Home sweet home? Growing old at home in the Spain of today
Almost three years ago now, at the end of 2018, I found myself, as usual, attending a session of a seminar on teaching innovation that was organised bi-weekly at the Royal Complutense College at Harvard (Cambridge, Massachusetts), the centre where I was doing my postdoc. I remember that, at the end of the soporific presentation, I stealthily got up from my chair with the sole intention of slipping away as quickly as possible from the moment of socialising that followed the usual torture. It was half past eight in the evening and I just wanted to go home. But then she intercepted me:
-Hi! Are you the one who works on things to do with the elderly? I'm also doing research on the subject. My thesis is on housing for the elderly.
Who was she? What did she want? Why was she addressing me with such glee? Tiredness, in its broadest sense, did not allow me to focus too much on his figure.
-That was the idea before I came here," I replied with disenchantment - and even with a certain air of superiority that I gave myself because of my seniority; I had never seen her before, so she had to be one of the new class of interns.
I cut the conversation rather abruptly to pursue my goal: to leave. In the days that followed, I couldn't even remember her name, but I couldn't stop thinking about the excitement I had sensed in her expression. Unfortunately - and for reasons unrelated to myself and my professional performance that are not relevant here - my first year at the RCC had not been wonderful and, without knowing her at all, I had good reason to believe that this charming girl was going to follow my fate. My concern, by no means mistaken, meant that we got to know each other on a more personal level.
She was Irene Lebrusán Murillo, a PhD in Sociology from the Complutense University of Madrid, a specialist in housing and inequality from an international comparative perspective, with a long research career and experience in knowledge transfer. She was the author of the doctoral thesis La vivienda en la vejez: problemas y estrategias para envejecer en sociedad (2017), which had received the Premio de Investigación en Economía Urbana del Ayuntamiento de Madrid and achieved its publication through the call for papers of the Politeya collection, edited by the CSIC (2019). She was the creator of the blog in which I now write, thanks to her kind invitation. She is my admired and dear friend Irene. The article with which I open the new academic year is a review of her book: a kind of tribute to her tireless efforts to improve society and, particularly, the lives of the elderly, and a well-deserved way of thanking her for her trust and generosity.
The story of how a copy of this work came into my hands is too intimate to relate here. Commitments have meant that it has been gathering dust on my bookshelf for months, until, at last, I have been able to give it the attention it deserves. It took me barely a full day to read it - one of the best of this summer - because, beyond my personal motivation for doing so, it is a text shrewdly committed to academic content for the specialist public, presented in a pleasant and accessible way - except, perhaps, for the methodological section, which can be more elusive, but which is not necessary to delve into to follow the thread - for the reader who is merely interested in the residential experience of old age in Spain today. Indeed, this is what the book is about: how ageing in place is highly valued by older people, positive in promoting independent and quality ageing in society and, at times, difficult to achieve for the most vulnerable older people in our country who have grown old in a situation of inequality due to the social policies of the past.
Throughout its almost two hundred and fifty pages, Irene analyses the concepts of old age and integrated old age, introduces the importance of remaining in the home - understood as "a cohabitation unit made up of the people (or persons) who live in the same dwelling" (p. 42) - until the last moment and, from here, begins to explore the complications faced by the elderly in achieving the objective of ageing in their homes. He is interested in focusing on those who have it hardest: to know their profiles, the causes and consequences of their difficulties. To do this, he not only traces the recent history of social policies on housing and the protection of the elderly in Spain in search of the origins of the structural differences that many people over sixty-five suffer today. It also dives into the data and gives it back to us chewed up to portray those who are at risk and with whom we often live without even realising it. Together with the testimony of some of them, and after putting on the table the real options they have to grow old in society in a successful way, it outlines, in the end, a critique of the system of provision of protection of the residential experience in old age and leads a call to action with a list of recommendations that both social agents and politicians should already be taking into account.
La vivienda en la vejez is structured in three parts comprising a total of eight chapters plus an introduction, a section on methodology, a methodological appendix and an inventory of bibliographical references. The manuscript begins, as I have warned, by examining the problem of the definition of old age, which is often elaborated on the basis of the association with negative changes. Irene acknowledges here the need to move towards a more inclusive synthesis of old age, but it is only in Ch. 1 that she explains that, in her opinion, this criterion is only met by the definition of old age from the chronological point in time when people start to benefit from specific public forms of protection and acquire new rights and obligations, i.e. the age of 65. This seems to me to be an intelligent decision, because it is just as absurd to talk about old age from a negative point of view as it is to talk about it exclusively from a positive one, as some people are now claiming.
Having overcome this debate, on which she must necessarily pause, Irene justifies the preference for ageing at home on the proven possibility of greater longevity and well-being - translated above all into independence - and on the guarantee of biographical continuity and continuity in society on the part of those who carry out this practice, without ignoring the benefits it brings for the State's coffers (Ch. 3). But it is not enough to stay at home until death. The place where people grow old has to meet the minimum requirements of suitability for the needs of the elderly in question. And this is where the problems begin, for although the elderly wish to grow old at home, not all living spaces are prepared to facilitate this goal in a safe and high-quality manner. Worse still, not all older people are in a position to adapt them or to look for alternatives that avoid institutionalisation.
In Chap. 2, Irene lists some of the "resistance" strategies that the elderly carry out in order to maintain their independence and continue to live in society. Presented from best to worst, on the one hand, there is the so-called permanence strategy, which consists of adapting the traditional home to the needs that appear as a correlate of the ageing process. On the other hand, there are the break-up strategies, which involve abandoning the usual space. These can occur with continuity in the home, when the elderly, when the time comes, move and buy, rent or live in a previously available dwelling (purchased or inherited) that suits their needs, and with household merger, if the cohabiting nucleus moves to the home of a relative, normally a descendant, on a permanent or rotating basis. This is without prejudice to combining the different strategies with informal or qualified home care, public or private. Finally, there is also the so-called marginal strategy of institutionalisation, which, according to the author, is not an option for ageing in society. All this is further developed in chapter 7, part three.
In this same Chapter 7, which is in fact a case study of Madrid, some of the impediments faced by the elderly in putting these strategies into practice are also explained. When the usual dwelling or the building in which it is located starts to present problems (e.g. ageing installations, maintenance failures, insufficient space, inadequate furniture, structural conditions...), in an increasingly expensive environment, factors such as the scarcity of economic resources and the culture of saving greatly hinder change. Another important aspect is attachment to the house and the neighbourhood, which is generated according to the length of time one has lived in the same place, the legacy that has been created there, familiarity with the environment, the feeling of belonging and identity or perceived and ontological security, among others, and which can lead to cognitive distortion to the point where the elderly deny or minimise the obvious problems of staying in the home. Sometimes it is the administrations themselves, with their high demands, prohibitions and endless bureaucracy, that stifle households' desires to improve. And, of course, the lack of knowledge and advice among the elderly about the social programmes available to meet their housing needs is also notorious.
For Irene, this is where the state has to come into play as a guarantor that no one is left behind. On this point, if you who read me - and I hope you read her if you haven't already - agree with socialist economic policy, you will be in complete agreement. But I, who am normally more sympathetic to neo-liberal positions, with a few admitted exceptions, cannot help but be a little shocked when state intervention is called for. The fact is that, in one way or another, the state does not deliver and, in the end, the responsibility for ensuring ageing at home in conditions of sufficient quality falls on the interested parties themselves (or their families).
-And where is the problem," I asked myself as I read, "What really prevents some people from implementing strategies to stay at home in optimal conditions? In the end it's money. You have to have foresight and save for your old age," I said to myself. "Why haven't these people made more money in their lives? Haven't they worked hard enough? Haven't they worked hard enough? Have they been wasteful? Some may have been disadvantaged by their nature or by the inefficiency of those administrations, but the others... they must have been irresponsible!".
It seemed to me at the time that, if "Daddy State" came into the picture to play the role of rescuing those who were incapable of saving themselves in the last stage of life, to provide what was necessary for old age in the shelter of a good home, regardless of whether one had been able to earn it oneself or not, nobody was going to work hard to provide for oneself in old age and the dependency of the citizenry would be perpetuated. These murky ideas were nothing but the fruit of ignorance.
The second part of the book enlightens me with an overview of the policies that have affected what is now the older population in terms of housing within the social welfare system throughout the twentieth and early twenty-first centuries. In Chapters 4 and 5, Irene presents the historical-political context in which those over sixty-five now live and the effects this has had on their current housing experience. In the first of these, she looks at the genesis and evolution of the social system for the protection of the elderly. The next one takes a closer look at the issues that have affected housing within this system.
It was then that I began to realise that this was not a problem of lack of desire or ineptitude. Seeing how little effort has been put into the protection of the elderly throughout our recent history (Ch. 4) - with the Dependency Law as one of the major milestones, despite its many shortcomings - and, especially, learning about the configuration of the Spanish residential system in which those who have already turned sixty-five matured, fuelled to a large extent by a policy that privileged some over others for purely ideological reasons (Ch. 5), made me realise that those who have already reached the age of sixty-five were not the only ones to be affected by the housing system. 5), made me understand that those who are in a situation of residential vulnerability are not so because of intrinsic age-related issues, nor because of their economic irresponsibility -although there will be all kinds-, but because they have not been able to compete on equal terms in the market due to the fact that they have been directly and discriminatorily affected by the administrative initiatives of the past. From here it became clear: if the state had been responsible for creating risky situations for some older people then, it must also be the one to sort out the mess now.
The third part of the book shows who the victims are. The distribution of the residential landscape in old age can be studied on the basis of isolable factors (sex, age, marital status, level of education, etc.) to find out what is the profile of the population in the worst situation and the problems that affect them. In Chapters 6 and 7, Irene sets out with her mixed research to find out. In general, there is a tendency to own a house because we think of it as "old age insurance", even if owning a house is by no means a guarantee of growing old in a good quality home. Men, especially married and widowed men, tend to respond to this situation with paid housing or a mortgage - in the latter case, as a result of the application of a break-up strategy with continuity in the home, which shows the possibility of adaptation even if renting is used instead of buying - while women are prone to other types of less secure tenure regimes (inheritance, transfer, renting, etc.). Those over 85 are more likely to live in rented or inherited houses. Those with lower levels of education are more likely to live in solidarity forms of tenure. There is more paid or mortgaged or rented property resulting from break-up strategies with continuity in the home in large urban centres, while solidarity prevails in small rural areas. Allochthonous people own, rural natives inherit, while urban people rent...
The reader has to dive deep into this jumble of data that Irene breaks down so lavishly. But, broadly speaking, the idea that women, the oldest, the unmarried, those who live in small towns, in old buildings, those who have never moved and those who have no education are the worst off. Among them are those who grow old at home in a situation of extreme risk, dealing with problems related to running water, the absence of a bath or shower and toilet, the poor state of the building, the lack of a lift and heating, overcrowding, accessibility... An appalling figure, which appears in all its crudeness only once (p. 151) to turn our stomachs, indicates that more than one and a half million people are ageing in place, which sounds so good, in appalling conditions. They are the ones who have not been able to meet their needs to get out of the hole during their lifetime.
Who is to blame for this? Well, sometimes it can be one's own fault. But, studying in detail those housing policies of the Franco regime that benefited traditional middle-class families - and above all the pater familias - and which Irene explains so well in Chapter 6, it may also be the fault of the mismanagement of the old age protection services which, as part of the welfare state, should have already provided the means to mitigate the consequences of the structural inequality to which many elderly people have been unjustly condemned by the whims of the dictatorship. Why is this not happening? At this juncture, Irene devotes Ch. 8 not only to concluding, but also to proposing solutions. Ideally, more public investment would be ideal, but if this is not possible due to lack of funds - which, she admits, is doubtful to say the least - it is also important to improve the administrative protocols and the counselling that the elderly receive.
After reading my friend's book, I had to put it aside for about a week. It awakened a conflict in me that I had not expected, and I had to discuss ideas from one section and another with those close to me in search of light to clarify my thoughts. I think this says a lot about the work Irene has composed. Her intention was always to shed light on the residential conditions in which ageing takes place in Spain, with specific attention to residential vulnerability in old age. The aim was, on the one hand, to reveal the vulnerability experienced in the process of ageing in housing, establishing which problems are important in our country and which factors predispose people to suffer them and, on the other hand, to find out the resilience strategies available and valued by the elderly in order to remain in society. But also, I would add, it has sought to highlight the shortcomings of the system of state provision for the protection of the elderly and their residential experience and has raised a harsh criticism of it.
In summary, the main conclusions of the book are 1) that housing is important in old age, but it is experienced in an unequal way, to which more or less adaptive responses are developed; 2) that growing old in housing is good for remaining in society, but, for this to happen successfully, it is necessary for it to cover the needs of the elderly, which is not always the case in Spain, giving rise to situations of vulnerability. 3) Those most sensitive to this respond to a specific profile (p. 142) determined by their biography, their circumstances and the way in which past social policy has affected them. 4) Thus, the state must take responsibility for those it has harmed, but it does not do so sufficiently.
And I ask myself, is it really in the state's interest for the elderly to age in their own homes, if doing so optimally in many cases requires its intervention? On reflection, it is in the best interest of the state to continue to promote this idea of ageing in place while encouraging the frustration tolerance that already exists for those who have been neglected all their lives. It will not have to invest in old people's homes, nor will it have to help those who want to grow old at home but do not have the means to do so. It is more economical for the administration to keep the elderly in their uninhabitable homes until the moment of death. And speaking of old people's homes: I find it hard to accept that institutionalisation makes it impossible to age in society. Here Irene and I are a little apart. She wants to move towards staying in the home for as long as possible, I want to move towards transforming residential homes into proper homes, so that moving to an institution is part of the strategy of breaking with continuity in the home. If this were possible today, I am convinced that she would agree with me. However, this is still a long way off. What Irene is proposing is not easy to achieve either, because the solutions she is proposing are only effective if they are implemented urgently, and the administration does not seem to be very keen. In the long term, all these problems will be reduced as the structural differences inherited from previous policies are dissipated by the inclusive policies of the present. At most, there will always remain the difficulty of distinguishing between those who are ageing in dysfunctional housing and those who are truly victims of those who were merely irresponsible, when it comes to providing assistance. Irene shows that there are objective criteria for doing so, what is lacking now is the will to do so.
La vivienda en la vejez has taught me a lot and has helped me to grow as a person and intellectually. The only thing I miss is that Irene did not mention boredom once, but that is because she did not know me yet. Other questions are on my mind; reflections that, fortunately, I will be able to discuss with the author one of these days. I am only a trainee in gerontology, but if my humble opinion is anything to go by, I think my dear friend's work should be required reading, at least for people who are close to the point where a strategy for the residential experience is to be adopted and for their families, as well as for anyone interested in improving the quality of life of older people in general and, of course, for those who have some responsibility for promoting it.
