The age of intergenerational care.

During a reconstruction in 1987, an established aged care facility in Edogawa, east of Tokyo, decided to become a yoro shisetsu, combining aged and childcare on its premises. Widely recognised as the first co-located intergenerational care model, Kotoen has been witnessing the positive effects on the lives of residents, children, staff and their families for almost 40 years. The sweet interactions between 'surrogate' grandparents and grandchildren – exercising, dancing, game-playing, reading – have captured the hearts of many. Anecdotes reveal older people experiencing more connection, meaning, value and purpose; while younger ones learn patience, acceptance and respect.

This isn't just a heartwarming story though. A considerable network of organisations and 'pracademics'¹ are experimenting and documenting the outcomes of best-practice co-located intergenerational care facilities around the world. The shared belief? Intergenerational care is not just 'nice' – it's essential. And together, they're gathering evidence to prove just how critical it is.

Weaving relational webs

Unlike Kotoen, Apples and Honey Nightingale in London, initially made its intergenerational connection from a distance. It started as an intermittent program in the early 1990s, between an early childcare centre, Apples and Honey, run by Judith Ish-Horowicz, and Nightingale House, a nearby aged care facility. "I decided that if we were going to provide children with a holistic education, you should really be mixing with all age groups," says Judith. "Otherwise, you're not really giving them a full life experience". Annual Hanukkah concerts grew into more regular visits, and the impacts were immediately positive. "You had relationships not just between children and their 'grandfriends', but also with the parents. We started to get these kinds of almost extended families. A lot of our children were from international families, or families who had relocated for work and didn't have grandparents nearby. So they would go and visit, even outside the school trips."

Witnessing these deepening relationships, Judith thought, why not formalise the connection between the organisations? She first approached Nightingale's CEO with the idea of co-locating in 2009, though it took until 2017 to develop a social enterprise structure, source seed funding and open the site.

Normalising the state of age

The impact of intergenerational care on young people is remarkable. Bayview in Seattle started offering co-located childcare in 1995 during an expansion, like Kotoen. Bayview's CEO Nancy Weinbeck believes,

"Too many families today raise children without proximity to grandparents or great grandparents, and so 'old people' become something foreign and even scary. An intergenerational program makes it comfortable and natural for young children to be around elders, their walkers, wheelchairs and hearing aids."

Marcie Jones, CEO and Co-Founder of Gentog (Generations Together) in Tigard, Oregon, agrees. "Children raised in our program learn to see disabilities differently," she shares. "One of my grandsons attended church with me one Sunday, where there was a young boy in an electric wheelchair who appeared to have cerebral palsy. When my grandson said 'Look, Mimi!' and pointed at the child, I held my breath for what was to come next. But he just said, 'He has a shirt and boots just like me!'. He only saw what they had in common, not what made the other child different. Walkers and wheelchairs were a regular part of his life, so he didn't notice that at all."

A space mission

One of several intergenerational care projects in Australia is The Herd, in Mornington, Victoria, a purpose-designed 'shared roof' model linking childcare with residential aged care. Finding a site was a major challenge, recalls Director and Co-Founder Anna Glumac, who opened the centre with her sister in memory of their grandmother. "With long waitlists in many residential aged care centres, it was hard to carve out the required space for childcare – and some that had the space didn't have the demographics and demand for it. It took us two years to find a suitable site."

Purpose-built intergenerational centres also need to be designed carefully. In 2013 LEVS architecten completed De Bouwmeester in Utrecht in The Netherlands, a "project that unites generations and fosters interaction between young and old," describes one of the practice's partners, Adriaan Mout. A shared central garden with winding paths and blooming flowerbeds is the primary space for generations to interact. Terraces, glazing and galleries also connect young and old visually; and at the same time, dedicated zones provide a safe, protected environment for care-dependent residents.

The scope of data

When it comes to research, there are "several arms of the octopus," as Director of the Australian Institute for Intergenerational Practice (AIIP), Anneke Fitzgerald, describes. Along with obvious outcomes like reducing social isolation and preventing ageism, intergenerational research is being planned and conducted on improved behavioural aspects of children on the spectrum, reduction of childhood delinquency, breaking cycles of poverty and domestic violence, the economic impacts of being able to "age in place" longer, reduction of frailty, optimised environmental designs, and the possibility of prescribing socialising in intergenerational programs as alternatives to antidepressants.

"[Intergenerational] practice is not new, but the theory is developmental," Anneke says. "And without analysis and reporting, the practice is not widely known about or spread." This is exactly why the AIIP was set up (in 2021), along with several collaborating bodies across Europe, the UK, US and Asia.

Intergenerational care centres are an ode to the possibilities of thinking creatively, combining resources and dissolving boundaries. Solving several problems – loneliness, ageism, care, health, housing and learning – at once, it appears to be a win-win scenario.

Challenges

Another organisation participating in this activity is United for All Ages (UfAA), a 'think-do' tank founded in 2010 to create a 'Britain for all ages'. Co-Founder and Director Stephen Burke says co-located intergenerational care organisations face economic, physical, planning and cultural challenges.

"Firstly, developing nurseries on care home sites or building new sites can be expensive and require significant economic investment," he says, and often require grants and philanthropic contributions. In addition, "There aren't many care home sites that are suitable with space in existing buildings, or [able] to build new provision". Thirdly, "Care providers find it hard to get planning permission for new co-located developments," he adds.

Anna experienced some of these challenges when opening The Herd. "Trying to 'sell' the concept when intergenerational care was in its infancy [was challenging]," she shares. "For some, it would have seemed so abstract and difficult to imagine." Similarly, Marcie says the biggest barriers for Gentog were "Finding a landlord willing to take a chance on an unknown business type; getting building permits, as inspectors did not know exactly how our business fit within the rules; and liability insurance."

"They just didn't understand [the intergenerational concept]," Judith agrees. "They were saying, 'Okay, you can get the insurance so long as they don't touch each other. And you're not allowed to leave the children in the care of the older people, or leave the children in charge of the older people.' I mean, come on. There just was a total lack of understanding."

Then, just as the co-located intergenerational model was taking off, Covid struck. "It took a toll on leadership and staffing, and also with enrollment shortages," recalls Nancy. "As well, keeping residents and children safe from the transmission of infections across populations added to the challenges." Research² shows that overwhelmingly, transmission concerns can be adequately managed through safety protocols, and that benefits far outweigh the risks. This is the on-the-ground approach at Apples and Honey Nightingale, says Judith. "If there is an outbreak in the care home, then we stop our intergenerational programs until that outbreak has stopped and vice versa. It's all manageable and should not prevent [intergenerational programs or facilities]."

Shifting culture: a long game

Intergenerational care centres are an ode to the possibilities of thinking creatively, combining resources and dissolving boundaries. Solving several problems – loneliness, ageism, care, health, housing and learning – at once, it appears to be a win-win scenario.

So much so, that it's puzzling that it hasn't caught on sooner.

Kotoen aside, legislative and economic hurdles could have been enough to stymie the rise of intergenerational care models elsewhere in the world. However, it's possible that cultural attitudes also play a part. Many of us live in societies where 'care' (and ageing in general) is considered embarrassing, shameful and effectively banished to the margins (spatial and mental). While childhood is seen as hopeful, joyful and full of potential – old age is often seen as bleak, depressing and full of fear.

"There is still not complete acceptance of the idea of children and older people sharing the same site, facilities and services, or understanding of the potential business savings from running childcare and eldercare on the same site," says Stephen. There can also be internal cultural challenges. "Not everyone moves to a retirement community to be around children," points out Nancy, "Nor does everyone see the value that an intergenerational experience can bring."

The apparent contradiction between young and old, growth and decline, strength and frailty, may be a mental block to intergenerational care. As it turns out though, we are well-equipped to dance with paradox. Elderly and infirm people can find joy, and in doing so, reduce their loneliness and increase quality of life. Young children can witness and interact with those ageing, and their associated deterioration, without being fearful. In fact, they will normalise it, cultivating more open and resilient characters. And the ripple effects of these outcomes is a more cohesive and connected world for us all.

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¹ Someone whose career spans the boundaries of academia and practice. In the case of intergenerational care, the term may include childcare, aged care, social work, health and education professionals.

² Brokered by AIIP with many collaborating universities around Australia