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Case Study: Sammen om Rødovre – Together with Older Citizens, Denmark

Background: Aging-in-place model and setting

Denmark is known globally for its advanced in-home and community-based health and social care systems, designed to support older adults and enable aging in place. High-quality, dignified care for older citizens is an important focus of the Danish Social Democratic welfare state. For the past half-century, the Danes have prioritized community-based care over nursing homes, emphasizing keeping elders in the community as much as possible. This preference for community-focused care is supported by policy, legislation and government budgets. Denmark’s 98 municipalities independently govern and provide care for their older citizens, enabling tailored solutions that reflect the unique needs of each community.

Rødovre Municipality is a suburban area with about 40,000 residents in the Capital Region of Greater Copenhagen. It has a long history of innovative initiatives aimed at improving care for older citizens in the community. In the early 1980s, it launched the Rødovre Project, which trialed regular home visits with older citizens to assess safety and well-being, as well as discuss self-care and the possible need for additional municipal care services. The outcomes were remarkable: older adults who participated in this project experienced longer lifespans, slower progression of illness and functional decline, fewer admissions to hospitals and long-term care homes and lower costs for the health system. In 1996, the success of the Rødovre project inspired a national law mandating preventive home visits for older adults across Denmark.

The Danish model for elder care aims to improve quality of life and provide value by enabling older citizens to maintain independence by staying in their own homes for as long as possible. The model uses a citizen-centered approach that involves and empowers every citizen to be in control of their lives at the highest level of community participation and inclusion. Older citizens are encouraged and enabled to contribute to their own care wherever possible. This active approach to care with as opposed to for older citizens recognizes and leverages their capabilities, resulting in greater autonomy and fulfillment – in contrast to treating them as passive recipients of care.

The Danish model for community-based care of older adults incorporates several key approaches: preventive home visits, rehabilitation and reablement care, assistive technologies, caregiver support and social volunteer efforts. Preventive home visits are regularly offered to citizens aged 82 years or older and elders in vulnerable conditions. In addition to home care services of personal care and practical help, municipalities are required to identify and support citizens who could benefit from short-term rehabilitation and reablement care. This type of care supports maintaining or regaining physical, mental and social abilities and through targeted activities and exercises. Increasingly, assistive technologies are used in the home to enable older citizens to be safer and more self-reliant. Lastly, several initiatives support informal caregivers and enable peer support and volunteer efforts.

Engagement approach with community

Rødovre Municipality has a long and deep historical commitment to fostering a sense of community and collective responsibility amongst its citizens. Recognizing that the municipality is more than just a service provider, Rødovre embraces the concept of community as a shared endeavour built on collaboration between citizens, organizations and government. In Rødovre, and across Denmark, there is a strong tradition of joining associations and volunteering. Engaged citizens often step up to support one another, fostering a spirit of solidarity that strengthens social cohesion and shapes the municipality's approach to aging-in-place. 

Local volunteer associations and initiatives are promoted and coordinated in the community by the Rødovre Volunteer Centre working in close collaboration with Rødovre Municipality.

Samskabelse: Co-creation through collaboration in community

Samskabelse (co-creation) is a hot topic in the Danish public sector, emphasizing citizen involvement in shaping the welfare society. It also serves as a strategic approach to foster inter-organizational collaboration and cooperation between government officials and public administrators, representatives from local institutions and community-based organizations, health and social care professionals, and civil society. Engaging citizens in the development of public sector solutions is believed to hold great promise to address many of society's challenges, including supports for aging-in-place. By bringing together diverse perspectives, Rødovre Municipality ensures that the development of aging-in-place initiatives directly reflects the needs of citizens. In other words, Rødovre Municipality accommodates its citizens rather than its citizens accommodating the municipality.

In the spirit of co-creation, citizens often feel a social obligation to care for their community and commit themselves to involvement in co-design, co-implementation and co-production of policies and initiatives. Actively involving citizens in decision-making processes ensures that initiatives reflect the lived experiences of Rødovre citizens while fostering collective responsibility for the sustainability of initiatives. This collaborative approach is embodied in the municipality’s current strategy, Sammen om Rødovre, which roughly translates to Together on Rødovre.

While each Danish municipality tailors its approach to local needs, the principles of co-creation are widely acknowledged as time- and resource-intensive. Authentic and effective citizen engagement demands significant effort, but Danish colleagues acknowledge that co-creation consistently yields better-aligned solutions that meet the needs and preferences of end-users. Further, co-creation initiatives often achieve greater long-term sustainability and implementation success, as citizens are engaged early in the process. Although the initial investment in co-creation may be high, the long-term cost savings and improved outcomes are usually much greater than the initial investment.

Co-location of nursing home café and volunteer centre

Engaging vulnerable older citizens living at home in co-creation requires addressing systemic barriers that affect older people’s ability to participate, such as mobility limitations and social isolation. Rødovre Municipality actively works to break down these barriers by creating inclusive and accessible environments that encourage vulnerable populations to engage with their community outside their homes. Another barrier to older people’s engagement is their experience with social isolation or loneliness. Although addressing this widespread social problem is not a municipal duty per se, Rødovre Municipality recognizes that people have poorer health and greater care needs when loneliness is not addressed.

To combat these issues, the municipality has had great success encouraging its older citizens to engage with their communities through cafés co-located in all nursing homes. Instead of offering meal delivery – a service reserved for housebound individuals – those who need meal preparation supports are offered subsidized meals in Rødovre’s nursing home cafés, encouraging older residents to venture out. Beyond nourishment, these visits promote physical activity, foster social connections and reduce loneliness. Crucially, the café setting minimizes the stigma often associated with loneliness, as gathering for a meal with neighbours feels natural and community-oriented. By addressing physical, social and emotional needs in tandem, these initiatives help keep older citizens healthier and more independent so they can stay in their homes longer.

In Rødovre, one of the nursing homes and Rødovre Volunteer Centre are strategically co-located within residential areas highly populated by older adults. This physical proximity of services enables staff from the Volunteer Centre to engage with the older citizens dining in the nursing home cafés. Staff provide support in facilitating and coordinating volunteer peer-led programs, such as self-help groups and recreational activities co-created with older volunteers.

The Volunteer Centre has observed that although older citizens typically start to engage in activities for their benefit, they often become motivated to engage as volunteers themselves, helping to develop and lead new initiatives. These easily accessible opportunities for community engagement provide great personal satisfaction for the older citizens involved while combatting loneliness by encouraging meaningful connections with neighbours.

This strategic co-location of services in Rødovre makes it easier for older adults to access supports and participate in volunteer activities that promote active aging and social inclusion. These centralized hubs serve as resource centres for care, engagement and volunteer opportunities, promoting a bidirectional flow of support and services. They also provide opportunities for co-creation of volunteer initiatives and associations tailored to older citizens.

By designing welcoming and accessible spaces, Rødovre Municipality encourages older citizens to remain engaged within their communities and build meaningful social connections with neighbours. This practice significantly reduces feelings of loneliness for many older citizens and supports healthy aging in place. Most importantly, it meets people where they are and offers them opportunities to engage in ways that suit them best. The geographic closeness also creates relational closeness, ultimately facilitating sustainable engagement within seniors’ volunteer life.

Citizens as part of the solution: Social volunteer collaborations

Volunteer organizations play a crucial role in supporting older adults and their caregivers in Denmark. Close collaboration exists between volunteer centers, community organizations and municipalities, reflected in inter-organizational collaborations involving collective strategic planning and shared resources of staff, infrastructure and budgets. This collaborative approach ensures resources are used efficiently to address the diverse health and social care needs of older citizens.

Volunteers take on roles, such as companionship to older citizens through a besøg ven (visiting friend), and offer end-of-life support for individuals in the community and nursing homes. The municipality aims for public sector staff to act as facilitators, building bridges between older citizens and their communities, rather than serving as the primary relationship for an older citizen. Harnessing the power of social volunteer collaborations not only enhances quality of life for older citizens, but also strengthens community bonds and social cohesion.

The Rødovre Volunteer Centre serves as a central hub for resources and coordination, supporting volunteer organizations and individuals interested in engaging with their community. A key engagement feature is the empowerment of community members to take initiative in co-designing and co-implementing volunteer initiatives. Through the centre, individuals can form groups to address specific community needs or interests, leveraging a vast resource list for new organizations.

The center also offers a "starter package" with essential pamphlets for new groups, and provides detailed guidance on the registration process and applying for municipal grants. This grassroots approach to support and information not only fosters a sense of ownership and empowerment, but also encourages collaborative efforts among diverse citizens to create positive change.

Centering older citizens: Rødovre Municipal Seniors Council

Older citizens play a central role in policy development and municipal planning in Rødovre through the Senior Council – an elected body of individuals aged 60 and older, chosen by individuals in the same age group, that holds elections every four years. The council serves as a vital platform and working group for citizen engagement by providing guidance on new initiatives and proposing changes to enhance conditions for older citizens. Established in 1992 – five years before such councils became legally mandated in 1997 – the Senior Council has been pivotal in shaping policies and initiatives within Rødovre Municipality.

The council appoints two representatives to the Regional Elderly Council, which addresses regional matters such as hospitals, ensuring that the interests of Rødovre's older population are represented at a broader level. While the council does not handle individual cases, it provides guidance and recommendations on matters affecting the elderly population at large. Though it does not have municipal decision-making power, the council plays a crucial role in directly co-creating policy, ensuring that initiatives are sustainable and effectively address the evolving needs of the older population. Most notably, despite lacking formal decision-making authority, the council exemplifies the principles of co-creation by offering collaborative input, engaging in consultative processes, influencing policy direction through its recommendations and advocating for the interests of older citizens at a regional level. Through its active engagement in policy and planning, the council facilitates a collaborative partnership between older citizens and local government, ensuring that initiatives are responsive to the evolving needs of the elderly population – even without the council having formal decision-making authority.

In addition to policy work, the Senior Council is actively engaged in developing programs for volunteers and further enhancing community involvement for older adults. These programs provide valuable assistance to older adults and foster a sense of camaraderie and social connection within the community.

The council participates in capacity-building courses, lectures and meetings on broader issues affecting older adults. It also collaborates with Rødovre a local newspaper, writing articles that inform the community about its activities and initiatives. The council also hosts events such as the municipality's forest trip and an orientation for new pensioners.

Conclusion

With active involvement of older adults in planning and developing care, the Danish model ensures that initiatives are tailored to meet their specific needs and preferences. This collaborative approach fosters a sense of ownership and empowerment among stakeholders, resulting in more effective and sustainable solutions for home-based health and social care for older adults.

Engagement at the system level underscores the Danish values of self-reliance and independence. Investments in initiatives like the Senior Council and volunteer programs enhance the well-being of older adults while reducing healthcare costs. By prioritizing community engagement and support, the Danish model promotes self-sufficiency among older adults while supporting their quality of life. This proactive approach not only addresses immediate needs, but also contributes to long-term sustainability, benefiting both individuals and the healthcare system.

Denmark’s commitment to engaging the community in the care of older adults is deeply rooted in a culture of innovation and continuous improvement. Although Denmark is internationally recognized for its community-based care of older adults, Danish professionals actively seek to learn from other countries about practices and approaches to enable aging-in-place – for example, Wigan in Greater Manchester, United Kingdom. They value professional development, research and innovation as essential tools for advancing engagement practices.