1. Acknowledgements

This survey and workshop could not have been undertaken without the financial support of UNCHS (Habitat), and the Netherlands Platform Older People and Europe. Thanks is also due to the Institute of Public Administration for its continued voluntary support services to the project. Advice and support was also given by the NGO Committee on Human Settlements, and the NGO Committee on Ageing, both at United Nations Headquarters in New York.

Great appreciation is expressed to the following Country Managers and their organizations who directed the Case Studies and Surveys of Older Persons for the Study; prepared the reports on their studies; and to those who participated in the Workshop:

Deborah Munns and Jim Longley of The People for Places and Spaces, and the Anglican Outreach Services, Sydney, Australia

Sonia Zapata Donoso, Escuela Trabajo Social, Universidad Santo Tomas, Santiago, Chile

Xiao Caiwei, China National Committee on Aging, Beijing, China

Dr. Magda Iskander, Coptic Evangelical Organization for Social Services, and the Centre for Geriatric Services, Cairo, Egypt

Edina Reviczky, Florence Nightingale Association, Budapest, Hungary

Dr. Shubha Soneja, HelpAge India, New Delhi, India

Dr. Denise Eldemire and Ken-Garfield Douglas, Dept. of Community Health and Psychiatry, University of West Indies, Kingston, Jamaica

Kathleen Okatcha, HelpAge Kenya, Nairobi, Kenya

Edward M. Gerlock, Coalition of Services for the Elderly (COSE), Manila, Philippines

Dr. Monica Ferreira, Centre for Gerontology, University of Cape Town, South Africa

Dr. Rusen Keles and Ms. Nilgun Gorer, Research Assistant, Department of City and Regional Planning, Gazi University, Ankara, Turkey

Ms. Khadijah Odeh-Piper, New Jersey Institute of Technology

Appreciation is also expressed to the following individuals who contributed greatly to the success of the Study and Workshop:

Richard May, Senior Associate, Institute of Public Administration

Selman Erguden, UNCHS (Habitat)

David Mammen, President of the Institute of Public Administration

Virginia Hazzard, of the NGO Committee on Ageing

Mieke Andela-Bauer, President, Ger J.M. Tielen, Director and Mira Weber of Netherlands Platform Older People and Europe

Prof. Dr. Gertrud Krueskemper, EURAG

Amanda Heslop and Mark Gorman of HelpAge International

2. Survey questionnaire

To guide the Country Managers and field interviewers a detailed questionnaire was prepared by IPA as a framework for conducting the community case studies and interviews. Translations of the questionnaire in Spanish and Chinese were provided by volunteers. The questionnaire form follows:

CASE - STUDY QUESTIONNAIRE

1. Identification

Country _______________________________ Date _____________________

Manager ___________________________ Interviewer ____________________

Organization______________________________________________________

Address_________________________________________________________

Phone ________________ Fax _________________ Email ________________

2. Local Government

2.1 Total population 1990 ________________ 1980 _____________________

2.2 Percent of population over 60 __________; Over 70 __________________

2.3 Percent of population over 60 who are disabled ______________________

2.4 Local government departments that exist in your City:

Health _____; Social Services _______; Housing _________;Transport ______

Water Supply ________, Waste Disposal _______

2.5 In your opinion, is the current annual funding for the needs of Older Persons adequate? (yes/no):

Health ____ Housing _____

Social Services ____ Transport______

3. The Low-income Community Environment

3.1 Name of community, neighbourhood or settlement ________________

____________________________________________________________

3.2 Size: _______ Hectares/Acres? Population (approx.) _______________

3.3 Distance from city centre: _____miles, or Kilometres _______?

Travel time by public transport: ___________minutes.

3.4 Character: Old? ______ Crowded, high density? _______

Built recently? ________ Squatter settlement? _________

Describe: _________________________________________________

3.5 Site conditions: Steep hillside? ______ Wetland ______ Other, describe:

________________________________________________________

3.6 Pollution conditions? Air ______Water______ Open dump______

Describe: _________________________________________________

3.7 Means of access: Road_____ Path_______ Stairs________

Describe__________________________________________________

3.8 Utilities and Public Services available: Piped - water _____Sewer____

Electricity ____Gas line ____Waste collection ____Police/Fire _______

3.9 In your opinion: are the monthly costs for these services too expensive for older people?

Water ____ Sewer ____ Electricity ____ Gas ____?

3.10 Are the following Public Facilities available?

Hospital or health clinic? _____ Distance? ______ km. Is it accessible by

Public transport? ________ Library _____ Distance ______ km.

By public transport? ______ Day Centre? _______ Distance _____ km.

By public transport? _____

3.11 Describe Day Centre facilities provided for older persons_______

________________________________________________________

3.12 Are there any private, non-governmental organizations (NGOs) or religious groups providing assistance or services to older or disabled persons in the community, such as: Home visits _______ Meals ______

Health visits ______ Describe ___________________________________________________

3.13 Are there any city or local government programmes for improving housing conditions or the environment underway or planned for in the community? ______ If yes, describe: ___________________________________

4. Home Interviews

Please interview at least 20 older persons living in this community to learn about their living conditions and problems. First, please note the condition of each dwelling, and then ask the following questions:

4.1 Building type: House? _____, or Apartment?______

4.2 Building material: Wood _____Block _____ Brick _____Earth_____

4.2 Size of dwelling: Number of rooms ________Yard/Garden?_______

4.3 Household description: Living alone? _____ With spouse?_______

Number of others: 1 - 3 persons _____; 4 - 6 persons_____

(Is this a Homeless person? ______)

4.4 Do you own: _____ or rent_______ your home?

Cost per month as a percent of income: 10-20%______; 20-30%_____

30 -50%_____; Over 50%______?

4.5 Sanitary facilities: Piped water in dwelling? _____. Public outdoor tap? _____;

Buy from tanker? ______.

Private _____ or Group _____Latrine?

Indoor _____ or Outdoor ______ Bath/Shower?

Is cost of water ______, or use of facilities ______affordable?

4.6 Utilities/Fuels available: Electricity? _____. Gas?_____

Oil? _____Coal? _____Charcoal?_____

Are fuel costs affordable? ________

Waste Disposal: Public? ______Private?_____

Night soil removal: Public? ____ Private? _____

At affordable cost? _____

4.8 Is Police/Fire protection adequate? Yes _____No____

Is street cleaning and lighting adequate? Yes ____No___

4.9 Community Services available? Hospital/Health clinic?_____

Park or Recreation facilities? _______Church? ______ Shops _____?

Elderly community centre? ________ School? Meal delivery _____?

Home visits?______ Which of these do you visit or use?___________

_______________________________________________________

Any Inter-generational programmes with youths?_________________

4.10 Public Transport Service to: shops?_____church?______Hospital or health clinic?_____Community centre?_____ Is the bus fare reduced for elderly persons?_______

4.11 Communication services: Do you have a Telephone? _____TV _______ Radio?

______; Postal service? ______

5. Personal/Family Description

5.1 Male _____ Female ______;Age? ______. Spouses age? ______

5.2 Health? Excellent ____Good _____Fair_____ Poor_____

5.3 Do you have any disabilities?

Respondent: Walking ____Sight _____Hearing _____ Other ______

Spouse: Walking ____Sight _____Hearing _____ Other ______

5.4 Moved to this City from? ______________ Year?______

How long have you lived in: This dwelling? _______ months/years

This community?_____

What place do you call your home? _______________________

5.5 Financial Situation

5.5.1 Do you have a job? _______Type of work _____________________

Hours per week? ___________

5.5.2 Do you receive a pension? ________Social Security?______

Is it enough for your living expenses? _______

5.5.3 Sources of funds for housing and other living expenses:

Job _____ %. Pension ______% Family _______% Savings ______%

Other ______%

5.6 Activities: Work _____ Social _____ Political ______ Voluntary ______ Housekeeping: Cleaning _____Cooking _____Watching children______

5.7 What are your most difficult Living Problems? For example:

Housing conditions: Size ______Needs repairs______

Access problems _____Too crowded? ______Too costly_______

Sanitary facilities: Lacking: ______Inadequate______

Transportation to: shops _____Health centres _____Church______

Environment: Hazardous location _____Unhealthy ____Polluted_____

Safety and Security: Inadequate police and fire protection.

How would you improve your living conditions?

_______________________________________________________

6. Evaluation by Interviewer and Manager

Please write your impressions of the living conditions of older people in this community, responding to the following questions:

- Most important living problems of older persons?
- Adequacy of local government services for older persons
- Are people in the local community trying to help the older people or improve living conditions?
- Involvement of older people in community improvement?
- Any other comments on the Case Study?

3. Best Practices

A session at the Workshop in Amersfoort was devoted to a presentation and discussion of programmes developed in countries to improve the living conditions of Older Persons. Among those discussed were examples from the Best Practices Programme which was conceived by UNCHS to identify success stories in human settlements development for the Habitat II Conference in Istanbul, 1996. Over 600 examples from 80 countries were submitted according to the criteria of impact, partnerships and sustainability. The work of identifying and disseminating best practices is now a continuing UNCHS programme. In 1998, over 300 submissions were made to the Dubai International Award for Best Practices from which 10 were selected.

A brief description of several examples of Best Practices focused on Older Persons are presented below to present an opportunity for their replication in other countries. More detailed descriptions of these examples can be procured from UNCHS through E-mail: bestpractices@unchs.org, or at their Web page: http://www.bestpractices.org.

“Care with love”, a training programme for home health care providers, Cairo, Egypt

In the last few years Egypt experienced socio-economic changes that have affected the structure of urban families. This has created new situations of need for health care for the elderly. There are an increasing number of ageing persons who need short or long term non-hospital health care. Family members are rarely available, have the time or the necessary skills to provide these services at home. This brings the need for training health care providers.

“Care with Love” is a training programme developed at the Centre for Geriatric Services in partnership with the Coptic Evangelical Organization for social Services with the following objectives:

1. To provide a comprehensive curriculum for training home health care providers
2. To provide for training of trainers in home health care
3. To create new job opportunities
4. To establish referral units providing accessible and reliable services

Students are recruited from communities where the Coptic Evangelical Organization have development projects and from other NGOs and Church groups. The training process is a well-balanced mixture of theory and lab training in: Public Health and Nutrition; Body mechanics; Communication; Daycare skills; First aid and common diseases. Upon completion of the course the trainees spend a month of internship as Home Health Care Providers under close supervision and evaluation before graduation. The first training course started in 1996 with the objective of training 80 to 100 trainees with two years. For more information contact Magda N. Iskander, MD, email: cgs@idsc.gov.eg.

Urban poor elderly health workers; the Philippines

Older people are respected, but not a priority on anyone’s agenda in the Philippines. For example: there are more than 200 groups in the Greater Manila area dealing with street children, but for “street elderly” and urban poor elderly, virtually nothing. Resources are scarce and the potential of residential care for older persons is economically, culturally unattractive.

The Coalition of Services of the Elderly (COSE) was founded in 1989 as an attempt to keep the elderly poor in the community. The programme empowers them to make decisions, which determine their lives. An organized urban poor community chooses two of its members to become “Community Gerontologists (CGs). A number of the chosen ones have been involved in traditional health care through herbal medicine, as massager, midwives, etc. For three days they are trained by a doctor, dentist and a nurse with an emphasis on ailments and their prevention, especially those of older people. Upon graduation, they receive a kit with a thermometer, blood pressure and sugar measuring instruments; basic tools for examining teeth and common medicines. The two then become the health workers for their own organized elderly in their area. Thereafter, all the CGs from different areas meet once a month with the medical staff/team of COSE to discuss their experiences of the past month and upgrade their skills. Four times a month, the medical team along with the CGs visit a community to render medical outreach services. On days when there is no outreach, the COSE medical team and a rotation of CGs maintain a clinic on health care for older people.

The COSE medical team has produced in Filipino a 120 page “Health Care Manual for the Community Gerontologists and Gerodontists”. The greatest indicator of the success of the programme has come from the Government Department of Health, which recently has proposed a nation-wide health programme for the elderly and invited the COSE medical team as health trainers to participate in the formulation of this programme. Legislation is pending in Congress to establish a national commission for older persons. Original funding for the health programme came from Caritas Netherlands with supplementary aid from HelpAge International. Total cost of the first year of operation was approximately US$15,000.

A city for all: Barrier-free environment in Finland

The neighbourhood of Marjala in the city of Joensuu in eastern Finland is designed to meet the needs of wheelchair-bound inhabitants. All the homes, connections between the home and all streets, parks, etc. are being planned and built to meet this requirement.

Over the past l5 years the City has built special housing for the elderly and disabled. A set of design guidelines require that all dwellings, all shared facilities and all connecting routes allow barrier-free access and mobility. This requirement is applied to even the smallest detail in the neighbourhood so that all streets, pavements, squares, bridges, parks and green areas with their paths and promenades are built to be accessible by all. In order to guarantee the high quality of design the City Council organized a nationwide architectural competition for the master plan for Marjala.

International estimates indicate that 18 to 20 percent of the population face difficulties in mobility in the ordinary urban environment. Many neighbourhoods in Finland have been built for the kind of life that people no longer lead. The majority of inhabitants today spend 24 hours a day in the areas where they live. The elderly, unemployed or people working at home and young people are often left without adequate facilities or opportunities for shared or individual activities. The unemployed rate of Joensuu is extremely high (27% in 1995) and has increased within the last few years.

Marjala has been built so that people can work, live and enjoy their leisure time within their residential area. Cooperation between the inhabitants and the city employees creates networks, which provide support, increase the inhabitants participation and create jobs within the area.

4. Speech of welcome to the workshop by Ms. Mieke Andela-Baur, President of Netherlands Platform Older People And Europe, 9 September 1999

Let me first welcome you on behalf of the Netherlands Platform Older People and Europe (NPOE) to this excellent conference Centre Onze Lieve Vrouwe Maria ter Eem in Amersfoort. The theme of this workshop: Living Conditions of Poor Older Persons in Human Settlements, is a serious and important issue, which has been a policy issue on our political agenda for many years. As people grow older they develop other priorities, demands and needs; a different space or adaptations of their homes that bring them comfort when mobility or visibility is declining. They may also need a different environment in which shops or public transport is available in the neighbourhood, or communication equipment, etc.

On Friday afternoon we hope to tell you about the “Senior Label” which is a sign or insignia indicating that a house is designed for a whole life course. Senior Organization has developed this Label with a research institute and it is being applied in many communities. Good criteria for building and renovation and for the environment are extremely important for the future of a graying society. The Dutch social system is intended to provide care and attention to frail older people in such a way that they still feel and are independent.

One matter of concern is the expectation of loneliness among older People. European research in 1993 found that the percentage of older people who feel lonely in the Netherlands and Denmark is the lowest in Europe: 4 - 5 percent against 36 percent in Portugal and Greece.

NPOE is a project organization aiming at stronger participation of older people in international co-operation and exchange of experience, knowledge and technology. We have developed a number of projects of interest to you. I will mention two briefly.

One of these projects called “Senior Web” is an internet web site and a training and education initiative involving more than 400 volunteer senior “ambassadors” all over the country who train older people in the use of computers and the internet. A new communication channel is opening for older people and is becoming a tool in international communication.

Two, we use the same internet technology to spread news and views on ageing through a website www.MediaAge.net. We would like your Workshop to decide that the wonderful network of experts gathered here will continue through a list, or for a website that Senior Web might build for you to make use of new technology to keep each other informed.

Thank you for your attention. I wish you a fine and fruitful discussion.