In the interviews, we found that discussions of current and future housing accessibility policies often were intermingled with thoughts and reflections of different factors that influenced, guided, or restrained the municipalities’ choice of action and their room to maneuver when addressing housing accessibility issues. We identified four such main themes concerning factors that influenced current and future policies, i.e., legal, organizational, socio-demographic, and political factors. We present these factors first and then proceed with the findings of actual measures or policies currently carried out or considered for the future.
Factors influencing housing accessibility policies
Legal factors
Policies addressing housing accessibility has to conform to a legal framework and several of the participants emphasized that the Swedish Planning and Building Act [44] and the National Board of Housing, Building, and Planning (BBR) [45] guide their policies regarding housing accessibility on the municipal level. Nonetheless, it was also noted that sometimes the current laws are vague and leave room for interpretation. On the other hand, they recognized there is limited leeway towards private housing companies to demand more than what is regulated in the law, for instance regarding renovation and housing adaptations. An officeholder at a municipal management office formulated it like this in the interview:
"Yes, and we can not make those demands [to private housing companies]. That is the crux, that we can only make demands that are supported by PBL and BBR, otherwise, there will be special technical requirements. So we can give inspiration to [private housing companies] …, and then we can give tougher directives to the municipal housing company.”
Organizational factors
The influence of different decision levels and the organizational structure within the municipality was mentioned by many participants. For example, issues, where a holistic approach seems appropriate, may instead be handled by committees with more narrow expertise. It was also described how the decision level occasionally leads to conflicts of aims when striving to address housing accessibility issues properly, such as considering individual circumstances that are addressed differently by general policies at the municipal level.
“So again, they [the Environmental- and Community Building Administration] are at the micro perspective in this particular residential building and in fact have the right competence and better skills, but we [the municipal management office] must always see the bigger picture, the bigger picture, the bigger picture. We can not say "Yes, absolutely on this [one]", because then we lose everything else. It is to both balance, politics, administration, and then also the municipality's offices and administrations. And the same with Health and Social Care where you can think―I do not have a great specific example, but they focus more on the micro perspective or on individual matters―for example "this person must have a solution in this way". So we may somehow get a policy mix that goes against it [the individual solution], we are not allowed to do it.”
Socio-demographic factors
The growing number of seniors was described as a major factor influencing housing policies both currently and when planning for the future. It was acknowledged that the growing number of seniors should significantly affect the development of new housing as well as the adaptation of the current housing stock. It was also considered a major challenge for the municipalities to predict the needs of the seniors since they are a heterogeneous group with different needs and various levels of functional limitations.
"It's very difficult to predict, because it could be that all those who turned 80 that we see in the statistics, "oh now there will be 30 new 80-year-olds compared to last year", perhaps they already live in senior housing and then there is no housing issue that needs to be resolved in that way. Or they are super healthy, live alone in a single-family house. In that case there are actually 30 single-family houses where healthy 80-year-olds live, who may actually be able to keep their house with the help of friends and acquaintances. Or they can not do it… So that is how it is, again macro-micro, we see a number. And I think above all it will only increase, the number of older people living in single-family houses will increase more and more. And there is also a bigger discussion here about how to get them to move. That challenge will only get bigger."
In the interviews, there was also the reasoning of how supply and demand for new housing and high market prices affect the construction of newly built accessible housing. In sparsely populated areas, it was recognized a challenge that there are no market players who want to invest and build. Moreover, the possibilities for private individuals to receive bank credits for new expensive construction is limited, despite the fact that there exists a need for new, more accessible housing.
Political factors
Political governance and different political views and values were frequently discussed as important factors influencing how housing accessibility issues are addressed. Many participants expressed that the political governance concerning how housing issues are addressed may not always take fact-based information from the public officials sufficiently into account. Instead, policies and courses of action are decided more from a political and ideological perspective. It was also emphasized that the political color of the governing party or coalition, and their awareness of housing accessibility issues, is crucial for how future policies concerning these matters will evolve.
“But there is always a big political discussion about what should be built. Should we build single-family houses, should we build rental apartments? If we build rental apartments, what kind of people will move in? If we build single-family houses, who do we get then? So, that can be quite… a discussion that I think can be quite clearly politically based. You have your own political views, you go hard on them, but rarely back them up with arguments that are actually based on facts, or another theory."
Current and future housing accessibility policies
We identified six main themes of housing accessibility policies from the content of the interviews and the policy documents: Organizational policies, Economic policies, Research and development policies, Preventive policies, Housing construction and design policies, and Legal policies. For each theme, we identified one or several categories, see Fig. 1. The results here mainly derive from the interviews. The housing supply plans added some complementary information and mostly from the bigger municipalities, with more elaborated plans.
Organizational policies
The theme of Organizational policies has one category focusing on Dialogue and collaboration with different actors. The participants described that the municipalities strive to be in dialogue with various actors such as pensioners’ associations, construction companies, carpenters, as well as private and municipal housing companies when they develop their policies.
"But we try to have a good dialogue [when planning new housing developments]. Now I know that we are only talking about settlements in a development district, but it is still pretty connected anyway, how the accessibility looks on the surrounding streets and other things as well. So in these matters we also have a good dialogue, I think, with our accessibility council which is a municipal council, or an interest organization, or whatever you want to call it. ”
Some of the participants emphasized that the municipality even collaborates with different actors to develop new ideas and solutions on how housing accessibility can be improved. Dialogue lays the groundwork for collaboration and goes one step further since it involves cooperative projects and a joint effort together with various actors.
Economic policies
Economic policies had a rich content and we identified four categories within this theme. Financial incentives for different housing provision actors, such as incentives to property owners and housing companies to implement housing adaptations, were considered an important tool to improve housing accessibility. Moreover, it was recognized that public expenditures through home services, for instance, can be decreased if seniors with reduced functional capacity are able to remain living in well-adapted homes that fit their needs, instead of moving to special housing. Furthermore, the participants described Financial incentives for individuals to stimulate relocation as something that will grow in importance in the future. The participants also expressed concern, that seniors with functional limitations and lower incomes are more likely to stay in their often inaccessible homes. Financial incentives for those individuals could decrease those “lock-in effects”.
“And then there are people, I mean older people, who perhaps could actually move to an apartment and leave their house - which is built in the 50s, 60s - but the economic conditions are generally not good for a person living in [this municipality]. So they live [economically] better in their old house rather than moving to something that is perhaps a little more accessible and actually better. And that means that we get very poor mobility in the housing market.”
The category Subsidies targeting the current housing stock captures discussions of the dilemma that although renovations and adaptations of the housing stock would improve housing accessibility, it would also result in higher rents. Especially, it was argued, seniors with lower incomes would have difficulties paying such rents, and property owners, as well as housing companies are therefore hesitant to renovate and improve their accommodations. Currently, there is no financial incentive in the form of subsidies to stimulate the renovation and adaptation of the existing housing stock, which in general is less accessible compared to newly built housing and thus more in need of such measures.
The participants often returned to the topic that housing accessibility issues are very complex and cannot be considered in isolation. In relation to this, Interventions focusing on social division were frequently mentioned. For instance, measures taking loneliness among seniors into account while building new accessible homes, or social measures such as dealing with homelessness among seniors with substance abuse or poor mental health, by providing them paid accommodation where accessibility issues deserve more consideration than is the case today.
Research and development policies
This theme mainly covers discussions related to Measures focusing on technology. The participants told about more general ideas of welfare technology and smart homes, but also gave concrete examples. For instance, one participant described the current usage of special assistive technology devices for home assistance personnel, which may compensate for some problems in the physical environment.
Additionally, one participant brought up the Development of new design solutions as a suggestion for future policies.
“Yes, it seems if there could come some new types of lifts that one may not know of or so, that there would be some smart solution to it. //……….//. But there is a company that has a product that is like a staircase, you could say. It looks like a regular staircase. And then you can adapt it so that the stairs, yes, become like a lift, that kind of platform. So it is aesthetically pleasing, but I think it is more perhaps intended for public spaces. I think it's pretty expensive too. But it is possible that there may be some new ideas like that. ”
Preventive policies
Accessibility inventories as a basis for future measures were identified by many participants as an essential policy to address housing accessibility issues. Some municipalities had already initialized such inventories while others were involved in discussions on how to go about them in methodological and practical terms. Accessibility inventories were acknowledged as important information to support future measures and initiatives to improve housing accessibility. Most of the actual inventories brought into the discussion, however, were conducted through private or municipal housing companies. Some participants said that even if they saw the benefits of such inventories, they had economic challenges to implement them.
"In that case, we should… if we were planning to make such an accessibility inventory, then it will still be something where we have to go beyond the regular budget ourselves."
There were also discussions concerning the benefits of Preventive measures that ensure accessibility is addressed before the need arises. One participant specifically mentioned current policies to remove barriers in the homes and make them more accessible in order to prevent falls and injuries in the home environment. To promote good health and sustainable use of economic resources, one municipality’s housing supply plan specifically focused on preventive policies such as social activities, housing counseling, and workshops targeting housing for senior citizens.
Mostly in terms of policies for the future, we identified the additional category Strategies targeting relocation. Within the individual interviews as well as in the housing supply plans, there were several examples of incentives of preventive character to stimulate relocation, such as relocation chains, relocation assistance, or information about relocation.
Housing construction and design policies
This theme captures one of the principal current policies in all municipalities to address housing accessibility issues, that is through needs-based, publicly funded Individual housing adaptations. The most common housing adaptations mentioned in the discussions were removing thresholds, installing and adaptation of showers instead of bathtubs, stair lifts, and stove guards. In general, this policy was positively described. However, the division of responsibility between the municipalities and the regional health care for special housing adaptations was occasionally found to be challenging.
"I can say, what has happened most about the housing adaptation issue, is that there has been a long dispute between [the municipality] and [the region] about who is responsible for wheelchair garages. Is it a housing adaptation issue or is it the region that is responsible for it, based on the fact that they prescribe the aid? There have been many years of trouble in between."
In both housing supply plans and interviews Refurbishment, renovations and maintenance were described as significant tools to improve housing accessibility as well as social sustainability and equitable living environments. The housing supply plans also showed the ambition to meet the needs and wishes of seniors through the Supply of different housing forms in the future, including a diversity of tenures such as rental apartments, co-operative apartments, and self-owned single-family houses. Furthermore, in response to increasing social segregation and the complexity of the housing market, we found socially mixed housing with innovative or different housing forms to be promoted. It was also acknowledged that not all older adults can age in place. Some need assistance as soon as functional limitations arise. The municipalities were therefore focusing on building additional intermediate forms of housing such as senior housing and sheltered housing.
Legal policies
This theme was mostly discussed in terms of future policies and concerned to Sharpen housing and building legislation. There were for instance suggestions by participants to address the challenges created by the vague formulation of the current law, particularly by the mix of accessibility and usability concepts.
“Even if it [the law] is clear, it becomes unclear precisely in the concept of “accessible and usable”, and it is really like a fluffy cloud to be “accessible and usable”. And the accessibility is easier for them [the building permit officers] to see. Just like yes, there are open areas and there is enough space, there are surfaces to move on, and so on. But the usability is a bit on another level, or how to say. That it is not so easy to get a grip on, I think.”
Policy suggestions considered to better support housing accessibility in the future
Starting from current and future housing accessibility policies and through the joint effort in a research circle format participants from the municipalities, senior citizens, and researchers developed and agreed upon a prioritized list of suggested housing accessibility policies for the future, see Fig. 2.
Priority 1
Coordination of accessibility issues at the national level was considered to be of the highest priority. This was not mentioned in the interviews or policy documents but was added through the joint discussions of the research circle. The consensus view was that this would create a more comprehensive approach to housing policies, planning, and implementation and strengthen the cross-sectorial collaboration.
Priority 2
Sharpen housing and building legislation was discussed in the interviews, but the research circle further developed this policy suggestion. It was argued that the current legislation is insufficient regarding universal design and housing accessible for all. Furthermore, it was considered that the current legislation does not sufficiently cover barriers for individuals with cognitive functional limitations, and needs to be amended in this regard. To support the overarching perspective on housing accessibility on a national level, the development of policies that encompass physical safety, fair socio-economic standards, proximity to service, transportation, and culture was embraced.
Priority 3
Dialogue and collaboration with different actors was prominent already in the interviews as well as the housing supply plans, and the research circle confirmed the importance of such policies. Collaboration and dialogue should include municipal and private housing companies, pensioners, and other non-profit organizations to take different expertise into account and benefit from a diversity of perspectives.
Priority 4
Information and improving knowledge base among public officials, politicians, and citizens was considered crucial in order to promote improved housing accessibility, and the research circle added more detail compared to what was discussed in the interviews. On an individual level, it was suggested it could be accomplished through for example relocation counselling or apps with support to choose a dwelling that matches individual accessibility needs. Furthermore, the spreading of information and knowledge among politicians to support informed decisions regarding housing accessibility was mentioned. An additional suggestion was to conduct a national information campaign to increase the knowledge and awareness among citizens about the importance to plan for future housing.
Priority 5
Financial incentives for different actors such as citizens, property owners, housing and construction companies, and municipalities were considered to be of high importance. In addition to incentives mentioned earlier from the interviews, it was argued that municipalities with extra needs due to special socio-demographic circumstances could require long-term national aid packages. Furthermore, national subsidies for targeted measures such as after-installation of lifts were mentioned.
Priority 6
Supply of different housing forms both regarding building and tenure type was deemed important. In addition to what was brought up in the interviews and housing supply plans, the research circle emphasized that proximity to transportation, service, and culture is of significance. It was therefore argued that when building new housing, areas close to public transport routes should be favoured.
Priority 7
Development of technology and design solutions to support ageing in place was considered to be highly needed. Such policies were touched upon in the interviews but were further underlined by the research circle. In particular, it was mentioned to be important to develop and implement technical solutions that improve accessibility for individuals with cognitive limitations. The development of innovative technical solutions, such as technical guides in the home environment was also emphasized in order to assure technical accessibility for all.