Jodi Sturge, Susanna Nordin, Elke Miedema, and Ivo Dewit
The healthcare system for older adults is shifting from institutional settings to home environments in many countries. Ageing in place policies emphasise individual choice, but the reality is far more complex—unfolding across a multi-environment care system that includes the built, social, and technological dimensions of care. While home-based care models, such as hospital-at-home and remote care, offer new possibilities for health and well-being, they also introduce relational and systemic challenges that impact healthcare delivery, patient experience, and caregiver support. Some older adults may prefer institutional care for greater social interaction and structured support, yet the service ecosystem can lack the flexibility to accommodate such needs. Furthermore, ageing in place depends on a network of interdependent actors and touchpoints, from informal caregivers to healthcare providers and digital services, all of which shape the experience of care.
This paper explores systemic and service design as an approach to map and improve the relational dynamics within the housing system of older adults ageing in place. We present ageing in place as an evolving service ecosystem, not just a policy framework. We take a multi-disciplinary perspective, integrating insights from architecture, health geography, nursing, and service design to reflect on the challenges and opportunities in designing socially sustainable environments to support the well-being of older adults. Based on two research projects, we present an understanding of the housing system that shapes the relationships and experiences of older adults. First, systemic design tools—the actor map and the three horizon map—are used to visualise the housing system, and explore new service interactions across different environments. Secondly, we present housing decision prototypes developed by people with dementia and stakeholders to promote conversations related to moving along the housing system based on their care preferences. Looking to the future, ageing in place presents complex, relational challenges that will intensify with the integration of emerging health technologies such as artificial intelligence and virtual reality. While these innovations promise new efficiencies, they also risk eroding human interactions in care delivery. Therefore, we propose a caring system proposition tool to reflect Joan Tronto’s phases of care to guide ageing in place systems and services. This tool brings attention to both tangible (physical environments, medical equipment, digital infrastructures) and intangible (care relationships, trust, autonomy, and decision-making) elements of healthcare for the future. Systemic and service design provide critical frameworks for navigating the evolving dynamics of housing and healthcare services for older adults by ensuring that technological interventions enhance rather than replace meaningful care relationships. By mapping systemic interdependencies, designing resilient service pathways, and “careful” design research and prototyping with older adults, designers can help shape the future of ageing in place as a relational, adaptive, and human-centred care system.
Keywords: ageing in place; careful systems; housing; older adults; social sustainability; systemic design