Social Work Review, 3/2014, 17-31

www.swreview.ro

The Subjective and Objective Dimensions

of Home in Later Life: Implications for
Aging in Place
Cătălina-Ionela Rezeanu
Abstract. The aim of the paper is to identify what Romanian research can learn from
international research trends regarding the subjective and objective dimensions of
home for older people and their relationship with the phenomenon of aging in place.
First, a literature review will be done, using theoretical justification and
conceptualization. Second, the paper will analyze the main research findings from
Romanian context. Third, it will provide some recommendations to guide future
Romanian research. The analysis is done using the person-environment model
(Oswald and Wahl, 2010 apud Oswald and Wahl, 2013) and the relational model of
space (Löw, 2008). There are two specific terms used for representing the notion of
dwelling: one for objective dimension (house) and one for subjective dimension
(home). The subjective dimension of home can be understood through the process of
social construction of home, while the objective dimension through the process of
social production of home. In international context, the study of subjective and
objective dimensions of home in later life and their implications for the phenomenon
of aging in place are very advanced. In contrast, in Romanian context studies about
the aging population are scarce and the same thing can be said about the aging in
place topic. Therefore, it’s difficult to talk about using research findings for improving
the social policies when so little research on these topics had been carried. The paper
shows why the topic is of general gerontological interest, but also of special interest
in the Romanian context.
Keywords: aging in place, environmental gerontology, meaning of home
Introduction
Aging brings social change. One way this determination manifests itself is reflected by
how living space is changing across the life course. As people grow old not only physical
house changes, but also the meaning attached to it. The demographic predictions show that
in the future the number of older people will continue to increase, and the number of years
lived after retirement as well. There is also an increasing trend regarding the preference of
elders to remain in their homes, in detriment of other housing facilities, which signifies
that more older people will spend more years in their dwellings. This social phenomenon is
called ”aging in place” and is gaining more and more attention in research literature.
Living longer implies dealing with physiological, psychological and social changes
associated with older age. Maintaining quality of life and autonomy in later life while
aging in place asks for social innovation: using technological and design progress in order
to adapt the house to the aging problems. Studying these processes can contribute to
effective strategy formulation for successful aging trough sustainable age in place
programs.
Every stage in human development brings new meanings of home: from a space of
exploration during childhood, through a space of occupation and ownership during
adulthood, and finally to a space of autobiographical expression and bonding in later life.

University of Bucharest, The Doctoral School of Sociology, E-mail: rezeanucatalina@gmail.com
2 Cătălina-Ionela Rezeanu /The subjective and objective dimensions of home in later life:
implications for aging in place

As people age the importance of home environment increases. The big majority of elders
live in their home, where they spent most of their time, and perform most of their
activities. Older people living home tend to concentrate their indoor activity around some
specific places in their dwellings, creating “control centers”/”living centers” characterized
by being comfortable, with a good view outside and closed to necessary items. The elders
try to compensate reduced functional capacity either by modifying their home environment
or by adapting their behavior (Oswald and Wahl, 2005, 23-25).
Although in developed countries research on these topics is very advanced (and even
extended to themes like age-friendly communities and cities), not the same can be said
about developing countries, and especially post-communist countries from Eastern Europe
– like Romania – where population ages more rapidly. For this particular context, it may be
possible to find differences related to the meaning of home, the structure of household, the
physical characteristics of house, the social perception about aging in place etc.
The question raised by this paper is: what do we know by now about the subjective and
objective dimensions of home for older people and their relationship with the phenomenon
of aging in place? The aim of the paper is to identify what Romanian research can learn
from international research trends on these topics. First, a literature review will be done.
Second, the paper will analyze the main research findings from Romanian context. Third, it
will provide some recommendations to guide future Romanian research.
1. Conceptual clarification
Dwelling can be defined as ”a physical unit, a defined place for its residents providing
shelter and protection for domestic activities and concealment, and an entity separating
private from public domain” (Flade, 1993; Lawrence, 1987; Rapport 1995; apud Oswald
and Wahl, 2005, 22-23). There are two specific terms used for representing the notion of
dwelling: one for objective dimension (house) and one for subjective dimension (home).
The concept of home is a physical, psychological and social construction (Sommerville,
1997, 226 apud Oswald and Wahl, 2005, 23). The physical home (or the house) consists of
”household facilities, everyday modern conveniences, style of architecture, and living
accommodations that afford opportunities for activities”: the social home (or the
household) implies ”relationships with others within a shared space”; and the personal
home is ”an extension of oneself, one’s own desires, feelings, hopes, and actions”
(Sixsmith, 1986, 290 apud Oswald and Wahl, 2005, 29).
Aging in place is defined as “the ability to live in one's own home and community
safely, independently, and comfortably, regardless of age, income, or ability level” (CDC,
2009); or as “remaining living in the community, with some level of independence, rather
than in residential care” (Davey et al., 2004, 133); suggesting that “what is best for older
people (and society at large) is to remain in the residential environment (e.g. home and
neighborhood) in which they have lived most of their lives”(Byrness et al., 2006, 50).
2. Theoretical models
One of the most recent theoretical models for studying the relationship between aging and
dwelling’ change in later life comes from environmental gerontology, being developed by
Frank Oswald and Hans-Werner Wahl in 2010 (apud Oswald and Wahl, 2013, 53) – see
Fig. 1. According to this model, the elder interacts with the environment (through
subjective “experience” and objective “behavior”) in order to maintain independence
(“identity” and “autonomy”), which depends on his capacity to control the use of the
 Revista de Asistenţă Socială, 3/2014 3

environment (“agency”) and his ability to create and recreate the meaning of home
(“belonging”). The processes of “belonging” consist of subjective experience with the
place (interpretation, evaluation, signification, attachment, bonding, familiarity etc.), while
the processes of “agency” underline the objective experience with the place (goal-oriented
behaviors: using, controlling, adapting, creating, sustaining etc.). “Identity” is about self-
integrity, whereas “autonomy” is about body-independence, and the relation between the
two of them is mediated trough “well-being” (2013, 53-56).
Person-environment model is useful because it offers a developmental perspective
which incorporates both subjective and objective dimensions of processes, but it
emphasizes more the psychological view, the micro level analysis, lacking the social and
structural perspective.
The study of the relationship between aging and living space could benefit as well from
using some theoretical models coming from the field of sociology of space. The relational
model of space was recently developed by Marthina Löw, who adapted Anthony Giddens’
“structuration theory”, so that the “duality of structures” becomes the “duality of space”,
meaning that space is constituted in cognitive structures and manifest itself through social
structures. In other words, agency constitutes space and this process influences and is
influenced by social structure (Löw, 2008, 39). Space is considered to be the “relational
orderings of people (living entities) and social goods. The term ordering denotes two
aspects: both the stative order created by spaces and processual ordering, the action
dimension” (idem, 38). The model contains two interconnected processes: “the social
construction of space” and “the social production of space”. The social construction of
space is defined as the “transformation of space – through people’ social exchanges,
memories, images and daily use of the material settings – into scenes and actions that
convey meaning”; and the social production of space “includes all those factors – social,
economic, ideological, and technological – that result, or seek to result, in the physical
creation of the material setting” (Löw, 2000, 127-128).
Even if this model is very abstract and relatively difficult to apply, it has the advantage
of adding the structural perspective and that’s why it could be very useful to study the
connections between elders’ experience of their home (social construction of space) and
social strategies to adapt the houses’ characteristics to elders’ needs (social production of
space).
3. Research findings
3.1. The social construction of home: the subjective dimension of home
As shown from a recent qualitative research (sample: 39 persons 64-103 years old from
England), aging in place is perceived by elders as ”an identifier of old age” and ”a means
of resistance to aging” (Graham et al., 2000, 193). Moreover, another qualitative study,
applied in New Zeeland (sample: 121 persons 56-92 years old), inferred that older people
associate aging in place with a sense of attachment and social connection with the
community, and also with a refuge providing security and familiarity (Wiles et al., 2012,
357-366).
Some other research has been done to study the relationship between the perception of
home and the tenure of home. One of these concluded that, in later life, homeownership is
understood as a source of ”ontological security”, which can be measured using 4
dimensions: ”home as a site of constancy in the social and material environment”; ”home
as a spatial context in which the day-to-day routines of human existence are performed”;
4 Cătălina-Ionela Rezeanu /The subjective and objective dimensions of home in later life:
implications for aging in place

”home as a site where people feel most in control of their lives”; and ”home as a secure
base around which identities are constructed” (Dupuis and Thorns, 1998, 29).
A quantitative research applied in France (sample: 103 persons 72-86 years old)
emphasized that residential satisfaction of elders is more a measure of physical location
rather than a psychological or behavioral one. The study validated 4 dimensions of the
concept of residential satisfaction for older people living in place: ”the local area”, ”access
to services”, ”relations with neighbors„ and ”the home itself„ (Rioux and Werner, 2011,
158-169). A similar, but quantitative, research was conducted in Detroit city (sample: 604
persons aged 60 and older). Using hierarchical logistic regression, the results revealed that
housing satisfaction was predicted by: ”home hazards” and ”neighborhood hazards”
(common housing and neighborhood issues), ”geographic location” (zip code), and
”interaction measures”. Residential dissatisfaction was predicted by lowest levels of
mental and physical functioning (Byrnes et al., 2006, 50-77).
Based on in-depth interviews (sample: 126 persons 61-91 years old from Germany),
Oswald and Wahl (2005, 32-33) have developed a model describing the meaning of home
for older adults using 5 typologies: physical – experiencing of housing conditions;
behavioral – everyday behavior in home like manipulating and rearranging items in home;
cognitive – statements of biographical bonding to home like familiarity or insideness;
emotional – emotional bonding related to privacy, safety, pleasure and stimulation; social –
relationships with cohabitants, neighbors, guests. Similarly, but regarding the oldest old, a
qualitative research conducted in Sweden (sample: 40 persons 80-89 years old) identified
two main categories of meanings of home for very old persons: security (with sub-
categories: “living in a familiar neighborhood”, “everything functions”, and “having
memories to live on”) and freedom (with sub-categories: “place for reflection”, “social
meeting-point”, and “leaving your own mark”) (Dahlin-Ivanoff et al., 2007, 25-32).
3.2. The social production of dwelling’ space: the objective dimension of home
In Britain, the preoccupation for studying the physical modifications of homes according to
the special needs of older population began to be popular in the 1960s. It appeared in the
context of public policy for improving sheltered housing. The main problem was that
recommendations were made primarily on the basis of stereotypes about older age
(ageism), ignoring the elders’ perspectives and wishes. This trend continued even in the
1980s. It was believed that older people had a reduced social life, were vulnerable and
dependent on others (Fairhurst, 2002, 96-107).
In US context, in the 1990s, AARP started a series of studies about elders’ opinions on
home modifications that enable them “to remain independent and that increase the safety
and convenience of their home” (Bayer and Harper, 2000, 1). In 2000, the report of the
fifth edition of the study (random digit dialing sample of 2.000 Americans aged 45 and
over – the baby boomers; weighted by age and gender) was published. It revealed that 62%
of respondents had difficulty getting around their home, most common problem being
climbing up and down stairs. 70% had made at least one major modification in their home
to make it easier for them as they get old (most common being: “installed light switches at
the top and bottom of dark stairwells”, modifications “that will allow them to live on the
first floor”, “handrails on both sides of their steps or stairs”, “handrails or hub bars in their
bathroom” (idem, 1-5). Knowing the elders’ needs for home modification can have a
significant contribution to effective social policy formulation to support independent
living.
 Revista de Asistenţă Socială, 3/2014 5

Moreover, research has been carried to assess the effects of the characteristics of home
on elders’ health. Research from Australian context has shown that physical and financial
limitations of the elders are associated with poor home maintenance and lack of optimal
home heating and ventilation, facilitating dampness and cold – which can lead to health
problems (especially respiratory illness). In older age, inappropriate home design can result
in more accidents. The incapacity to make home repairs also affects the psychological
wellbeing of the elders, their felling of insecurity and even their mental health, which can
lead to social exclusion (Davey et al., 2004, 24-26). A recent cohort study from North
America, Europe, and Australia proved that, for elders, the interconnection between aging,
health and housing has impact on their independence, safety and participation (Kendig et
al., 2012, 150-155).
Physical characteristics of homes can be adapted to facilitate aging in place by applying
technological and design innovations in order to maintain “autonomy, security, dignity, and
reasonable quality of life” for the elders (Normie, 2011, 47), on condition that: the
intervention is unobtrusive, doesn’t change the familiarity of surroundings, is optional and
controllable by the elder (idem, 48). Much of the effort has been oriented toward
compensating physiological changes associated with older age (loss of mobility, manual
dexterity and physical strength; breathing difficulties, incontinence, digestive problems,
memory problems, impaired vision, hearing or sense of smell/touch, increased sensitivity
to extremes temperature) (Robson et al., 2005, 28-31) through modifications of homes
which can enable the elder to continue to perform the basic ”activities of daily living”
(dressing, doing laundry, cooking, cleaning, eating, sleeping etc.) (van Hoof et al., 2010,
207-211). Some relevant modifications of homes, recommended for the elders by design
specialists, are presented in Table 1.
In the last decade a lot of research has been done regarding the way home adaptation
and “assistive technology”/”assisted living space” (AT/ALS) can improve “activity of daily
living” (ADL) of the elders. Research has shown that both of them can “substitute for
traditional formal care services and supplement these services in a cost-effective way”
(Lansley et al., 2004, 571).”Ambient intelligence”, referring to ”means to support aging-
in-place by monitoring clients in the home”, can positively influence the perception of
safety and security and help to postpone institutionalization (van Hoof et al., 2011, 310). A
study conducted in Scotland showed that ALS (defined as ” a technology-enabled
environment designed to allow people with complex health or social care needs to remain,
and live independently, in their own home for longer”) in order to be effective, it should
create ”dynamic, flexible and adaptable living environments” and should be acceptable nor
only for the elders but also for their families and carers, as well as for health and social
care services (Linskell and Bouamrane, 2012, 147).
Another concept used, coming from the design field, is that of ”smart homes” defined
as ”residential settings equipped with sensors and other devices that enable the monitoring
of residents, aiming to improve residents’ quality of life and support their independence”
(Demiris and Hensel, 2009, 106). This solution has been studied as regards to technical and
clinical aspects of its applications, and to ethical considerations (privacy vs. data recording
technologies; informal consent vs. lacking of technical familiarity; autonomy vs.
dependence on the technology; replacing face to face interactions with virtual interactions;
medicalization of the home environment vs. stigmatization of the elder seen as someone
dependent on medical devices; the perception of technology as obtrusive) (idem, 109-113).
6 Cătălina-Ionela Rezeanu /The subjective and objective dimensions of home in later life:
implications for aging in place

The adoption of technological innovations by the elders raises the problem of ”cultural
lag” (technological change taking place more rapidly than social change), and, more
specifically, the problem of rigidity and conservatism associated by some with older age.
One argument against this concern comes from Danigelis et al. (2007, 812-830) who
studied changes in sociopolitical attitudes that occur within cohorts during the life course
(sample: 22 nationally representative surveys from 1972 to 1998, 38.116 adults 18 years
and over from US). The main conclusion was that ”change is as common among older
adults as younger adults” (idem, 823). In addition to this, a recent content analysis on
research reports (published in peer reviewed journals; sample: 21 studies published in
English before January 2000) about assessing the effectiveness of the smart-home
technology concluded that ”older adults were reported to readily accept smart-home
technologies, especially if they benefited physical activity, independence and function and
if privacy concerns were addressed” (Morris et al., 2013, 1-3).
Studying the impact of physical home modifications on the elders’ independence
(competencies and functions) is necessary, but not sufficient because home is “is much
more than a physical environment” (Tanner et al., 2008, 195). “Home modifications have
the potential to enhance the experience of home as a place of significant and unique
personal and social meaning for older people. Care needs to be taken, however, to ensure
an awareness of the meaning of home to older people is embedded in the policy and
practices surrounding the provision of home modifications” (idem, 211). In other words,
the social production of living space for the elders can be improved through social policy
based on research results about both objective and subjective dimensions of home.
3.3. Aging in place
Recently, a group of 4 researchers (Vasunilashorn et al., 2012, 1-5) had analyzed scholarly
articles about aging in place, published between 1980 and 2010 in 11 leading gerontology
journals. The number of articles doubled in the first decade, and continued to increase in
the second. In 1980 the concept was only indirect mentioned, but starting from 1990 it
begun to appear as a central theme (in 1990 the ratio of direct-indirect was 0.55, and in
2010 was 0.75). The proportion of articles about aging in place relative to the number of
the total published articles increased over time, and also the diversity of the topics covered.
In the 1980s most of the articles were about two topics: “environment” and “other”
(especially migration); while in the 1990s other topics appeared: “service”, “health” and
“technology”. The proportion of research-based articles to policy-related articles increased
over time too. Four main trends were identified: 1. themes ranged from general (aging in
place in global context) to specific (for instance, “palliative care”); 2. articles focused on
two dimensions of the environment: “home” and “community”; 3. variations of the process
in different populations and subpopulations were emphasized (national context, rural-
urban, income, sexual orientation etc.); 4. technology was gaining more and more
attention.
Based on a secondary analysis using the data from Community Partnership for Older
Adults Program Survey (sample: 4.611 adults aged 60 years and older), a relevant study
was performed in US. Applying multiple regressions, the results revealed that the
characteristics of older adults who were likely to expect not to be institutionalized were:
”young old”, ”male”, ”high socioeconomic status”, „good health” and ”living with others”
(Tang and Pickard, 2008, 404-422).
 Revista de Asistenţă Socială, 3/2014 7

An important role in understanding aging in place has the research on household

composition in which elders reside. For instance, based on US census from 1980, a
secondary analysis has been done to study multigenerational households from the
perspective of the elder (sample: 47.286 individuals 65 years of age living in
multigenerational households; 19.8% from 1% stratified random sample from the
population). The main research findings were related to: “the prominence of blood
relationships”, “the association between age and the composition of multigenerational
households”, “gendered differences among adult children”, ”the issues of dependency in
multigenerational households” (Coward and Cutler, 1991, 55-73).
Research about aging in place in multigenerational households has focused not only on
elders, but also on their family caregivers. A relevant study was conducted in US (sample:
54 multigenerational families composed of: daughter of the elder, her husband, their child
at least 12 years old, and an elder 65 or older) to compare the perceptions of caregivers
(daughter and wife) and their children who live in the same space with an elder. The
reduction of space available in the house, as results of the elder’ moving in, is perceived
negatively by the adult caregivers, but not by their children. Correlation analysis showed
associations between “household space perceptions”, “burden”, and “caregiver
satisfaction”. Regression analysis emphasized that the variance of “household space
perception” was explained by: ‘household conversion” (for daughters); “household
conversion” and “elder spending more time in shared living space” (for husbands); “the
absence of elder amenities” (for children) (Pruchno et al., 1993, 349-366).
An important role in understanding the aging in place phenomenon has the analysis of
demographic data. A good example comes from New Zeeland, where, in order to offer a
report for the Centre for Housing Research, a group of researchers identified the main
characteristics of the older population (”the older population is itself aging”; ”life
expectancy is increasing”; ”women outnumber men among older people”; ”the older age
groups are fairly homogenous by ethnicity”; ”marital/partnership status varies by age and
gender”; ”older people generally live in small households”; ”disability rates increase with
age; incomes are generally low among older people”; ”most older people have low levels
of savings and investments”); and of their housing situation (”most older people live in
private dwellings”; ”few older people live in residential care, but the proportion increases
with age”; ”multi-unit dwellings are a significant housing type for the very old”; ”the
proportion living in smaller dwellings increases with age”; ”mortgage-free ownership is
high among older people”; ”housing costs vary by tenure”; ”income patterns vary across
housing tenure categories”; ”there are gender differences in housing tenure”; ”living alone,
differences by tenure and gender”) (Davey, 2004, 33-52).
As for the global context, demographic data shows that modernization of society brings
changes in living arrangement of older people. The majority of older people (60%) live in
multigenerational household. There are differences between developed and developing
countries as regards to older people living independently (alone or with a spouse). 75% of
all older people form developed countries live independently, as compared to only 25% of
all older people from developing countries (UNFPA and HAI, 2012, 27). In spite of these
results, a big issue is the fact that in developing countries there is not enough research data
about informal caregivers (idem, 91).

3.3.1. Relevant research findings from Romanian context

8 Cătălina-Ionela Rezeanu /The subjective and objective dimensions of home in later life:
implications for aging in place

As is been shown before (Bodogai and Cutler, 2013, 1-3), in Romanian context studies
about the aging population are scarce, predominantly descriptive, focused on needs
assessments, not well applied to improve social policy, and without the availability of their
data bases for secondary analysis. The literature about personal, social and material
dimensions of home for older people is also scarce. The same thing can be said about the
aging in place topic, except the fact that some general information could be obtained from
the demographic data available from Eurostat.
From the ethnographic research field, as regards to social dimension of home, in her
study about the urban neighborhood, Dana Cornelia Niţulescu (2004, 6) has identified the
social relationships based on common concerns formed between elders living on the same
flat. Another research topic is that of the “Neighborhood Institution” created in Romanian
rural context, particularly in Transylvania, by the Saxons. The Romanian elders from this
context have to deal with the disappearance of this institution (Coman, 2002, 102). Some
interesting studies have been conducted in the ethno-linguistics research field, analyzing
the symbol of house, as a socio-cultural sign, expressed through the preservation of some
basic terms like casă, gospodărie, vatră, sat [house, household, fireplace, village] with
identity connotations in Romanian culture (Creţu and Buzatu Hriban, 2012, 1032). Even
so, these studies are very general and do not focus on the elders perceptions of home.
In 1999 two researchers from US had made a study to analyze elderly living
arrangements in Bulgaria, the Czech Republic, Estonia, Finland, and Romania. In
Romania, living in an institution was higher among unmarried men 65-69 years of age, and
lower among widows and separated/divorced elderly (De Vos and Sandefur, 1999, 7-8).
More than half of elders lived only with a spouse or alone. Living with a child was found
to be pretty common too for elders in Romania (24%) (idem, 12). 37% of 80+ Romanian
females lived alone, and among unmarried elders, half of them lived alone (idem, 19). The
proportion of elders residing in institutions was so small (less than 1%), that was
considered negligible (idem, 19), suggesting that aging in place was the unanimous option
for Romanian elders. Coverage rates for residential care for people aged 65+ were also
very small (0.5%) (Bettio and Verashchagina, 2012, 71), but the affordability criteria 1 was
fulfilled2 (idem, 89, 157). In the report ”Long-Term Care for the elderly”, published by
European Commission, some useful information about personal care delivered at home in
Romania can be found. In Romania, home caregiver has been included in the official
occupational code, receiving trainings in new techniques for rehabilitation and specialized
assistance (Bettio and Verashchagina, 2012, 141). The eligibility criteria is the right
granted to care for husband/wife or an older dependent relative; home care being a paid
part-time work without time limits (idem, 161). A very big issue regarding home care is the
abuse applied to the elder by home care workers. A recent study form Romania showed
that most of the home care workers could not identify abusive behavior: ”they were less
likely than the older people to correctly identify neglect, restriction of liberty and possibly
psychologically abusive strategies as abuse” (Caciula et al., 2010, 407).
The Special Eurobarometer 378 published in 2012 by European Commission (sample:
26.723 respondents from EU27 - 1.045 form Romania, aged 15 and above) can give some
relevant information about elders’ situation in Romania. 49% of respondents from
Romania considered that older people are perceived totally negative (EU27: 28%), but
81% said that older people play a major role in their family (EU27: 43%). 36% of
Romanian respondents appreciated that the environment from their local area was not
 Revista de Asistenţă Socială, 3/2014 9

adapted to the needs of older people (EU27: 37%). 26% of respondents from Romania
thought that the use of modern communication technology by public services is not an
obstacle for older people (EU27: 13%). So, it can be said that elders from Romania need
intervention for adapting the environment to their needs as much as elder for other EU
country. In Romania, this process can be slowed down by the fact that older people have a
more negative image, but also facilitated by the fact that older people play a more major
role in their family and are more accustomed to modern communication technologies.
Some useful data about elders from Romania and their home are available in Eurostat
database (see Table 2) and in European Commission projections (see Table 3). In 2010, life
expectancy at age 65 was 14.01 years for males (projected to grow to 16.9 in 20130 and to
20.8 in 2060) and 17.02 years for females (projected to grow to 20.0 in 20130 and to 23.8
in 2060). Healthy life expectancy based on self-perceived health at age 65 was 11.2 years
for males and 11.6 years for females. The percent of very elderly population (80+) of total
population is expected to grow from 3.2 in 2010, to 5.1 in 2030 and to 13.3 in 2060. This
implies that more elders will live longer, and consequently will spend more years in their
homes.
In 2010, 19.6% of population 65+ declared severe long-standing limitations in usual
activities due to health problems. In 2008, as regards to population from 65 to 74 years:
more than one third declared severe physical and sensory functional limitations, and a
relative small percent (3.1%) severe limitations in personal care activities, and severe
limitations in household activities (8.9%); as regards to population from 75 to 84 years:
more than half declared severe physical and sensory functional limitations, almost 10%
severe limitations in personal care activities, and almost 20% severe limitations in
household activities; as regards to population 85+: 8 in 10 declared severe physical and
sensory functional limitations, 2 in 10 severe limitations in personal care activities, and
more than 40% severe limitations in household activities. In other words, Romanian elders
are experiencing age-related limitations of activities of daily living too, which are
becoming more and more widespread in very elderly population.
In 2012, in Romania, 15.4% of persons 65+ were at risk of poverty 3. Almost 3 in 10
persons 60+ were in a state of severely material deprivation 4. Material deprivation for the
housing dimension5 for population 65+ was bigger than 40%. Also, the percentage of the
population 65+ living in households where the total housing costs represent more than
40% of disposable income6 was 17.3. The overcrowded rate 7 for population 65+ was
13.2% in 2011. What raises more attention is the fact that the percent of Romanian elders
facing housing problems is quite elevated. It will be difficult to think about home
adaptation and assistive technologies when 4 in 10 elders don’t even have basic housing
conditions for decent living.
In Romania expenditure on care for elderly was, in 2008, 0.04% of GDP. Based on
different scenarios, the total health care spending as percent of GDP is expected to grow
from 3.7 in 2010 to [3.9-4.2] in 2030, and to [4.6-5.1] in 2060. Similarly, the total long-
term care spending as percent of GDP is expected to grow from 0.6 in 2010 to [0.8-0.9] in
2030, and to [1.7-2.2] in 2060.

Final considerations
10 Cătălina-Ionela Rezeanu /The subjective and objective dimensions of home in later life:
implications for aging in place

In international context, the study of subjective and objective dimensions of home in later
life and their implications for the phenomenon of aging in place are very advanced. Aging
in place is becoming a topic of its own, developing theoretical models, testing schemes of
conceptual operationalisation and using divers methodologies. Qualitative and quantitative
designs are being applied to draw conclusions about subjective and objective dimensions
of home for the elders. There are, of course, limitations of these studies. Some of them do
not use representative samples, and even when they do they are only cross-sectional
studies and most of them cannot differentiate between age, cohort and period effects. Even
so, their conclusions make interesting assumptions that could be used as hypotheses for
future studies.
In contrast to this international trend, Romanian research on these topics is very scarce.
Subjective and objective dimensions of home in later life are not topics of their own for
local researchers. The particularities of the phenomenon of aging in place in Romania had
drawn the attention of international researchers, but only some general data about objective
dimensions of home and elders perceptions are available through public statistics from
European Commission (Eurostat database). It’s difficult to talk about using research
findings for improving the social policies when so little research on these topics had been
carried. On the one hand, the elders from Romania are experiencing too some of the
international trends related to the process of aging. On the other hand, the poverty, the poor
housing conditions and the small percent from GDP allocated for expenditure on care for
elderly could contribute to some particularities of the phenomenon of aging in place in
Romania.
Moreover, the meaning of home for the elders was not studied in Romania. It is
possible that the communist experience had modified the elders’ perceptions of home and
of nursing homes (home being the hiding place against the system constraints and nursing
home the place where the system exercise its power over people because it was very
common to send people to asylums as a strategy to correct disobedience). In addition to
this, the fact that Romanian culture is very home and family centric, with bonding social
capital being prevalent to the detriment of bridging social capital (Voicu, 2008, 10), could
contribute to some specificities of the phenomenon of aging in place. However, all these
are only speculations without a solid research base, but they could make good hypotheses
for future research. For, instance, it would be very interesting in the future to study why
nursing home is not an option for Romanian elders, what is the meaning of home for
Romanian elders and how these affects aging in place and the social policies related to it in
this particular context.

Appendix 1
 Revista de Asistenţă Socială, 3/2014 11

Source: Oswald & Wahl, 2010, 114 apud Oswald and Wahl, 2013, 53)
Figure 1. Conceptual Framework of Person-Environment Processes in Later Life

Appendix 2

Table 1. Home’ modifications recommended for the elders

Impairments of old age Recommended home modifications

Loss of mobility Circulation spaces accommodated for wheel chair; handrails; chairs
installed in circulation spaces; handles, switches, sockets, knobs clearly
visible and conveniently located; offering good visual contact with the
outside world
Loss of manual dexterity Handles, handles, switches, sockets, knobs specified with ease of
operation and maximum leverage; avoidance of stiff or fiddly controls
Loss of physical Horizontal travel distances kept at a minimum; centrally located lifts;
strengths and fitness vehicle drop-off close to entry; the stairs design and location should
encourage their use; avoidance of heavy doors closers
Breathing difficulties Horizontal travel distances kept at a minimum; dust free environment;
heating system discouraging dust and micro-organism
Incontinence Bathrooms and toilets provided for all flats, designed with full mobility
standards, with hygienic and easy cleaned surfaces; communal toilets in
convenient locations and in close proximity to all facilities
Digestive problems Convenient planned individual and communal kitchens; small group
dining rooms for ”meals on wheels”
Mental frailty Secure, reassuring and stimulating environment: avoidance of
unfamiliar shapes or installations, clear patterns of circulation with
memorable visual events; design to minimize frustration, respect for the
need of privacy, security, dignity, and individual expression,
encouraging independence and the use of personal possessions
Impaired vision Strong and clear colors in circulation spaces with contrast on door,
stairs etc.; adequate and even background lighting levels; avoidance of
glare (naked light sources, windows at end of corridors; dimmer
switches which allow individual control
Impaired hearing Good sound insulation between flats; design for low reverberation;
place hearing add systems in communal rooms
Impaired sense of smell Aural and visual fire alarm systems in high risk area
 12 Cătălina-Ionela Rezeanu /The subjective and objective dimensions of home in later life:
implications for aging in place

Impaired sense of touch Low surface temperature heat emitters; hot water supply pipes
enclosed; placing temperature limiting thermostatic controls
Increased sensitivity to Draught proof doors and windows with adequate ventilation for high
extreme of temperatures insulation standards; adequate, responsive, economical heating systems
and which can maximize comfort and offer a degree of individual
control.
Source: adapted from Robson et al, 2005, 28-31

Appendix 3

Table 2. Characteristics of Romanian elders and their households

Year 2007 2008 2009 2010 2011 2012

Indicator

Healthy life at age 65 – males (years) n. a. 7.7 7.8 7.2 5.9 n. a.

Healthy life at age 65 – females (years) 7.8 7.9 7.1 5.0 4.7 n. a.
Healthy life expectancy based on self-perceived health at age 10.5 10.9 11.0 11.2 11.2 n. a.
65 – males (years)
Healthy life expectancy based on self-perceived health at age 11.2 12.0 12.1 11.6 11.6 n. a.
65 – females (years)
Self-perceived health - 65 years and over– very good and good 21.1 21.7 21.3 20.4 18.8 n. a.
(%)
Self-perceived long-standing limitations in usual activities due 21.5 19.6 20.4 13.3 25.3 n. a.
to health problem - 65 years and over – severe (%)
Physical and sensory functional limitations –from 65 to 74 n. a. 33.8 n. a. n. a. n. a. n. a.
years- severe (%)
Physical and sensory functional limitations –from 75 to 84 n. a. 57.3 n. a. n. a. n. a. n. a.
years- severe (%)
Physical and sensory functional limitations –85 years and over- n. a. 82.0 n. a. n. a. n. a. n. a.
severe (%)
Limitations in personal care activities - from 65 to 74 years – n. a. 3.1 n. a. n. a. n. a. n. a.
severe (%)
Limitations in personal care activities - from 75 to 84 years – n. a. 9.5 n. a. n. a. n. a. n. a.
severe (%)
Limitations in personal care activities - 85 years and over- n. a. 21.1 n. a. n. a. n. a. n. a.
severe (%)
Limitations in household activities - from 65 to 74 years – n. a. 8.9 n. a. n. a. n. a. n. a.
severe (%)
Limitations in household activities - from 75 to 84 years – n. a. 19.7 n. a. n. a. n. a. n. a.
severe (%)
Limitations in household activities - 85 years and over – severe n. a. 44.4 n. a. n. a. n. a. n. a.
(%)
At-risk-of-poverty rate – population 65 years or over (%) 30.6 26.0 21.0 16.7 14.1 15.4
Persistent at-risk-of poverty rate - population 65 years or over n. a. n. a. n. a. 17.3 13.2 n. a.
(%)
Median net income - 60 years or over (euro) 1369 1794 2147 2078 2215 2227
Mean net income - 60 years or over (euro) 1640 2058 2410 2358 2500 2515
 Revista de Asistenţă Socială, 3/2014 13

Relative median income ratio - 65 years or over (ratio) 0.76 0.85 0.93 0.97 1.01 1.01
Severe material deprivation rate - 60 years or over (percent) 45.9 37.3 33.2 31.3 28.0 27.5
Material deprivation for the 'Housing' dimension - 65 years and 30.8 32.9 35.8 37.5 40.7 43.8
over (%)
Housing cost overburden rate - 65 years or over (%) 26.2 26.2 19.1 16.8 9.7 17.3
Overcrowding rate - 65 years or over (%) n. a. n. a. n. a. 17.3 13.2 n. a.
Expenditure on care for elderly (% of GDP) 0.03 0.04 n. a. n. a. n. a. n. a.
Legend: n. a. = not available
Source: Eurostat database http://epp.eurostat.ec.europa.eu/portal/page/portal/statistics/search_database

Notes

References

Bayer, A.-H. Harper, L. (2000) Fixing to stay. A National Survey of Housing and Home
Modification Issues, May 2000. Washington: AARP. Retrieved from
http://assets.aarp.org/rgcenter/il/home_mod.pdf, accessed December 2013.
Bettio, F., Verashchagina, A. (2012) Long-Term Care for the elderly. Provisions and providers in 33
European countries. European Commission, November 2010. Luxembourg: Publications
Office of the European Union.
Bodogai, S.I., Cutler, S.J. (2013) Aging in Romania: Research and Public Policy. The Gerontologist,
Accepted Jul 24, doi:10.1093/geront/gnt080.
Byrnes, M., Lichtenberg. P.A., Lysack, C. (2006) Environmental Press, Aging in Place, and
Residential Satisfaction of Urban Older Adults. Journal of Applied Sociology, 23, 2, 50-77.
Caciula, I. Livingston, G., Caciula, R., Cooper, C. (2010) Recognition of elder abuse by home care
workers and older people in Romania. International Psychogeriatrics, 22, 3, 403-408.
Coman, G. (2002) Vecinătăţile fără Vecini [Neighborhoods without Neighbors]. In V. Mihăilescu
(ed.), Vecini şi Vecinităţi în Transilvania [Neighbors and Neighborhoods in Transylvania]
(93–118). Bucureşti: Paideia.
Coward, R.T., Cutler, S.T. (1991) The Composition of Multigenerational Households that Include
Elders. Research on Aging, 13, 1, 55-73.
Creţu, E., Buzatu Hriban, M. (2012) Reprezentări cultural-lingvistice ale locuirii [Cultural-
Linguistic Representation of Habitation]. In The Proceedings of the Communication,
context, interdisciplinarity Congress, 2, 1032-1041. Târgu-Mureş: Petru Maior University
Publisher.
Dahlin-Ivanoff, S., Haak, M., Fänge, A., Iwarsson, S. (2007) The multiple meaning of home as
experienced by very old Swedish people. Scandinavian Journal of Occupational Therapy,
14, 1 25-32.
Danigelis, N., Hardy, M., Cutler, S. (2007) Population Aging, Intracohort Aging and Sociopolitical
Attitudes. American Sociological Review, 72, 5, 812-830.
Davey, J., de Joux, V., Nana, G., Arcus, M. (2004) Accommodation Options for Older People in
Aotearoa/New Zealand. Report prepared for the Centre for Housing Research,
Aotearoa/New Zealand (CHRANZ), June 2004. New Zeeland Institute for Research on
Aging.
De Vos, S., Sandefur, G. (1999) Elderly Living Arrangements in Bulgaria, the Czech Republic,
Estonia, Finland, and Romania. Center for Demography and Ecology, Working Paper No.
99-14. University of Wisconsin-Madison.
Demiris, G., Hensel, B. (2009) ”Smart Homes” for Patients at the End of Life. Journal of Housing
for the Elderly, 23, 1-2, 106-115.
14 Cătălina-Ionela Rezeanu /The subjective and objective dimensions of home in later life:
implications for aging in place

Dupuis, A., Thorns, D.C. (1998) Home, Home Ownership and the Search for Ontological Security.
The Sociological Review, 46, 1, 24-47.
Fairhurst, E. (2002) Fitting a quart into a pint pot: making space for older people in sheltered
housing. In T. Chapman and J. Hockey (eds.), Ideal Homes? Social change and domestic
life (2nd ed., 96-107). London and New York: Rutledge.
Graham, M., Pain, R.,Talbot, C. (2000) The ageing body and homespace. Area, 32, 2, 189-197.
Kendig, H., Clemson, L., Mackenzie, L. (2012) Older people: well-being, housing and
neighbourhoods. In S. J. Smith, M. Elsinga, L. Fox O'Mahony, O. S. Eng, S. Wachter, G.
Wood (Eds.), International Encyclopedia of Housing and Home (150-155). Oxford:
Elsevier.
Lansley, P., Mccreadie, C., Tinker, A. (2004) Can adapting the homes of older people and providing
assistive technology pay its way? Age and Ageing, 33, 6, 571-576.
Linskell, J., Bouamrane, M.-M. (2012) Assisted-living spaces for end-users with complex needs: A
proposed implementation and delivery model. Health Informatics Journal, 18, 2, 147-156.
Löw, M. (2000) Spatializing Culture: The Social Production and Social Construction of Public
Space. In On the Plaza: The Politics of Public Space and Culture (127-154). Austin:
University of Texas Press.
Löw, M. (2008) The Constitution of Space: The Structuration of Spaces through the Simultaneity of
Effects and Perception. European Journal of Social Theory, 1, 11, 25-49.
Morris, M.E., Adair, B., Miller, K., Ozanne, E., Hansen, R., Pearce, A.J., Santamaria, N., Viegas, L.,
Long, M., Said C.M. (2013) Smart-Home Technologies to Assist Older People to Live Well
at Home. Journal of Aging Science, 1, 101, doi: 10.4172/jasc.1000101. Retrieved from.
www.esciencecentral.org/journals/smart-home-technologies-to-assist-older-people-to-live-
well-at-home-jasc.1000101.pdf, accessed December 2013
Niţulescu, D.C. (2004) Vecinătăţile de locuire urbană [Urban living neighborhoods]. Sociologie
românească [Romanian Sociology Journal], 2, 1, 60-78.
Normie, L. (2011) Technology for Ageing in Place. IFA (International Federation on Ageing)
Global ageing, 7, 2, 45-53.
Oswald, F., Wahl, H.-W. (2005) Dimensions of the Meaning of Home in Later Life. In G. D. Rowles
and H. Chaudhury (eds.). Home and Identity in Late Life: International Perspective (21-
45). New York: Springer Publishing Company.
Oswald, F., Wahl, H.-W. (2013) Creating and Sustaining Homelike Places in Residential
Environments. In G. D. Rowles & M. Bernard (eds.), Environmental Gerontology: Making
Meaningful Places in Old Age (53-73). New York: Springer Publishing Company.
Pruchno, R.A. Dempsey, N.P., Carder, P., Koropeckyj-Cox, T. (1993) Multigenerational Households
of Caregiving Families: Negotiating Shared Space. Environment and Behavior, 35, 3, 349-
366.
Rioux, L., Werner, C.M. (2011) Residential satisfaction among aging people living in place. Journal
of Environmental Psychology, 31, 2, 158-169.
Robson, D.G., Nicholson, A.-M., Barker, N. (2005) Homes for the Third Age: A Design Guide for
Extra Care Sheltered Housing. Taylor & Francis e-Library.
Tang, F., Pickard, J.G. (2008) Aging in Place or Relocation: Perceived Awareness of Community-
Based Long-Term Care and Services. Journal of Housing for the Elderly, 22, 4, 404-422.
Tanner, B., Tilse, C., de Jonge, T. (2008) Restoring and Sustaining Home: The Impact of Home
Modifications on the Meaning of Home for Older People. Journal of Housing for the
Elderly, 22, 3, 195-215.
van Hoof, J. Kort, H.S.M., Ruttenb, P.G.S., Duijnsteea, M.S.H. (2011) Ageing-in-place with the use
of ambient intelligence technology: Perspectives of older users. International Journal of
Medical Informatics, 80, 310-331.
van Hoof, J., Kort, H. S. M., van Waarde, H., Blom, M. M. (2010) Environmental Interventions and
the Design of Homes for Older Adults with Dementia: An Overview. American Journal of
Alzheimer’s Disease & Other Dementias, 25, 3, 202-232.
 Revista de Asistenţă Socială, 3/2014 15

Vasunilashorn, S., Steinman, B.A., Liebig, P.S., Pynoos, J. (2012) Aging in Place: Evolution of a
Research Topic Whose Time Has Come. Journal of Aging Research, Volume 2012, Article
ID 120952, 6 pages. Retrieved from
http://downloads.hindawi.com/journals/jar/2012/120952.pdf, accessed December 2013.
Voicu, B. (2008) Riscurile politicilor de dezvoltare bazate pe formarea capitalului social [The risks
of development policies based on social capital formation]. Sociologie Românească
[Romanian Sociology Journal], 6, 1, 11-25.
Wiles, J.L, Leibing, A., Guberman, N., Reeve, J., Allen, R.E.S. (2012) The Meaning of « Aging in
Place » to Older People. The Gerontologist, 52, 3, 357-366.
***UNFPA (United Nations Population Fund), HAI (HelpAge International) (2012) Ageing in the
Twenty-First Century: A Celebration and A Challenge. New York: UNFPA and London:
HAI. Retrieved from www.helpage.org/download/50af6e9c8f44b, accessed December
2013
***CDC (Center for Disease Control and Prevention) (2009) Healthy Places Terminology. Prepared
by the American Planning Association and the National Association of County and City
Health Officials with funding from the Centers for Disease Control and Prevention.
Retrieved from www.cdc.gov/healthyplaces/terminology.htm#a, accessed December 2013
***EC (European Commission). (2012) Special Eurobarometer 378. Active Ageing Report. January.
Retrieved from.
http://ec.europa.eu/public_opinion/archives/ebs/ebs_378_en.pdf, accessed December 2013
***EC (European Commission) (2012) The 2012 Ageing Report. Economic and budgetary
projections for the 27 EU Member States (2010-2060) European Economy 2/2012.
Retrieved from.
http://ec.europa.eu/economy_finance/publications/european_economy/2012/pdf/ee-2012-
2_en.pdf, accessed December 2013
***EC (European Commission). EUROSTAT Database. Retrieved from
http://epp.eurostat.ec.europa.eu/portal/page/portal/statistics/search_databaseaccessed
December 2013
***EC (European Commission). EUROSTAT Glossary: “At-risk-of-poverty rate”. Retrieved from
http://epp.eurostat.ec.europa.eu/statistics_explained/index.php/Glossary:At-risk-of-
poverty_threshold, accessed December 2013
***EC (European Commission). EUROSTAT Glossary: “Housing cost overburden rate”. Retrieved
from

http://epp.eurostat.ec.europa.eu/statistics_explained/index.php/Glossary:Housing_cost_ove
rburden_rate, accessed December 2013
***EC (European Commission). EUROSTAT Glossary: “Overcrowding rate”. Retrieved from

http://epp.eurostat.ec.europa.eu/statistics_explained/index.php/Glossary:Overcrowding_rat
e, accessed December 2013
***EC (European Commission). EUROSTAT Glossary: “Relative median income ratio”. Retrieved
from

http://epp.eurostat.ec.europa.eu/statistics_explained/index.php/Glossary:Relative_median_i
ncome_ratio, accessed December 2013
***EC (European Commission). EUROSTAT Glossary: “Severe material deprivation rate”.
Retrieved from

http://epp.eurostat.ec.europa.eu/statistics_explained/index.php/Glossary:Material_deprivati
on_rate, accessed December 2013
***INS (Institutul Naţional de Statistică) [National Institute of Statistics]. TEMPO database:
”Material deprivation for the housing dimension”. Retrieved from
16 Cătălina-Ionela Rezeanu /The subjective and objective dimensions of home in later life:
implications for aging in place

http://statistici.insse.ro/shop/index.jsp?page=tempo3&lang=en&ind=SAR110A, accessed
December 2013
1
fees absorbing at most 85% of the income
2
because the fee was €45-70/month and the median net income of 65+ person living alone was €113.67/month
3
The share of people with an equivalised disposable income (after social transfer) below the at-risk-of-poverty threshold, which is set at
60 % of the national median equivalised disposable income after social transfers
4
The enforced inability to pay for at least four of the following items: to pay their rent, mortgage or utility bills; to keep their home
adequately warm; to face unexpected expenses; to eat meat or proteins regularly; to go on holiday; a television set; a washing machine; a
car; a telephone.
5
The share of persons facing at least one housing problems: leaking roof, damp walls, floors, roof or foundation of house, or rot in
window frames or floor; too dark, not enough daylight; no bath or shower; no flushing toilet
6
Housing cost overburden rate
7
A person is considered as living in an overcrowded household if the household does not have: one room for the household; one room per
couple in the household; one room for each single person aged 18 or more; one room per pair of single people of the same gender between
12 and 17 years of age; one room for each single person between 12 and 17 years of age and not included in the previous category; one
room per pair of children under 12 years of age