategy (NBOS7), the Bangladesh Family Care program was initiated in 2012 to provide holistic health and social support to older persons, the disabled and single mothers where different government agencies network, collaborate and share resources to deliver services to the home of target recipients and located nearby housing area (Report on the Policy Dialogue of Asian Parliamentarians and Experts on Ageing, 2016).For the population to prepare for their financial security and health care in old age, the Bangladesh government has developed savings and investment schemes in various sectors which for the lower income and more vulnerable groups, financial assistance is needed.The pension systems in most Asian countries funded by the government are also not fully developed and the older population relies on family for old age support due to the lack of social protection.
Bangladesh is facing shortages in healthcare staffing, low levels of savings for retirement among the future generations of the elderly, increasing loneliness and isolation of older persons in the community, a funding gap in social care, an undersupply of retirement housing and underemployment of older persons due to shortage of flexible working opportunities.Even the elderly's social support is declining more rapidly than the government's ability to set up viable, alternative systems especially in the urban areas where the housing design is not conducive for multigenerational families.The insurance coverage among the older population is low and it's worse for the elderly at the bottom 40% of household in Bangladesh.
Bangladesh currently counts only around 20 geriatricians and 10 psycho-geriatricians, a significant shortfall compared to the supposed requirement of over 700 geriatric specialists.Consequently, older individuals in the country often find themselves compelled to exit the labor force prematurely.Several barriers to healthy aging exist, including outdated and ageist stereotypes, insufficient policies, limited accessibility, the absence of adequate services, and the lack of consultation and engagement with relevant stakeholders.Furthermore, there is a pressing need for improved coordination in policymaking across various government ministries and agencies, encompassing health, housing, social welfare, transportation, and other sectors, to create more affordable choices and alternatives for the elderly.
According to insights from Professor Atiqur Rahaman, a public health expert associated with the Aged Association Bangladesh, the country currently lacks the necessary healthcare and elderly care infrastructure to support its growing aging population.Much more needs to be accomplished, including establishing a framework of responsibility for elderly care.He has proposed the development of policies that guide comprehensive elderly care programs, encompassing social, economic, and healthcare dimensions [3].Additionally, Professor Nathan Vytialingam, an advisor to the Malaysia Healthy Ageing Society, has emphasized the challenge posed by the insufficient number of elderly care homes established by both the public and private sectors, as well as the shortage of geriatric specialists and dedicated professionals to serve the elderly population [4].

The National Policy addressing the needs of elderly individuals
In October 1995, the government introduced the National Policy for Older Persons.Following this policy, the National The National Policy for Older Persons 2011 acknowledge that older persons as citizens with varied background and experiences, have the right to enjoy a comfortable and respected life and contribute to the development of the nation.This policy is the government's commitment to creating a conducive environment for older persons who are independent, with dignity, high sense of self-worth and are respected by optimizing their self-potential through a healthy, positive, active productive and supportive aging to lead a well-being life.The objective of the policy is to empower individual families and communities to provide friendly services to older persons efficiently and effectively and to ensure enabling and supportive environment for the well-being of older persons.There are six strategies outlined in this policy, namely: Second: advancing health and well-being into old age where the National Policy for Older Persons addresses the safety and wellbeing of older persons through its third objective.Services and health care, prevention of diseases and improving the quality of life of older persons are some of the strategies outlined in the Plan of Action for Older Persons.
Third: Ensuring enabling and supportive environments which are among the strategies that are planned to achieve enabling and supportive environment for older persons; accessibility and capacity-building of the organizations; and intergenerational interdependence.

The Elderly Activities
Activity Centers for Older Persons, also known as Pusat Activiti Wargi Emma's (PAWE), serve as hubs that enable senior citizens to engage in community and recreational activities free of charge.This development initiative has been in operation since 2001 under the framework of the National Policy for Older Persons and the Plan of Action for Older Persons [5].
PAWE initiatives are the result of strategic collaboration between the ministry, other governmental bodies, and nongovernmental organizations (NGOs).The objectives of these activity centers encompass the expansion of facilities for the wellbeing and growth of elderly citizens, the provision of spaces where seniors can share their experiences and skills and feel valued, the promotion of participation and cooperation among various stakeholders, the offering of an alternative for seniors from lowincome families, and the enhancement of the quality of life for older individuals, in alignment with the principles of an active and productive lifestyle.These centers host a variety of activities, including religious programs, recreational activities, therapy and rehabilitation sessions, health seminars, and training programs [6].
The prior administration had undertaken the commitment to establish PAWE centers in every parliamentary constituency, and as of March 2020, approximately 129 such centers have been established [4].

Various Categories of Housing and Communities for the Elderly and Senior Citizens
In Bangladesh, there exists a variety of housing and facility options catering to the needs of the elderly population, typically categorized into four main types, as outlined by: family homes (aging in place) [7], elderly care facilities, medical institutions, and retirement villages.Among these options, family homes or 'aging in place' is the most prevalent choice among the elderly, according to numerous surveys.However, some individuals eventually opt for alternative arrangements.
Elderly individuals who choose to remain in their family homes, or 'age in place,' can continue residing within their communities while retaining a degree of independence compared Volume 04; Issue 01 to those living in residential care settings, as noted by Wiles et al. in 2011.Those facing specific health challenges and requiring additional attention and support often select elderly care facilities.These facilities are community-based housing designed to accommodate senior citizens who may be financially disadvantaged, childless, or even abandoned, as observed by Barry and Conlon in 2010.For seniors grappling with severe health conditions such as Alzheimer's and dementia, medical facilities provide specialized care and housing, distinguishing them from other facility options available to the elderly, as highlighted by [8].
The demand for retirement villages in Bangladesh is on the rise, reflecting the evolving lifestyles of seniors who seek greater independence.Retirement villages are residential communities or housing complexes designed for seniors who can generally live independently and care for themselves.Some communities permit assistance from home care agencies and offer basic medical services, along with social activities and opportunities.Residents of retirement villages typically enjoy the freedom to maintain their preferred lifestyle without strict dietary or scheduling constraints, as explained by Jotham Lim in 2020.Property developers in Bangladesh have recognized this growing demand within the silver-haired market and have responded by providing retirement residential options.A challenge for these developers is to create housing features and environments tailored to the needs and preferences of the elderly, recognizing that housing is a fundamental human requirement.
In Bangladesh, specific Physical Guidelines for the Elderly have been established, focusing on site planning, building design, and the provision of facilities in three types of settlements for the elderly: new housing construction, retrofitting of existing homes, senior care centers, and retirement villages.A senior citizen or retirement village is a planned area where elements of accommodation and support services are available within its boundaries.Residents may choose to live there voluntarily, either on a long-term or temporary basis, as described by Yuen Meikeng in 2017.

Agreement
Agreement, concerning layout planning, building design, and settlement environment for senior citizens, refers to a state of balance and cohesion where these elements complement and support one another.An environment that is harmonious takes into consideration the specific needs of senior citizens, aiming to create spaces that promote social interaction and a strong sense of community.Additionally, it seeks to embody a distinct local character, fostering a sense of belonging and identity among the elderly residents.Ultimately, achieving harmony in such settings ensures that the physical aspects and social aspects of the living environment are in sync, contributing to the well-being and quality of life of senior citizens.

Environment
A healthy environment encompasses several essential aspects to promote well-being and improve the quality of life for its residents.It includes the provision of safe walking and cycling routes, facilitating easy movement between different areas.Additionally, it offers comfortable and secure living spaces within safe neighborhoods.Access to recreational areas, places of worship, and educational facilities contribute to a balanced lifestyle.
Furthermore, the presence of job opportunities fosters economic stability and personal growth.Access to a range of healthcare services that are comprehensive, high-quality, and cost-effective is crucial in supporting the overall health of the community, ensuring that individuals can lead healthy lives.By addressing these various aspects, a healthy environment promotes the well-being of its residents and enhances their overall quality of life.

Convenient
Convenient housing refers to housing that is reasonably priced and within the financial means of individuals or families.The financing for affordable housing often comes from various sources, such as savings, pensions, and contributions from family members.These housing options are typically situated in proximity to places of worship, healthcare facilities, recreational areas, and public transportation to make it convenient and accessible for senior citizens to move around and access essential services.

Communicative
It provides older individuals with the opportunity to embrace a sense of community and enjoy life together through acceptance, association, interaction, and the mutual sharing of rights.Additionally, it enables them to engage in meaningful communication, collaborate, and continue learning alongside the broader community.This environment also affords them the freedom to make decisions and choices independently, ensuring they can maintain their autonomy, privacy, and quality of life.

Secure
The planning and development of senior citizens' settlements should prioritize safety and minimize exposure to catastrophic risks, such as erosion, landslides, floods, and proximity to potential hazards like electricity leaks and industrial areas, particularly those with high risk levels.It is advisable to avoid placing such settlements in swampy, hilly, or steep slope areas.An ideal approach involves promoting gated community housing that places a strong emphasis on the safety and well-being of senior citizens.This can be achieved by implementing various security facilities, including 24-hour security control, regular patrols, wellmaintained fences, and the use of CCTV surveillance.Furthermore, the layout of the buildings within the settlement should be designed with security elements in mind.Providing open spaces that are not concealed and ensuring clear visibility throughout the area can contribute to creating a safe and crimefree environment for the senior residents.Taking these precautions into account ensures that senior citizens can live in a secure and protected environment, fostering a sense of safety and tranquility within the community.

Easy to access and user-friendly
Elderly settlements should prioritize easy and convenient access, particularly through well-connected public transport facilities.Direct connectivity to essential services such as hospitals or health centers, public parks, and shops is crucial to ensure the convenience and well-being of senior residents.To achieve this, the placement of facilities within the settlements should be strategically planned, allowing for proximity and seamless access through a network of pedestrian paths that are safe, comfortable, and obstacle-free.Moreover, the provision of support facilities like parking areas, elevators, and user-friendly public transport services should be implemented practically and in a manner that does not physically burden any specific group, including senior citizens, the disabled (both temporary and permanent), children, or active adults.By adhering to these guidelines in line with the requirements of Bangladesh Standards, elderly settlements can be designed to cater to the needs of all residents effectively, fostering a community that is accessible, inclusive, and supportive of its diverse population.

The Residential Support Facilities for Senior Citizens: Comfort and Safe Housing as a Choice
The developer addresses aging in place on two levels: within the home and in the community.At the home level, they incorporate step-free access in places such as bathrooms and have wide doorways that allow wheelchair access.They are also careful with the choice of floor materials to reduce the chances of slips and falls.Their fittings and wares also take into consideration the ergonomics for people of all ages, such as the height of switches and sockets, and using levers instead of knobs for doors.On the community level, they incorporated universal design concepts in its townships, such as covered walkways and link bridges that allow for safe and comfortable travel between buildings.The developer has also installed lifts in strategic locations and accessibility ramps.The sidewalks and pavements within the company's township are built wider and there are plenty of pedestrian crossings for the elderly and disabled.
Regarding the requirement of most people to live their retirement years in neighbourhoods that are safe and supportive of their overall health and well-being, with good access to amenities, they have ensured all their township and integrated developments have easy access to healthcare in case of emergencies.Besides, the developer had many closed-circuit television (CCTV) cameras in the common areas to keep the environment safe.The developer has studied a senior's typical day and considered what it can do to make basic living easier for them.Design parameters such as low hazards, minimum physical effort requirement, usage convenience, flexibility in use and a good line of sight are critical when it comes to designing a home to meet seniors' daily needs (Jotham Lim, 2020).
Under the Physical Guidelines, retirement villages and other settlements must include elderly-friendly elements such as suitable height levels of electrical switches and windows for wheelchair users as well as pedestrian crossings with sufficient walking time.
Senior citizen settlement must also be easily accessible and reached by public transport and close to facilities such as hospitals, parks and shop lots.The location of facilities should be within reach and easily accessed with a network of interconnecting footpaths, safe, convenient and without any obstacles (Yuen Meikeng, 2017).Sr.Dr. Siti Uzairiah et al (2019) have proposed a guidelines framework for the aging in place population in Bangladesh.The developed framework consists of the 'Key Themes' and 'Sub-Themes' that are related and complemented each other, inclusive of the following connecting items: Housing, Social and Facilities and Services.The 'Housing' item includes Tangible, Intangible factors and UD Regulated.The 'Social' item includes community safety and security, dissemination of information, financial stability, funding and support, promoting independence and self-empowerment, social activities by the Agency and close with family and relatives.The 'facilities and service' item includes the facility's transportation and mobility and also the healthcare service.Therefore, it should be used as a reference guide and consideration for both the policymaker and implementer before any development in relation to the aging community is undertaken.The framework may be extended to other factors that contribute towards a proper guideline for the aging-in-place population in Bangladesh [3].
Housing must fulfill the needs for the daily activities of aging people and provide them with the feeling of satisfaction, security, comfort and independence [7].Several researchers suggested that the elderly population mainly experiences risk and problems since they occupy old houses and neighbourhoods which can threaten their mobility, comfort as well as their safety [9].The aging population needs housing that will not only facilitate their mobility and comfort but is also safe for them.Besides, between the elderly and their environment, the elderly is generally satisfied with their living environment which makes them feel a sense of attachment and comfort in their current living area [10].

Conclusion
The global elderly population is on the rises each year.Numerous countries are now focusing on developing age-friendly housing options that cater to the needs of seniors and offer services to support independent living, ensuring they can reside comfortably and securely.Creating secure living spaces is particularly essential as many young individuals nowadays do not live with their parents, and older adults seek a sense of safety in their living environment.In today's society, we often witness sandwiched generations, where adult children find themselves balancing the responsibility of caring for both their young children and aging parents simultaneously.Consequently, there is an urgent need to address the issue of safe housing for the elderly, which requires significant attention.Implementing appropriate policies is crucial for countries to effectively respond to the challenges posed by population aging and to reap the potential benefits of providing comfortable and secure housing options for the elderly [11][12][13][14][15][16][17][18][19][20][21].
Advisory and Consultative Council for Older Persons, chaired by the Minister for Women, Family, and Community Development, was established in May 1996.In December 1998, a Plan of Action for Older Persons was devised as an outcome of this Council's establishment.The Department of Social Welfare, operating under the Ministry of Women, Family, and Community Development, functions as the Council's secretariat and central hub for all matters related to older individuals.On January 5th, 2011, the Government of Bangladesh sanctioned a new National Policy for Older Persons and Plan of Action for Older Persons.These documents were developed following a review of the earlier National Policy for Older Persons from 1995 and the Plan of Action for Older Persons from 1998.The government conducted this review with the aim of promoting the self-worth and dignity of older individuals and exploring opportunities for their development and reintegration into society.
(1) Promotion and Advocacy; (2) Life-long Learning; (3) Safety and Security; (4) Governance and Shared Responsibility; (5) Intergenerational Solidarity; and (6) Research and Development.The National Policy for Older Persons and Plan of Action for Older Persons were formulated taking into consideration of various international conferences that focus on aging including principles outlined in the Madrid International Plan of Action on Ageing (MIPAA).This National were drafted based on the three priority areas outlined in MIPAA: First: Older Persons and Development where the first objective of the National Policy for Older Persons is to develop a caring society and capacity-building of society to face the aging phenomena.Mainstreaming aging in the nation's developmental agenda is addressed in one of the strategies in the Plan of Action for Older Persons.

Figure 1 :
Figure 1: Concept of Wellbeing, Housing Environment and Mobility.Source: Developed for this study.

Figure 2 :
Figure 2: The Factors of Elderly Homelessness.Source: Developed according to the findings of this study