Intergenerational Housing: The Case of Humanitas Netherlands

Abstract

We analyze a case study of an innovative intergenerational housing arrangement in the Netherlands as an example of how a local long-term elderly care practice evolved in response to contemporary challenges. Identified elements of the established local practice relate to the characteristics and strategies of an institutional entrepreneur and elements of the new practice that comes into being, in which reciprocity and mutual learning have a central place. These elements might benefit future elderly housing initiatives as well.

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Journal of Housing For the Elderly
ISSN: 0276-3893 (Print) 1540-353X (Online) Journal homepage: https://www.tandfonline.com/loi/wjhe20
Intergenerational Housing: The Case of Humanitas
Netherlands
Marlous Elisabeth Arentshorst, Roy Reinier Kloet & Alexander Peine
To cite this article: Marlous Elisabeth Arentshorst, Roy Reinier Kloet & Alexander Peine (2019):
Intergenerational Housing: The Case of Humanitas Netherlands, Journal of Housing For the
Elderly, DOI: 10.1080/02763893.2018.1561592
To link to this article: https://doi.org/10.1080/02763893.2018.1561592
© 2019 The Author(s). Published with
license by Taylor & Francis Group, LLC.
Published online: 26 Jan 2019.
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Intergenerational Housing: The Case of Humanitas
Netherlands
Marlous Elisabeth Arentshorst
a
, Roy Reinier Kloet
b
, and Alexander Peine
c
a
Department of Innovation Studies, Copernicus Institute of Sustainable Development, Utrecht
University, Utrecht, The Netherlands;
b
Geofoxx Milieu Expertise, Gouda, The Netherlands;
c
Department of Innovation Studies, Copernicus Institute of Sustainable Development, Utrecht
University, Utrecht, The Netherlands
ABSTRACT
We analyze a case study of an innovative intergenerational
housing arrangement in the Netherlands as an example of
how a local long-term elderly care practice evolved in
response to contemporary challenges. Identified elements of
the established local practice relate to the characteristics and
strategies of an institutional entrepreneur and elements of the
new practice that comes into being, in which reciprocity and
mutual learning have a central place. These elements might
benefit future elderly housing initiatives as well.
KEYWORDS
Intergenerational living;
social innovation; system
perspective; institutional
entrepreneur
Introduction
Due to changing circumstances in, among other things, demography and
demands and perspectives on “good”health care, changes in health systems
are inevitable for health care services to remain acceptable, accessible, afford-
able, of high quality, and trustworthy (e.g., Broerse & Bunders, 2010), includ-
ing those in the field of elderly housing and care. Although this need for
change is broadly recognized and accepted, the majority of initiatives, while
different in dynamics, structures, and contexts, have not been successful in
realizing their desired gains (Simmons, Fajans, & Ghiron, 2007; Stambolovic,
2003). In this article, we present a case study of an innovative intergenera-
tional housing arrangement in the Netherlands, called Humanitas, as an
example of how a local long-term elderly care practice evolved in response to
contemporary challenges. Via observations, interviews, and inspection of arti-
facts, we analyze and reflect on this local practice. We especially zoom in on
its transition of a predictable and controlled environment toward an intergen-
erational living environment that is lively and joyful with an unconventional
ß2019 The Author(s). Published with license by Taylor & Francis Group, LLC.
This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivatives
License (http://creativecommons.org/licenses/by-nc-nd/4.0/), which permits non-commercial re-use, distribution, and reproduction
in any medium, provided the original work is properly cited, and is not altered, transformed, or built upon in any way.
CONTACT Marlous E. Arentshorst m.e.arentshorst@uu.nl Department of Innovation Studies, Copernicus
Institute of Sustainable Development, Utrecht University, Heidelberglaan 2, 3584 CS, Utrecht, the Netherlands.
Affiliation at the time the research was executed and the article was written.
JOURNAL OF HOUSING FOR THE ELDERLY
https://doi.org/10.1080/02763893.2018.1561592

approach that received both national and international attention (e.g., AFP,
2014; Turner, 2016). We identify elements that make this practice work and
aim to give more insight in the role of both actors and their (systemic) envir-
onment in realizing the transition made. That way, we strive to inform further
research, and the design, implementation, and management of approaches to
health care reform, and elderly housing initiatives in particular.
Background
A growing body of literature is dealing with the analysis of transitions of socio-
technical systems and the system innovations these require (e.g., Geels & Schot,
2007;Raven,2007). This literature provides relevant insights, understandings,
and strategies for more effectively realizing health system reforms (Broerse &
Bunders, 2010). At the same time, the importance of agency, that is, the critical
role of actors in transforming a system, is also increasingly recognized in litera-
ture that focuses on actors that maintain, create, and disrupt institutions (de
Savigny & Taghreed, 2009;Zietsma&Lawrence,2010). Here the notion of
institutional entrepreneurship has a central place, which refers to those actors
or agents who initiate changes that contribute to transforming existing or to
creating new institutions (e.g., Battilana, Leca, & Boxenbaum, 2009). In this art-
icle, we bring to bear approaches from this literature, most of which emerged in
domains not related to health or elderly care, on our understanding of health
system reforms. More specifically, we found the institutional entrepreneurship
literature useful because it zooms in on actors, that is, institutional entrepre-
neurs, and their agency as being embedded in an institutional environment
(Battilana, Leca, & Boxenbaum [2009] refer to this as the “paradox of
embedded agency”). Indeed, we found much of what seems relevant to change
in the Humanitas case to resonate with the description of institutional entrepre-
neurship, that is, an institutional entrepreneur who has carefully maneuvered
her environment to produce change that would break away from the existing
institutional order (we return to this point in more detail in the following).
1
We present the case as a historical case study that, hopefully, provides
inspiration for pondering elements that may or may not explain the ena-
bling factors for health system reforms at larger scale. That is, we use a sin-
gle-case study to enable informed suppositions about the elements
explaining its (apparent) success that can be exposed to more systematic
research in the future.
1
Battilana et al. (2009) define institutional entrepreneurs as actors that initiate and subsequently participate in
the implementation of divergent change (pp. 68–69). Institutional entrepreneurs do not necessarily have to be
aware that they are engaged in institutional change, and they do not have to be entrepreneurs in the
traditional sense (i.e., interested in launching a new venture).
2 M. E. ARENTSHORST ET AL.

Methodology
To gain in-depth insight into the elements that have been relevant for the
transition of Humanitas toward an intergenerational living environment,
we made several on-site visits and conducted interviews with the director,
with two members of the works council, with three of the managers, with
one employee whose assignment is the “normal life”within Humanitas,
and with one of the resident students (n¼8). In addition, one of the
authors (RK) visited Humanitas six times in the past 2 years. Each visit
took 2 to 6 hours, and consisted of observations and walking interviews
with staff—including the director—and people living and volunteering in
Humanitas. Notes were taken of all interviews, meetings, and observations,
and preliminary analysis of identified elements and strategies contributing
to the new practice of Humanitas was discussed with the director, manag-
ers, and/or the employee of “normal life”and adjusted subsequently. In
addition, news articles, policy documents referring to Humanitas, and
external communications were analyzed to identify elements relevant for
the transition toward an intergenerational living environment.
To have a specific analytical focus on the critical role of actors in transi-
tions, we used the theoretical framework of Battilana et al. (2009), in par-
ticular the two categories of interrelated enabling conditions for the
emergence of institutional entrepreneurship: field and actor characteristics.
According to Battilana and colleagues, relevant field characteristics are jolts
and crises; acute field-level problems that might precipitate crises; problems
related to scarcity of resources; and the degree of heterogeneity and institu-
tionalization. Social position and individual actor characteristics such as
demographic and psychological factors are considered relevant actor char-
acteristics. Analyzing the presence of these enabling conditions in the
Humanitas case provided understanding of the transition Humanitas made
so the relevant elements contributing to the realization of the new local
practice could be identified. In addition, we also analyzed activities under-
taken in support of the implementation of the changes. Building on man-
agement literature of change, Battilana and colleagues summarize three sets
of activities relevant in implementing change that we applied in analyzing
the Humanitas case. These activities relate to (a) developing a vision, (b)
mobilizing people behind that vision, and (c) motivating others to achieve
and sustain the vision.
Results
The remainder of this article is structured as follows: We start with describ-
ing the relevant field and actor characteristics in the Humanitas case. Then
we elaborate on the actual (tactical and operational) process of
JOURNAL OF HOUSING FOR THE ELDERLY 3

implementing changes and on the new practice that emerged, including its
new institutional logics. Finally, we describe the relevant elements we iden-
tified from this case in realizing an innovative intergenerational living
environment.
Field characteristics
The trends of an aging population, increasing numbers of chronically ill
elderly people, a required increase of labor force to fulfill all future care
tasks, and less financial means for health and care services influenced the
stability of, among other things, the regime of long-term care. When the
Dutch government decided in 2012 to stop funding care costs for citizens
over the age of 80 without an urgent care need (Bijvank, 2016), the elderly
care sector faced a situation in which fewer people applied for a place in
retirement homes, resulting in less financial means and empty rooms. In
other words, trends at the macro level caused crises and problems related
to scarcity of resources at the meso level. The government’s’decision to
stop funding led to acute field-level problems of how to stay in business.
Combined, these trends resulted in an environment in which changes in
long-term health care delivery for elderly people were needed in order for
such care delivery to survive.
In addition, two other relevant dynamics were present at the level of
regimes that fueled the transition of the Humanitas home for the elderly.
First, managerial developments in the professional care environment over
the past decades led to a situation such that people living in elderly care
facilities were taken care of in a more or less “mechanistic”approach (e.g.,
Bone, 2002; Pfaff et al., 2010). Frequently, people became “objectified”and
(merely) received minimal, efficient, and cost-effective assistance in daily
life. Most of them had limited interaction with the world outside the care
facility. As a result, many people living in long-term care facilities were
lonely, isolated, focused on their limitations, and unhappy, which is associ-
ated with increased mortality (Steptoe, Shankar, Demakakos, & Wardle,
2013). At the same time, student housing in the Netherlands was and still
is expensive, cramped, and limited, and many students had troubles finding
a room.
Actor characteristics
Humanitas faced these trends and challenges when its new director started
in 2012. The director saw these field-level conditions as opportunities to
change the current way of health care delivery. In other words, the limita-
tions and negative side effects of current dynamics of the sociotechnical
4 M. E. ARENTSHORST ET AL.

system around Humanitas, combined with trends at the macro level,
resulted in an environment in which the director felt a need to and could
start acting. Driven by the belief that elderly care homes could be organized
in a different, more personal, and “better”way, it was her passion and firm
conviction to realize this change. She acted from a holistic perspective,
being convinced that the current mechanistic approach in health care in
which care was provided to people in order for them to stay alive could be
changed toward an approach in which assistance and care were provided
for people with a focus on individuals: their needs, desires, demands, and,
specifically, their abilities and happiness. She was also aware of the student
housing problem and envisioned a profitable situation for both groups. As
she aimed for a warm and comfortable home (not a house), having young
people living inside Humanitas could make this happen, according to her.
At the same time, students would have to borrow less money because they
could rent a room for free at Humanitas in exchange for being a
“good neighbor.”
Process of implementing divergent changes
The process of implementing the envisioned changes resulted in several
challenges. First, the director needed to convince the board that her vision
was going to result in a “better”Humanitas, both socially and financially.
After several meetings, the board agreed to a pilot project in which one
student would live in Humanitas for 1 month. The director shared her
vision with an interested student and explained that, besides being a “good
neighbor,”no other rules applied. Apart from organizing one evening meal
a week, he was mainly expected to spend time with the residents. Nobody
was keeping track of time: The relationship with the student was based
on trust.
Second, having a student living in an elderly home was new for every-
one, both staff and residents, and resulted in unpredictable and new situa-
tions: for example, the smell of alcohol in the elevator late at night when
the student came back home, or the alarm that went off when one of the
girls he brought back to his apartment was searching for a toilet. Initially,
these new situations resulted in complaints, primarily from worried staff
members. However, the director stuck to her vision and decided that as
long as the residents did not experience strong negative consequences of
these actions, the student could stay. Again, her vision was not to manage
a sterile, controlled house without risks and romances, but to enable a
home environment where real people live real lives. And, as one of the staff
members explained, “a certain degree of friction is what makes life lively.”
JOURNAL OF HOUSING FOR THE ELDERLY 5

Third, starting the new intergenerational way of living resulted in the
articulation of many opinions and questions from others, including board
and family members. The main questions related to the balance between
happiness and safety. Board and family members argued from a risk avoid-
ance perspective that, for example, racing on mobility scooters as competi-
tion between students and residents was not safe. After all, residents could
fall and break something, or worse. In response to these questions, the dir-
ector articulated from her vision that residents are experienced adults, able
to make their own decisions. If they decided to take a risk, it would be
their own decision. Why should she, or other staff members, protect people
from joy?
New practice: lively, joyful, inclusive living environment
Currently, the intergenerational living environment of Humanitas consists
of six students and 160 elderly residents. It is a place where people love to
come and live. Although, for example, the living of a student in Humanitas
first seemed to result in new situations with undesirable consequences,
such as alarms that went off late at night, a situation arose in which
Humanitas’s residents love to keep track of which student is bringing
someone back to the home. Instead of having no new conversation subjects
except different medications and doctors’appointments, the love lives of
the students are the subject of the day and reconnect the residents with
their own romantic selves and remembering their own youth, including
pick-up lines. The students share their experiences when coming home
from class, a concert, or a party and form a connection to the outside
world for the elderly residents. They also help residents with their com-
puters, tablets, and telephones, which, for example, resulted in online con-
nections between residents and students via Facebook and Instagram, and
other digital connections of residents with family and friends. Together the
residents and students play games, both traditional Dutch games and col-
lege drinking games, go to the shopping mall, go to restaurants, and so on.
But also nonresidents are welcome at Humanitas. A group of children with
autism, for example, has built a train set in the basement, which is regu-
larly visited by them, a local photographer uses the digital screens in the
home to exhibit recent work, there is billiards club, and the garden is open
for everyone. In other words, Humanitas is part of, and perhaps a central
place in, the community.
The appreciation of all efforts made and changes realized by staff mem-
bers, residents, students, volunteers, or others is central to the vision that
drives Humanitas’s living environment. All ideas proposed are answered
with “yes.”This “yes-culture”(Van Marrewijk & Becker, 2004) is a central
6 M. E. ARENTSHORST ET AL.

element in all Humanitas organizations and stimulates all those involved to
articulate their ideas and solutions and to undertake a variety of activities,
and ensures that all ideas are considered. Furthermore, there is, for
example, a program developed for Humanitas staff in which employees can
choose how they further want to develop themselves. This program is based
on the intake procedure that is also used for future residents and has three
central questions: Who were you, who are you now, and who do you want
to be? Also, gift vouchers are frequently provided to show appreciation for
the efforts made. In addition, knowledge or expertise that is not (yet) pre-
sent within the organization but considered of added value to realize a pro-
posed idea, for example, is acknowledged and acquired via external
resources, in terms of training of current staff or employing people.
Currently, there are no intentions to increase the number of student
inhabitants, but the director took her dream one step further. She strives to
turn her intergenerational home into an (even more) inclusive home.
Therefore she recently introduced the “Adelbold project.”In the direct
environment of the Humanitas home, a neighborhood called Adelbold, sev-
eral people live who are in need of some sort of social or practical support
and/or assistance in daily life, that is, people with a disability, a chronic ill-
ness, and/or other limitations. Many of them are unemployed and have an
above-average care demand, resulting in high costs for both local author-
ities and insurance companies. Actively outreaching, Humanitas welcomes
each of them to their facility, providing attention and free structural, tem-
porary, and emergency support. Furthermore, Humanitas emphasizes the
value, options, and possibilities of these people, instead of their limitations,
disabilities, chronic conditions, and related cure and care needs. As a result,
Humanitas is able to provide an environment for these people in which
they live as independently as possible and are stimulated to contribute in
line with their possibilities. The result is an even more inclusive place,
where neighbors love to come and spend time with each other and with
the Humanitas residents, and where several assist freely with gardening and
technical support for instance. Humanitas’s residents and people participat-
ing in the Adelbold project indicate that their quality of life is improved
and care costs consequently most likely drop. In sum, Humanitas is profit-
able and inspires and connects elderly residents, students, people in need
of support, and many others, including staff, family, local community
members, municipalities, educational facilities, and foreign programs.
Analysis: new practice with new institutional logics
In realizing an inclusive living environment, Humanitas’s institutional log-
ics changed (e.g., Rao, Monin, & Durand, 2003), that is, the underlying
JOURNAL OF HOUSING FOR THE ELDERLY 7

values and beliefs that shape the cognition and actions in practice. In
Table 1 we summarize this change. Humanitas’s health care delivery
changed from care provided to people to care provided for people. With
this, the purpose of the health care service is no longer to assist people to
avoid risks, survive, and stay alive, but to enable people to live a life that
matches their needs, desires, and happiness, based on their abilities. The
tasks and responsibilities of staff members are no longer primarily based
on standardized procedures and efficient and tight schedules. Realizing
health care delivery in Humanitas has become a shared effort and responsi-
bility of both staff members and residents. Besides the professional qualities
Table 1. Humanitas’s institutional logics before and after the transition toward an inclusive liv-
ing environment.
Dimension/
element/principles Before transition After transition
Guiding principles health
care service
Elderly care’s raison d’^
etre is to take
care of an increasing group that is
becoming older and, because of this,
increasingly fragile and vulnerable
and who should be protected from
further decline; care is provided
to people.
Elderly care’s raison d’^
etre is to cele-
brate life, and to enable individuals
to express and collaboratively make
use of their unique qualities—reci-
procity is key; care is provided
for people.
Focus on safety and risk avoidance Focus on autonomy and happiness
Purpose health
care service
Generic assistance to deal with age-
related decline in functionality and
limitations, and coping with decline
Tailored assistance to enable an individ-
ual’s options, qualities, interests, and
possibilities, and combinations with
other residents, staff, and visitors
Living and working
environment
Predictable and controlled environment
in which people receive assistance in
daily life
Surprising, anticipating, and enabling
environment in which people “really
live,”i.e., do the things they can do
and that they enjoy doing and
receive tailored assistance accordingly
House with facilities and services—resi-
dents are treated as permanent
guests or clients
Home—staff and visitors see themselves
as guests
Conversational topics mainly revolve
around family visits, loss of friends,
loss of functionalities, and doctors’
appointments
Conversational topics include the light-
ness that youth can bring, about
their study, their holidays, and their
romances, and bring back memories
of residents’own youth
and romances
Quality is measured Quality is experienced
Detached from outside world Central place in the community
Role of staff members Each staff member has his or her own
tasks and responsibilities based on
his or her job profile, i.e., standar-
dized procedures, efficient, tight
schedules to realize health
care service.
Shared efforts and responsibility of staff
members and residents to realize
health care service. This demands
interpersonal qualities of individual
staff members, besides professional
qualities. Mutual learning has a cen-
tral place.
Focus on what a (future) resident can
and can no longer do
Focus on who a (future) resident was,
who she or he is and wants to be
Workflow organized around
target/client/patient groups
One cannot love a patient group, but
one can love a person. This is the
starting point for group processes
and organizing the workflow.
8 M. E. ARENTSHORST ET AL.

of staff members, their interpersonal qualities and mutual learning have a
central place in realizing such bespoke care. In other words, the elderly
home made a transition from a predictable and controlled environment in
which elderly people were objectified and received minimal, cost-effective,
and efficient assistance in daily life to a surprising and anticipating inter-
generational, enabling environment in which elderly people live; they do
the things they can and enjoy doing and receive assistance accordingly.
Furthermore, these experienced adults themselves contribute to their envir-
onment, and assist and inspire staff, students, and neighbors with their sto-
ries and experiences, and by slowing them down. In sum, reciprocity is key
in Humanitas. It is no longer a house with facilities and services in which
elderly people are permanent guests and conversations focus on losses and
doctors’appointments, but a home in which elderly people and students
are the residents and staff and visitors are guests and conversations focus
on the everyday things of life of the residents. Moreover, it is not only an
environment in which elderly people live, but a central place in the com-
munity where elderly people, students, and others in need of support live
together and the broader community enjoys spending time as well. As a
result, the quality of life and health care has a different dimension: It is
experienced and not “just”measured.
Elements contributing to the realization of Humanitas’s intergenerational
living environment
Based on the analysis just described, a number of elements can be identi-
fied that were important in realizing Humanitas’s transition. Although the
elements described in the following are interrelated and can therefore not
be viewed separately, for analytical purposes it is useful to elaborate upon
them separately.
First, field characteristics were present that resulted in a window of
opportunity to initialize and implement changes. Here the relevant element
is the development of an innovation that addresses the experienced prob-
lems at all levels of relevant field conditions, that is, at both macro level
and meso level. In the Humanitas case this implied that the intergenera-
tional living concept addressed both the undesirable “mechanistic”
approach in which elderly people are “objectified”and receive minimal,
efficient, and cost-effective assistance in daily life, and the problem of less
financial means and available staff to provide care for elderly people seek-
ing for long-term care facilities in an aging society.
Second is the enabling role of actors. In this case, the director of
Humanitas can be identified as an institutional entrepreneur. First, she had
a personal belief and conviction that (health) care could be organized and
JOURNAL OF HOUSING FOR THE ELDERLY 9

provided in a different way—away from monocultural total institutions,
toward mixed and personalized homes. That is, she was interested in diver-
gent change, knowingly or unknowingly, that would break with the existing
institutional logic. In addition, she was willing and able to realize and ini-
tialize the changes needed. With “willing”we refer to an intrinsic motiv-
ation to realize a “better”practice. “Able”refers to the social position an
actor has (see also Battilana, 2006), including the access to relevant
resources. In other words, the director of Humanitas had the personal
characteristics and social position to start acting on the opportunities that
the field-level conditions posed. Subsequently, she developed a vision that
motivated and mobilized people and resources to make her vision a reality.
The Humanitas case shows that a vision that guides actions in practice is
crucial. Our analysis shows that the new director of Humanitas was able to
mobilize and motivate people based on a (guiding) vision. Although she
initially developed the vision herself, she disseminated the vision so that it
became a shared one that motivates and guides the people working and liv-
ing in Humanitas to realize, sustain, and optimize the established living
environment. In other words, the vision makes the underlying reasons for
change clear and provides a road map how to act accordingly. Another
identified element is persistence: the ability to keep acting in line with the
guiding vision, including the continuous stimulation of others to sustain
the vision and acquiring knowledge and expertise that are not present but
of added value in implementing changes. As the Humanitas case shows,
innovations create new problems as well. Anticipating new, often unfore-
seen, situations requires the ability to let go, including acceptance of the
risk of failure. By letting the new situation take its course, new cultures,
structures, and practice have time and space to develop. This includes the
acceptance that things might fail. The director of Humanitas showed she
was able to take distance and embraced what came into being. A final iden-
tified factor is value and appreciation, visible in the appreciation of all peo-
ple living in and contributing to Humanitas.
Discussion and conclusions
By analyzing the case of the Humanitas home for the elderly that resulted
in a local new practice of inclusive long-term elderly care, we were able to
identify factors relevant in the evolution of this practice. In line with previ-
ous research in the field of innovation studies (e.g., Geels, 2002), we show
that an enabling environment for initializing divergent changes comes into
being when trends at field level implicate a need for change of established
institutional logics and when the perceived undesirable consequences of
these established logics have manifested itself locally. In this case, an actor
10 M. E. ARENTSHORST ET AL.

had the personal belief and conviction that the envisioned innovation
would address the problems at both levels, thereby resulting in improve-
ments of the current situation, and was willing and able to implement this
innovation. This research shows the importance of the formulation of a
vision by the actor who initializes and drives the transition, that is, the
institutional entrepreneur. This vision functions as an explanation of the
relevance of the intended changes and motivates and mobilizes others to
realize the intended transition, including the provision of a common lan-
guage that guides actions in practice and interactions between different
actors (e.g., Grunwald, 2004; Mambrey & Tepper, 2000). Furthermore, we
show that an institutional entrepreneur should be persistent, able to not
give in, and able to keep acting in line with the vision, including the con-
tinuous stimulation of others to act according to the vision, while at the
same time having the ability to let go and embrace what comes into being,
including the acceptance of potential failure. This specifically applies during
the first phases of implementing changes. Unexpected and unforeseen con-
sequences and situations should be embraced instead of diminished or
taken care of in order to let a new practice come into being. To realize
this, the focus should be to realize reciprocity, responsibility and efforts
made should be shared, and actors should continuously be involved in a
mutual learning process and adjust their actions and structures accordingly.
We hypothesize that the identified factors relevant to Humanitas’s transi-
tion are also applicable, at least to some extent, to other initiatives aiming
to establish changes in health care services and practice. Further research is
needed to explore whether the informed suppositions about enabling fac-
tors for health system reform resulting from this research are relevant to
realizing health system reform at a larger scale.
Disclosure statement
The authors report no conflict of interest.
ORCID
Marlous Elisabeth Arentshorst http://orcid.org/0000-0003-2348-1364
References
AFP. (2014). Dutch students can live in nursing homes rent-free (as long as they keep the res-
idents company). Retrieved from September 27, 2017, http://www.thejournal.ie/help-the-
aged-1814698-Dec2014/
JOURNAL OF HOUSING FOR THE ELDERLY 11

Battilana, J. (2006). Agency and institutions: The enabling role of individuals’social pos-
ition. Organization,13(5), 653–676. doi:10.1177/1350508406067008
Battilana, J., Leca, B., & Boxenbaum, E. (2009). How actors change institutions: Towards a
theory of institutional entrepreneurship. The Academy of Management Annals,3(1),
65–107. doi:10.1080/19416520903053598
Bijvank, E. O. (2016). Het verzorgingshuis, achterhaald concept of nieuw en betaalbaar
woonproduct? Gero
̄n,18(2), 66–69. doi:10.1007/s40718-016-0054-6
Bone, D. (2002). Dilemmas of emotion work in nursing under market-driven health care.
International Journal of Public Sector Management,15(2), 140–150. doi:10.1108/
09513550210419564
Broerse, J. E. W., & Bunders, J. F. (2010). Transitions in health systems: Dealing with per-
sistent problems. Amsterdam: VU University Press.
de Savigny, D., & Taghreed, A. (Eds.). (2009). Systems thinking for health systems strength-
ening. Geneva: Alliance for Health Policy and Systems Research, WHO.
Geels, F. W. (2002). Technological transitions as evolutionary reconfiguration processes: A
multi-level perspective and a case-study. Research Policy,31(8-9), 1257–1274. doi:
10.1016/S0048-7333(02)00062-8
Geels, F. W., & Schot, J. (2007). Typology of sociotechnical transition pathways. Research
Policy,36(3), 399–417. doi:10.1016/j.respol.2007.01.003
Grunwald, A. (2004). Vision assessment as a new element of the FTA toolbox. In New hori-
zons and challenges for future-oriented technology analysis. Proceedings of the EU-US
Scientific Seminar: New Technology Foresight, Forecasting & Assessment, Sevilla
(pp. 53–67).
Mambrey, P., & Tepper, A. (2000). Technology assessment as metaphor assessment.
Visions guiding the development of information and communications technologies. In
Vision Assessment: Shaping Technology in 21st Century Society (pp. 33–51). Berlin:
Springer.
Pfaff, H., Driller, E., Karbach, U., Kowalski, C., Scheibler, F., & Ommen, O. (2010).
Standardization and individualization in care for the elderly: Proactive behavior through
individualized standardization. Open Longevity Science,4,51–57.
Rao, H., Monin, P., & Durand, R. (2003). Institutional change in Toque Ville: Nouvelle
cuisine as an identity movement in French gastronomy. American Journal of Sociology,
108(4), 795–843. doi:10.1086/367917
Raven, R. (2007). Co-evolution of waste and electricity regimes: Multi-regime dynamics in
the Netherlands (1969–2003). Energy Policy,35(4), 2197–2208. doi:10.1016/j.enpol.2006.
07.005
Simmons, R., Fajans, P., & Ghiron, L. (2007). Scaling up health service delivery: From pilot
innovations to policies and programmes. Geneva: World Health Organization.
Stambolovic, V. (2003). Epidemic of health care reforms. The European Journal of Public
Health,13(1), 77–79. doi:10.1093/eurpub/13.1.77
Steptoe, A., Shankar, A., Demakakos, P., & Wardle, J. (2013). Social isolation, loneliness,
and all-cause mortality in older men and women. Proceedings of the National Academy
of Sciences of the United States of America,110(15), 5797–5801. doi:10.1073/
pnas.1219686110
Turner, J. (2016). Is this the world’s coolest old people’s home? jThe Times Magazine jThe
Times & The Sunday Times. Retrieved September 27, 2017, from https://www.thetimes.
co.uk/article/is-this-the-worlds-coolest-old-peoples-home-g2xcxnxsf
Van Marrewijk, M., & Becker, H. M. (2004). The hidden hand of cultural governance: The
transformation process of humanitas, a community-driven organization providing, cure,
12 M. E. ARENTSHORST ET AL.

care, housing and well-being to elderly people. Journal of Business Ethics,55, 205–214.
doi:10.1007/s10551-004-1902-1
Zietsma, C., & Lawrence, T. B. (2010). Institutional work in the transformation of an
organizational field: The interplay of boundary work and practice work. Administrative
Science Quarterly,55, 189–221. doi:10.2189/asqu.2010.55.2.189
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