Retrospective Real Estate Congress, Nieuwegein | 'Silver tsunami requires additional nursing capacity, housing forms and prevention'

A smart healthcare organization builds for the future, preferably with an eye on several decades. But what exactly does the combination of aging, longer home living and technological development do to the residential care demand of say, 2040? The challenges are diverse. 'Living longer at home is not yet healthy aging,' was one of the words heard at the last real estate conference of Zorgvisie in Nieuwegein.   

Interaction with conference participants, a mixed group of healthcare managers, consultants and even general practitioners, is a great thing, Zorgvisie believes. At Green Village Nieuwegein on Oct. 24, the audience was regularly polled, based on stimulating propositions. Three-quarters of respondents to such a real-time poll thought, for example, that the time-honored nursing home should be revived, but that is no longer going to happen, says speaker Cees van Boven, chairman of the board of the largest operator of senior housing in the Netherlands (Woonzorg Nederland). "There is a silver tsunami coming. That requires a three-pronged approach: more nursing capacity, new intermediate forms and preventive measures." Under Drees, living on favor became a right, allowing even the widower who could not yet fry an egg a place in a nursing home. That category has now disappeared altogether, "but the number of falls among seniors living at home is increasing, 265 a day in the emergency room."

Financial advisor Pim Diepstraten.

Standardization

Van Boven notes that among the congress participants there is not a single delegate from the traditional corporate world. Remarkable? Housing corporations are not waiting for healthcare real estate, he thinks. "Care real estate is a separate line of business with a higher investment burden." So what then, as a solution to the investment question? "Standardization. Foreign investors are interested but find the Dutch market too fragmented. We shouldn't want a 'custom suit' everywhere." At the same time, the days of Drees are over. Older people are growing older and more self-conscious. According to Van Boven, this calls for new intermediate forms, such as the Stadsveteraan in Amsterdam, a kind of student house for the elderly. Or the proprietary concept Zelfstandig Plus, with 24-hour care based on about €100 service charges. "We also see housing groups emerging based on lifestyle. Regionally, we are going around the table in the context of care for the neighborhood, because there is a need for a new conception of care and society. We assume a caring neighborhood, with multifunctional buildings, neighborhood entrepreneurs, exercise and meeting and development combinations between corporations and private parties. This requires 'coalitions of the willing'."

Who is the investor?

Investor volume in healthcare real estate has grown to just under a billion euros over the past year. "Still only a fraction of the 25 billion from corporations," says Pim Diepstraten, director of healthcare and senior advisor to Finance Ideas. Who is that investor? "The investor perspective assumes that healthcare real estate is a cyclically insensitive and therefore safe investment; CSR investing is on the rise. There are often social organizations behind investment funds. Not for nothing did the GP pension fund get into healthcare investing." The audience, however, has mostly negative reasons for engaging with an investor. "Strategic real estate is not a core business" and "the banks don't want to," are the most popular arguments in a subsequent poll. "Banks do want to, but the interest rate is too low," says Diepstraten. "The return is too low. And of course the institution has to be able to present good financial ratios." Problem in working practice: 20-, 25-year leases offer too little flexibility. "Standardization of real estate, often an investor's desire, is inhibited by institutions sticking to their own PoAs."

Chairperson for the day Elisabeth van den Hoogen.

Healthcare Architecture

We are becoming "grayer, greener and smarter," says Chair of Architecture in Health Masi Mohammadi (Arnhem and Nijmegen University of Applied Sciences), who believes in "compassionate and empathetic healthcare real estate. "A living environment tailored to the technological elder. Around, not around him. Designers are society's doctors." Digital society is creating paradigm shifts. Technology is already in our heads and eventually in our bodies, with smart pacemakers that regulate circulation and Augmented Reality glasses for the visually impaired. "Technology has a big impact on real estate development, especially when all the software 'eats' the hardware. Technology is like oxygen, is a Philips slogan. If we misuse technology, it's because of us, not the technology. But it's not about technology or bricks or money: it's about living," Mohammadi said. But an empathetic living environment? "Maybe we will soon be living in a robot. Really, we will," says the optimistic scientist. "Living will become less static, there will be more diversity. Just building tiny houses is not enough." A similar perspective could be noted at the end of the day from the mouth of Menno Hinkema, who researches within TNO on life-cycle living.

Roundtable sessions

Many of the same voices were heard in roundtable sessions: there is a dichotomy between home and nursing care, and it is growing. "But if you live at home, you're not always better off. Living at home longer is not yet healthy aging," said the family physician at the table. "On the other hand, loneliness cannot be solved by admission to a nursing home either," says a care manager. "In fact, care real estate does not exist, when it comes to living. 93 percent of the elderly live and die at home." The care manager is joined by the consultant, a supervisor of development processes. "Through own initiatives, the supply is fragmenting, which means that in time, real care real estate will no longer exist." Another table brought solutions. "Across sectors, a social Delta Plan needs to be created for senior living, from which politicians are staying away." But who will take the lead? "Care providers have the intrinsic motivation to take that role. The client can't do it, neither can building owners." Finally, Bob Janse of housing corporation for seniors Laurens Wonen talked about "Together & Different. Residents of a Rotterdam care center redeveloped into an apartment complex pay a low rent with a commitment to put in at least 10 hours a month for each other, the building or the nursing home residents. With a local, integrated approach based on new intermediate forms, we are back to Cees van Boven's story.