Community-Centered Solutions for Aging at Home

Community-Centered Solutions for Aging at Home

Highlights

• Naturally occurring retirement communities (NORCs), such as the East Point NORC in the Atlanta suburbs, offer supportive services to neighborhoods with high concentrations of seniors, including transportation assistance, health and wellness programs, home repairs, and social and educational programs.
• Villages such as the Newton at Home program in Massachusetts are membership-based organizations with paid staff who coordinate access to services through trained volunteers, referrals to screened vendors for complex jobs and needs, and affinity groups led by community members.
• Some Villages, such as the Concierge Club in San Diego, offer a tiered membership structure with more intensive engagements to help seniors with greater needs remain in their homes.

Many older members of our society wish to age safely in their homes and neighborhoods but have limited financial means, are unaware of community supports and services that could help, and lack the travel options that allow them to move about freely and to participate fully in community activities. The results are undesirable: social isolation, economic hardship, declines in health and well-being, and the loss to the community of one of its richest resources — its elders.

Among the many initiatives to facilitate aging in place, two prominent community-centered models that have emerged are Naturally Occurring Retirement Community Supportive Services Programs (NORC SSPs) and Villages. NORC SSPs and Villages developed to address the discrepancy between how communities are designed and what older adults need to age in place. Because of their location or cost, Villages and NORC SSPs are not accessible to all who might benefit from them due to location or affordability and they are not the complete solution to the burgeoning needs of an aging cohort. These models, however, raise seniors’ awareness of available supportive services, fill service gaps to prevent or delay moves to institutional settings, and engage elders as active community members.1 This article briefly discusses each model and examines a NORC SSP and two types of Villages.

NORC SSP Model

Newton at Home members organize affinity groups around common interests like kayaking. Such social activities build community among members and enrich their daily lives.
Photo courtesy: Newton at Home In the mid-1980s, naturally occurring retirement communities (NORCs), characterized by a predominantly older population, emerged throughout the United States. These communities are not planned or designed for elderly residents but rather arise naturally, often as a result of people remaining in the homes in which they have raised their families. This concentration of older adults makes it possible to deliver elder-specific services using economies of scale and the NORC SSP model, defined as a “community-based intervention designed to reduce service fragmentation and create healthy, integrated communities in which seniors living in NORCs are able to age in place with greater comfort and security in their own homes.”2 Typically, NORC SSPs are initiated and governed not by the elders they serve but by community service providers.3

The NORC SSP model promotes independence and healthy aging by engaging seniors and addressing their changing needs as they age; coordinates health care, social services, and group activities onsite through partnerships that integrate the efforts of housing entities, residents, service providers, government agencies, and philanthropies; involves seniors in the program’s development and operation; and fills service gaps resulting from inadequate or uncoordinated services provided by the Administration on Aging, the Centers for Medicare and Medicaid Services, state agencies, and other community-based services.4

NORC SSPs also facilitate change to make communities more livable for aging residents. Penn South, the original NORC SSP launched in 1986 in New York City with private philanthropic support, exemplifies this proactive approach to aging in place. The advocacy of the residents and founders of the SSP in this moderate-income cooperative of 10 high-rise apartment buildings led both New York State (1995) and New York City (1999) to institute public policies and legislation that provide ongoing funding for NORC SSPs.5

Building on the success of this model, the Jewish Federations of North America (JFNA) advocated for federal funding to expand the number of NORC SSPs. Between 2002 and 2010, Congress funded the first 3 years of nearly 50 different demonstration SSPs in 26 states. These NORC SSPs were led by JFNA’s National NORCs Aging in Place Initiative and administered by the Administration on Aging.6 A national evaluation of these demonstrations in 2007 concluded that NORC SSPs effectively facilitated aging in place. The results showed the following:

• Socialization increased and social isolation declined among NORC SSP participants, 88.1 percent of whom agreed or strongly agreed that participation led to talking to more people than in the past.


• NORC SSPs were effective at linking older adults to services that enabled them to age in place; 95.4 percent of participants agreed or strongly agreed that they had learned more about community services.


• NORC SSPs can improve volunteerism among older adults; 48.1 percent agreed or strongly agreed that they volunteered more frequently as a result of program participation.


• NORC-SSP participants felt healthier (70.5%) and more likely to stay in their community (88.1%) as a result of the program.7

East Point NORC’s Supportive Services Program

Penn South has served as a prototype for many NORC SSPs, including in East Point, a suburb of Atlanta, Georgia. East Point’s population of 36,000 is 75 percent black and has a median household income of $41,622. Today the area, composed mostly of single-family homes, has a large concentration of seniors, many of whom are homeowners living on limited incomes in aging homes built in the 1950s and 1960s or earlier.8 In 2003, the Jewish Federation of Greater Atlanta (JFGA), the Atlanta Regional Commission (ARC), and the Fulton County Office for Aging, acting on a shared interest in helping local elders successfully age at home, collaborated to organize East Point NORC’s SSP.9 These partners began by surveying 1,200 older adults and found that, rather than traditional services such as home care or home-delivered meals, seniors wanted broader community support that would enable independence and aging in place. Through focus groups, door-to-door surveys, and community mapping, the “pulse of the community was taken,” according to Regine Denis, program manager of aging services for Fulton County. The priority needs of East Point’s seniors were identified as access to information and referral services, safety, transportation, and home repair.10 Annual surveys to assess needs and a Participant Advisory Committee that advises JFGA and the county about the needs and interests of older residents help keep the program relevant.11

Today, JFGA serves as an umbrella agency; coordinates with other NORC sites in Georgia; and assists with fundraising, advocacy, marketing, and impact evaluation. The Fulton County Office for Aging is the lead agency that manages East Point’s efforts, secures needed services for residents, and develops partnerships to enhance its programs.12 One of Fulton County’s community centers is located in East Point and is not only a focal point for many senior activities but also the site of the NORC SSP office; the office’s outreach coordinator is over 60 and has lived in the neighborhood since 1975.13

Membership in the East Point NORC SSP is free for city residents who are over 60. New members are recruited through word of mouth recommendations from other members and through community organizations, neighborhood groups, and churches that have contact with older adults.14 Members receive a community newsletter, information about volunteer opportunities, and notices about upcoming events and services available to seniors.15 As of June 2013, East Point’s membership totaled 1,153; the average age of members was 68, 74 percent were female, and 53 percent lived alone.16 The types of services available to East Point members reflect the program’s priorities and are adapted to the needs of the community’s senior residents. East Point’s services include the following:

• Transportation assistance.


• A walking club.


• Monthly workshops on senior health and safety topics.


• A health and wellness program, including vision and hearing clinics, foot clinics, health screenings, a farmers’ market, and an annual Seniors Partnering with Artists Citywide event.


• A neighbor-to-neighbor program to maintain contact with those living alone or who are shut in.


• Home repairs provided by volunteers or, for major jobs, through referrals to other community partners such as Rebuilding Together Atlanta. Residents pay for materials and volunteers facilitate, if necessary.


• Group activities such as exercise classes and a book club for elders cosponsored by the public library.17

Increased social and physical activity are goals of East Point NORC.
Photo courtesy: East Point NORC Social and educational activities, transportation, and information and referral services are used most frequently.18 Mobility for seniors is a pressing need in Fulton County, which has significant transportation challenges. To meet this need, East Point NORC’s partners have successfully implemented a transportation coupon program for seniors. East Point members may buy a transportation coupon booklet worth $100 for the price of $10. Purchasers needing to travel find their own driver, who can be anyone who does not reside with the senior, including a friend or a family member. East Point outreach coordinator Diana Stevens explains that the price for the trip, agreed on by the senior and the driver ahead of time, is $10 an hour for the first 3 hours and $5 per hour after that, plus a set mileage rate. Stevens says, “The senior pays the driver with a coupon. The driver fills out a voucher for a completed trip, which the senior must review and sign to approve.” NORC program staff collect and review the voucher and then approves payment to the driver, which JFGA makes using grant funds set aside for this purpose. This program has proven to be a popular and cost-effective means for enabling older adults to remain mobile and age in place. As Denis points out, “It’s a win-win for all seniors to be able to move about freely and go where they want to go.” This simple, innovative way of delivering a service is possible through continued partnerships with JFGA as well as ARC, which has replicated the transportation coupon program elsewhere in its service area.19

One half-time and one full-time county employee coordinate the community partners and volunteers who provide most of East Point NORC’s services. One challenge in operating this program, Denis reports, is maintaining an adequate pool of volunteers to provide services and conduct surveys to stay in touch with needs of the city’s aging residents. Fortunately, Hands on Atlanta, a program partner and nonprofit organization that connects volunteers to service opportunities, helps East Point NORC build its volunteer pool.20

Local partnerships and collaborations are key to leveraging existing resources and offering services, states Denis. She says that East Point NORC’s strength is that it is a true community effort, with numerous partners who provide space, support, expertise, and in-kind contributions. These partners include the public library, Hands on Atlanta, home health services, the local fire and police departments, places of worship, ARC, and local higher education programs such as Brenau University, which sends occupational therapy students to help with home assessments and programming for safety and fall prevention.21 In addition, East Point’s public leaders appreciate the program and attend its events.

One lesson learned from East Point’s seniors is that some elders distrust government programs and associate them with handouts that erode self-respect. To avoid this stigma, the program does not use the county’s logo on any of East Point NORC’s promotional materials even though the Fulton County Office for Aging is the program’s lead agency. Instead, the state NORC logo, featuring a friendly streetscape, is used to market the East Point NORC SSP as a broad, community-driven initiative.22

The program relies heavily on volunteers, community partnerships, and in-kind contributions. All costs incurred are met through fundraising for particular service initiatives, funds from philanthropies, and sometimes from the state, although state funds are not guaranteed because there is no ongoing legislative commitment. JFGA is advocating for a state statute to make the NORC program model a permanent part of Georgia’s strategy to enhance aging friendliness as the population of seniors grows.23

JFGA is using program outcome data to support its advocacy efforts. In 2006, JFGA partnered with Georgia State University to make a baseline assessment of East Point residents’ health, physical activity, mental health, socialization, perceptions of the environment and the community, and feelings about aging in place. Annual followups are conducted with a random sample of East Point members, and data are entered into a program management system to allow monitoring and reporting.24

The researchers emphasize simple ways to measure the results of the East Point NORC SSP, such as demonstrating that members have increased their activity levels, used more community services, gone when and where they could not go before, practiced healthy behaviors, shown progress in achieving weight and blood pressure goals, felt safer at home and in the community, and felt more confident that they will be able to age in place. For the 12 months ending in June 2013, the numbers show that large majorities of East Point seniors have become more mobile, more socially active and engaged, healthier, and more able to avoid falls, hospitalizations, and emergency room visits.25

The East Point NORC SSP reflects the efforts of a broad spectrum of the community. Its success, suggests Denis, lies in the integration of so many individuals and groups who, as stakeholders, participate in making East Point a city where seniors can age in place and remain actively engaged in their community.

Two Kinds of Villages

East Point NORC sponsors educational and social events for its members, such as a gathering to celebrate Black History Month.
Photo courtesy: East Point NORC As with NORCs, Villages promote access to services, strengthen older adults’ social relationships, reduce social isolation, promote members’ contributions to community, and help communities become more aging friendly. The Village model emerged as an alternative to traditional approaches that relied on private social services or government agencies. Government programs tended to target the very poor or disabled and were often unavailable to those with relatively more resources. To the founders of the first Village, Beacon Hill in Boston, assisted living, continuing care communities, and nursing homes seemed too “regimented, expensive, and isolating.” Instead, Beacon Hill Village organizers preferred to “design their own lifestyles and create their own futures” as they crafted the support systems needed to successfully age in place.26 The founders realized that everything they needed to age in place was available somewhere in the greater Boston area. Rather than replicate existing community services, Beacon Hill Village organizers chose to consolidate and arrange access to services for members through strategic partnerships with service providers. Programs were designed for the whole person — that is, to meet the emotional, intellectual, physical, social, and spiritual needs of individuals — by building community around shared interests, addressing member service and information needs, and promoting healthy aging. Since 2002, when the Village was first organized, Beacon Hill’s model has been adopted in more than 100 localities nationwide and in Canada, Australia, and the Netherlands, with another 123 Villages in development.27

To promote the development of aging-friendly communities, Beacon Hill Village produces a manual for grassroots groups to use to establish their own Villages. In addition, Beacon Hill has joined with NCB Capital Impact, a national community development financial institution, to create a peer network to encourage communication between Villages and assist new Village startups.28 Approximately 85 percent of existing Villages belong to this Village to Village (VtV) Network.29

Villages have structured themselves in diverse ways, although the model’s main components are common to most. Some Villages operate as a division or program within a parent organization, while a majority of Villages (77%) are freestanding with their own governance or advisory board and staff.30 An example of the former is the Concierge Club, a program of ElderHelp of San Diego, whereas Newton at Home, located in a community near Boston, exemplifies the latter. Both Villages are members of the VtV Network.

Newton at Home: A Freestanding Village

Newton at Home (NAH) is a freestanding Village conceived by longtime residents of Newton, Massachusetts, who created a community support system that would enable city residents to remain in their homes as they grew older. Fully operational since April 2011, NAH is a membership-based, 501(c)(3) nonprofit organization with 178 members.31

Governance for NAH is through a board of directors composed of 14 NAH members and interested community residents with diverse backgrounds, including a physician, a social worker, a retired microbiology professor, and an economist. The board engages in a continuous planning process delegated to active committees that work on programming, health and wellness, fundraising, marketing and communications, and technology support. NAH devotes significant energy to planning and programming activities such as an annual Intergenerational Senior Walk, museum trips, and concerts. Popular affinity groups formed by members who share similar interests foster such activities as attending book clubs, dining out, kayaking, seeing films, visiting museums, painting, and attending cultural events. Village members form and run the affinity groups while staff arrange for necessary transportation and publicize dates, times, and locations. Communication with members is a constant challenge for NAH staff. Although the Village’s website maintains a schedule of events, Maureen Grannan, NAH’s director, says communications with members can be challenging if members suffer from memory impairment or do not use a computer.32

Three paid staff members arrange services for NAH members through a centralized information and referral contact point. NAH membership benefits include access to services provided primarily by screened and trained volunteers, resources to help members navigate the health care system, and referrals to screened vendors for complex jobs such as roofing, construction, gutter replacement, and landscaping. These vendors frequently offer discounts to NAH members. NAH staff selects and vets vendors so that members can be confident of their honesty, reliability, and quality of work. The type of screening depends on the vendor’s type of work and may include criminal background, license, and insurance checks. NAH staff also follows up after jobs are completed to make sure that members are satisfied.33

Recruiting volunteers young and old, Newton at Home encourages intergenerational interactions.
Photo courtesy: Newton at Home Members request and receive many services, including light in-home maintenance projects, health and fitness activities and classes, daily telephone check-ins, transportation, convenience services (such as dog walking, house sitting, or waiting for a delivery or service person when a member is not at home), technology assistance and education, and gardening advice and help. Many requests are for help with seasonal chores like installing window air conditioners in the summer and putting them away for the winter. Transportation is the most frequently requested service. Local rides are free, and round-trip rides into Boston cost a flat $10. All parking fees are paid by members; volunteers cover fuel expenses, which are tax deductible.34

NAH’s volunteer-first philosophy means that the Village attempts to identify a volunteer who can meet member requests before making a referral to a paid vendor. As a result, 98 percent of services are provided by a pool of about 110 volunteers that includes more than a third of NAH members, which builds community. All volunteer candidates are interviewed, receive criminal background checks, and participate in a comprehensive orientation program before their first service assignment. “We are always looking for volunteers,” says Grannan. “It’s a multipronged approach. We work closely with a group called Soar 55 that places retirees in volunteer positions, we put out emails on listservs from which we get many responses, and we recruit at schools.” NAH especially encourages youth volunteers and has local athletic teams, Boys and Girls Clubs, and Boy Scout troops providing support.35

An essential component of NAH’s existence is its collaboration with agencies and community organizations that already serve older adults. NAH avoids duplicating services and works to add value to its partnerships. One example of such collaboration is a recently developed partnership with Newton-Wellesley Hospital to help prevent rehospitalization of Medicare patients within 30 days for the same diagnosis (for which the hospital cannot be reimbursed). As Grannan explains, “We can help discharged, at-risk individuals stay at home just by doing the kinds of things we do for our members: daily home visits, grocery shopping, putting the trash out for pickup, delivering prescriptions, taking them to doctor appointments.” The hospital pays $180 for a 30-day membership for the released patient, NAH supplies the necessary patient support, and everyone benefits. The patient stays at home, and the hospital saves a significant amount of money by avoiding a nonreimbursable readmission.

With volunteer drivers using their own cars and paying for gas, Newton at Home coordinates free local travel for members.
Photo courtesy: Newton at Home NAH enjoys community support from the mayor’s office, numerous nonprofit partners, and many businesses that make in-kind contributions such as the local hardware store, which donates rakes and leaf bags for the autumn leaf removal. NAH members can also receive carpentry and auto repair services from volunteers at one of the town’s high schools. In addition, a nonprofit group called Food to Your Table goes to the local farmers’ market every Tuesday afternoon to collect unsold produce; these vegetables and fruit are bagged and delivered for free to Village members. “We also work closely with an elder affairs officer in the police department on safety issues for our members. To sustain Newton at Home, this kind of continued community support is essential,” says Grannan.

Annual membership fees for Newton residents aged 60 and older are $660 for an individual living alone and $780 for a household. A limited number of reduced-fee memberships are offered to modest-income residents. Newton also offers a six-month trial membership at a reduced rate and a BreakAway Membership plan that prorates the annual fee if a member spends at least three consecutive months a year away from their Newton home.36 Membership dues cover about 60 percent of NAH’s $165,000 budget; donations from businesses, individuals, foundations, and an occasional grant account for the remainder of revenue. Salaries for three full-time staff members, modest rent for a one-room office, technology costs, and postage account for most of the program costs.37

Fundraising is crucial, says Grannan. She has several volunteers who help with grant writing. Currently, an assisted living facility, a physical therapy business, and NAH are collaborating on a grant application to fund a fall prevention program to safeguard members and clients, prevent hospital stays, and save the health care industry money in the long term. The president of NAH’s board of directors assumes the responsibility of chief fundraiser. Membership continues to grow, and Grannan stresses that to be sustainable, NAH will need more money to hire additional staff, rent a larger office space, and acquire additional technology and a van for event transport.

NAH is a grassroots initiative, and many of its members are invested in Village activities that also build community. Although NAH’s volunteer-first philosophy effectively meets a variety of service requests and its membership is growing, the organization is labor intensive for staff. To remain sustainable, NAH must continue to secure and maintain the necessary resources, energies, and investments of members, staff, volunteers, and community partnerships.

The Concierge Club: A Parented Village

ElderHelp of San Diego, a nonprofit with decades of experience in providing services to seniors, became increasingly aware of a need for affordable support for frail seniors who wish to live independently in their own homes. In 2009, ElderHelp launched the Concierge Club, which is patterned on the Village model. Membership in the Concierge Club is open to seniors aged 60 and older who live in a service area covering much of mid-city San Diego and a small portion of the East County region. Most Club members are relatively homebound and have limited resources.38 Deb Martin, Concierge Club’s chief executive officer and executive director, states that “about 50 percent of our members pay nothing, and the rest pay on a sliding scale from $25–$300 per month for services, depending on income level and choice of services. Less than two percent of our members pay the maximum monthly fee.”39 The average annual membership fee paid in 2011 was $377, whereas the average value of assistance received by each member was $4,156 per year.40 Donated funds and services cover most of the difference between membership dues collected and total expenses.

The Concierge Club offers three levels of member services, explains Anya Delacruz, member services director for the Club.41 The first consists of information and referrals requested by members who call in for a quick resource. The second level is any kind of volunteer service that members need. The greatest demand is for drivers, but other volunteer services are also available to members who choose to take advantage of them: housekeeping, grocery shopping, bill minding, budgeting, home repair, gardening, social visits, and pet care.42 In 2011, Club members received 10,627 hours of volunteer services valued at $10 to $29 per hour.43 The third level of member services includes care management and coordination plus volunteer services, meaning that, if needed to allow aging in place, members receive personal care management, monitoring, and assistance as indicated by an in-depth biopsychosocial assessment.44 Club staff provided 4,500 hours of such care management at a value of $115 an hour in 2011.45

Approximately 310 volunteers provide the bulk of direct services to about 250 Club members at any one time, and 6 or 7 staffers recruit members, find and train volunteers, match volunteers with members, perform ongoing care coordination, and oversee member services.46 Concierge Club personnel connect members with needed volunteers and, as at NAH and most other Villages, the Club screens providers and arranges for member discounts. Delacruz says their network of preferred providers consists of “community partners who provide services that we don’t so that we can offer a more comprehensive set of services, knowing that we can’t be everything to everyone.” These partners are thoroughly vetted through interviews, applications, license verifications, and checks on their standing with the Better Business Bureau. Delacruz says, “We really try to take the guesswork out of things for members so they’re not just looking through the Yellow Pages or Craigslist, but can know these are trusted people in the community.” Members are also able to purchase in-home care services at $19 per hour, a discount of 14 percent from the standard rate of $22 per hour, and Lifeline medical alert services are available from a preferred provider at a discount of 27 percent.47

Club membership offers seniors more than just access to needed services. The University of California at Berkeley completed an 18-month evaluation of the Concierge Club in 2012 that identified additional social and economic benefits for members that could lead to improved quality of life. The study indicates that after joining the Club, members who were “very confident” that they would be able to remain in their own home as they age increased from 24 to 71 percent. Forty-four percent of members found it easier to take care of their home. After six months of membership, the number of seniors who often felt socially isolated, lacked companionship, or felt left out declined by approximately two-thirds. The Club also improved members’ health outcomes and addressed their safety concerns. For example, the number of home hazards that might cause injury declined from an average of 1.43 to 0.76 per home and the number of falls experienced in the previous 6 months declined from a total of 28 down to 4.48

Although Club staff use these findings to support its grant submissions and reports, they are still exploring how to use them to enhance Club programs and to reduce social isolation. “We’re trying to translate a lot of our services into measurable medical health benefits and cost savings,” says Martin. “When unmanaged chronic illness worsens for a socially isolated individual, there’s an increase in serious functional and mental debilitation that overburdens the health care system. What we do directly correlates with reducing isolation among seniors and all of the health and medical problems that occur when they are left alone.” The Club believes the services its volunteers provide, such as transportation to medical appointments and the pharmacy, home and safety improvements, and fall prevention, translate directly into health benefits for seniors and health cost savings.

Although the organization constantly tries to diversify its revenue streams, its funding comes primarily from foundations and donations from individuals and corporations, with a very small percentage coming from membership fees. Martin says that “fundraising is always going to be a challenge in this day and age with thousands of nonprofits out there. But we have a unique model, we’ve done this job well for a long time, and our reliance on volunteers keeps things affordable.” To be sustainable in the long term, however, Martin emphasizes that the Club must find ways to increase revenue. The Club’s original membership structure fails to cover program costs, and the organization is exploring how to attract people who can afford to pay for services to subsidize those who cannot.49

Another key to sustainability, says Martin, is to retain and continually build alliances and partnerships. “At the same time, we try to increase our capacity, which is contingent on the number of volunteers we can recruit. They are both our growth and our limit.” One of the Club’s biggest challenges is to meet members’ demand for transportation; keeping up with all of the rides requested is possible only because of help from a nonprofit partner who has vans, including wheelchair-accessible ones. Finally, Martin stresses the importance of controlling costs and overhead and ensuring that the Club is able to retain experienced, skilled staff.

Issues and Challenges for NORC SSPs and Villages

Concierge Club volunteers help members pursue interests such as gardening.
Photo courtesy: ElderHelp Staff and Volunteers The objectives and types of services that seniors need in East Point, San Diego, and Newton are markedly similar. All experience heavy member demand for transportation services. The amount and nature of member activity and involvement varies across these NORC SSP and Village examples — high and multifaceted in NAH’s Village, a grassroots, self-governed initiative in a relatively well-educated community; curtailed by health and frailty, as are many Concierge Club members; and constrained by limited economic resources, as are the members of East Point NORC’s SSP and the Concierge Club. An additional constraint for the Concierge Club’s program is its large service area, which makes recreation and socializing activities logistically difficult (although it has successfully planned some excursions to museums, the wild animal park, and musical performances). The Club provides the bulk of its services in members’ homes, which has resulted in meaningful relationships between volunteers and Club members.50

Both Villages and NORCs are challenged with securing funds to sustain their programs. NAH and the Concierge Club depend on revenue from membership fees but also require additional operating funds. NAH depends most on membership fees and has diversified its membership options while also seeking grants and gifts. The Concierge Club plans to restructure and broaden its membership base but also relies heavily on fundraising.

East Point NORC’s two largest revenue sources are government grants and contracts and contributions from businesses and private philanthropies, sources that are always accompanied by a degree of uncertainty. JFGA hopes to secure a state legislative commitment in Georgia that would provide more certain funding, just as Penn South accomplished in New York through its advocacy. Villages, too, often rely on fundraising to compensate for insufficient revenue from membership fees, which is why VtV Network members seek help to recruit and reach target populations able to benefit from Village membership.51 Having extensively researched the Village model, Scharlach et al. posit that Villages may be a workable solution for middle-income households if more stable funding can be assured and if affiliation and partner networks can be sufficiently strengthened to secure access to needed resources.52

These issues and challenges are similar to those found in a national study of NORC and Village programs by Greenfield et al. despite significant variation in their “unique development histories.” The specific services delivered, the populations served, how services are provided, and how they are financed are the primary dimensions of these programs, according to Greenfield et al. Factors affecting these dimensions include the characteristics of the program’s geographic service area, population density, health status and needs of participants, degree of participant engagement, coordination and involvement of community groups, and the fiscal status of the participants.53

Finally, NORCs and Villages increasingly need outcome-oriented data, such as those gathered by Concierge Club program evaluators, to compete successfully for grants and donations that help support staff, transportation, information dissemination, education, and volunteer programs. Stakeholders want to know whether these initiatives are reducing costs and are socially beneficial, underscoring the critical role of good research and program evaluation in securing an adequate flow of revenue.54 Obtaining such data also makes it possible for others to replicate successful programs.

Fredda Vladeck, director of United Hospital Fund’s Aging in Place Initiative, stresses that data also help create and strengthen the community infrastructure necessary to support aging in place.55 Vladeck has shown how data-driven initiatives have identified and closed gaps in health and social services, improving clinical outcomes for NORC SSP participants with diabetes. This evidence is significant for the individuals involved but also reinforces the essential role that effective collaboration has in sustaining the aging friendliness of a community.56

Vladeck also points to having collected baseline data on the health status and risks for older adults living in NORCs. Subsequently, interventions were designed and implemented to address prevalent health risks (heart disease, diabetes, and falls) in these populations. Over the next 18 months, the interventions resulted in improvements, such as increased percentages of quarterly blood pressure readings taken and blood pressures that were under control.57 “The value of these studies,” Vladeck notes, “is that the conversation is no longer about one case or individual at a time but about a whole population. For example, when health care organizations know that 42 percent of seniors living in two communities are diabetic, it offers a unique opportunity for providers to partner with other community agencies to improve management of diabetes and prevent numerous emergency room visits and amputations.”58

Conclusion

Membership in a community is a vehicle for self-fulfillment for people of all ages. To avoid social isolation, older adults must “have a community to belong to that supports their needs and gives meaning to their lives,” explains Ann Bookman, a social anthropologist from the University of Massachusetts at Boston.59 East Point NORC, Newton at Home, and the Concierge Club are helping seniors remain in their own homes, independent and socially engaged. While these organizations are respecting the housing choices of aging individuals, they are also creating better integrated communities by closing service gaps, building partnerships among organizations and institutions, and — in one case — intentionally adding cross-generational engagement by actively recruiting youth volunteers.

The evidence suggests that both seniors who wish to age in place and their communities can benefit from Village and NORC SSP initiatives as well as other models that attempt to integrate individual and community health needs, such as Vermont’s SASH program (see “Aging in Place: Facilitating Choice and Independence”). Questions remain as to how resources can be aligned to provide more certainty and long-term stability for these programs and how a wider spectrum of consumers can be included. Stakeholders are also interested in learning whether efforts to facilitate aging in place will be instrumental in reducing the health care costs associated with aging. A rigorous research agenda designed to identify outcomes of programs, as well as the conditions under which working Villages and NORC SSPs are most effective in helping particular groups and subgroups of older adults to successfully age in place, could answer these questions and guide the way forward.60

Related Information:

The Original NORC Supportive Services Program

1. Ann Bookman. 2008. “Innovative  models of aging in place: Transforming our communities for an aging population,” Community, Work & Family 11:4, 419–38.
2. Ibid.; The Jewish Federations of North America. 2013. “What is a NORC SSP?” defines a naturally  occurring retirement community (NORC) as comprised of a significantly large proportion of older  residents whose needs  have changed with aging and are no longer  adequately met by the physical and social environment.
3. Emily A. Greenfield, Andrew Scharlach, Amanda  J. Lehning, and Joan K. Davitt. 2012. “A conceptual framework  for examining the promise  of the NORC program and Village models to promote aging in place,” Journal of Aging Studies 26, 273–84.
4. Center for the Advanced Study of Aging Services. 2010. “Compendium of Community Aging Initiatives, 67.
5. Kathryn Lawler. 2001. “Aging in Place: Coordinating Housing and Health Care Provision for America’s Growing Elderly Population,” Joint Center for Housing Studies of Harvard  University and Neighborhood Reinvestment Corporation, 42–4.
6. United Hospital  Fund.  2013. “9 Frequently Asked Questions about  NORCs.” Accessed 21 August 2013; Emily A. Greenfield, Andrew E. Scharlach, Carrie L. Graham, Joan K. Davitt, and Amanda  J. Lehning. 2012. “An Overview of Programs in the National NORCs Aging in Place Initiative: Results from a 2012 Organizational Survey,”Rutgers University School of Social Work.
7. Barbara  Joyce Bedney, David Schimmel, Robert  Goldberg, Laurence Kotler-Berkowitz, and Debbie Bursztyn. 2007. “Rethinking Aging in Place: Exploring the Impact of NORC Supportive Service Programs on Older Adult Participants,”presented at Joint Conference of the American  Society on Aging and the National Council  on the Aging, March 7–10; United Jewish Communities. 2007. “NORCs National Evaluation.”
8. United States Census Bureau.  2013. “State and County Quick Facts”  and “2007–2011 American  Community Survey 5-Year Estimates,”DPO4 and DP05. Accessed 5 September 2013; Atlanta.net. 2013. “About East Point.”Accessed 5 September 2011.
9. Jan M. Ivery and Deborah Akstein-Kahan.  2010. “The Naturally Occurring Retirement Community (NORC) Initiative in Georgia: Developing  and Managing Collaborative Partnerships to Support Older  Adults,”Administration in Social Work 34:4, 329–43.
10. United Hospital  Fund.  2012. “East Point NORC Program, Atlanta, Georgia.” Accessed 8 August 2013.
11. City of East Point, Georgia.  n.d. “What is a NORC?”Accessed on 16 July 2013.
12. Jewish Federation of Greater Atlanta. 2013. “How Does NORC Help Our Community?”Accessed 8 August 2013.
13. Interview with Diana Stevens, East Point Outreach Coordinator, August 2013.
14. Ivery and Akstein-Kahan.
15. Interview with Regine Denis, August 2013.
16. Jewish Federation of Greater Atlanta. 2013. “NORC Evaluation  Report  2012–2013.” Unpublished, provided by JFGA.
17. Jewish Federation of Great Atlanta. 2012. “East Point NORC.” Accessed July 2013.
18. “NORC Evaluation  Report  2012–2013.”
19. Regine Denis interview; United Hospital  Fund.  2012. “Custom-Tailored Transportation.” Accessed July 2013.
20. City of East Point, Georgia.
21. Ivery and Akstein-Kahan.
22. United Hospital  Fund,  2012. “Establishing a Brand”; Interview with Regine Denis .
23. Jewish Federation of Greater Atlanta. 2013. “What About Funding?” Accessed 8 August 2013.
24. Ibid.; “Is the NORC Model Working?”; Ivery and Akstein-Kahan;  “NORC Evaluation  Report  2012–2013.”
25. Ibid.
26. Susan McWhinney-Morse.  2009. “Beacon Hill Village,” Generations 33:2, 85–6.
27. Village to Village Network. “About the VtV Network.”Accessed 10 July 2013.
28. Ibid.; Beacon Hill Village. 2013. “Thinking About Starting a Village?” Accessed 10 July 2013.
29. Emily A. Greenfield, Andrew E. Scharlach, Carrie L. Graham, Joan K. Davitt, and Amanda  J. Lehning. 2012. “A National Overview of Villages: Results from a 2012 Organizational Survey,” Rutgers University School of Social Work, 6.
30. Ibid., 2–3, 5.
31. Newton at Home.  2013. “Living in your community—staying in your home.” Accessed 3 July 2013.
32. Interview with Maureen Grannan, August 2013.
33. Newton at Home.  2013. “Membership Services”; Interview with Maureen Grannan.
34. Ibid.
35. Ibid.
36. Newton at Home.  2013. “How You Can Become a Newton at Home Member.”
37. Interview and email communication with Maureen Grannan.
38. ElderHelp. 2013. “Concierge Club.”
39. Interview with Deb Martin, August 2013.
40. Center for the Advanced Study of Aging Services. 2012. “Results of Evaluation  of Concierge Club.” Internal document provided by ElderHelp.
41. Interview with Anya Delacruz, August 2013. According to Greenfield et al., this is a typical service delivery structure for Villages.
42. ElderHelp. n.d. “Caring  Services In Your Own Home.” Concierge Club brochure.
43. Center for the Advanced Study of Aging Services.
44. Interview with Anya Delacruz. The biopsychosocial approach systematically considers biological,  psychological, and social factors and their  complex interactions in understanding health, illness, and health care delivery.
45. Center for the Advanced Study of Aging Services.
46. Interview with Deb Martin.
47. Center for the Advanced Study of Aging Services.
48. Ibid.; Andrew E. Scharlach, Carrie L. Graham, and Clara Berridge.  2012. “ElderHelp Concierge Club Evaluation  Final Report,” University of California, Berkeley Center for the Advanced Study of Aging Services. Copy provided by lead author.
49. Interview with Deb Martin.
50. Ibid.
51. Andrew Scharlach and Christabel Cheung. 2010. “The Village Movement:  Data Collection & The Practical Application of Data,” 27 October webinar.
52. Andrew  Scharlach, Carrie Graham, and Amanda Lehning. 2012. “The Village Model: A Consumer-Driven Approach for Aging in Place,” The Gerontologist 52:3, 418–27.
53. Emily A. Greenfield, Andrew E. Scharlach, Amanda  J. Lehning, Joan K. Davitt, and Carrie L. Graham. 2013. “A Tale of Two Community Initiatives for Promoting Aging in Place: Similarities and Differences  in the National Implementation of NORC Programs and Villages,”The Gerontologist (April), 1–11.
54. Jean C. Accius. 2010. “The Village: A Growing Option for Aging in Place,”AARP Fact Sheet.
55. Fredda  Vladeck. 2006. “Testimony  before  the Subcommittee  on Retirement, Security and Aging of the Health, Education, Labor, and Pensions  Committee, United States Senate,”  16 May.
56. Corrine Kyriacou and Fredda  Vladeck. 2011. “A new model  of care collaboration for community-dwelling elders: findings and lessons learned from the NORC Health Care linkage evaluation,”International Journal of Integrated Care 11 (29 April), 1–20.
57. Fredda  Vladeck. 2011. “A New Role for Senior Serving Community Based Organizations in Chronic Care Management,” United Hospital  Fund Research Symposium PowerPoint presentation, 13 October, and accompanying notes provided by the presenter.
58. Interview with Fredda  Vladeck, July 2013.
59. Bookman.
60. Greenfield et al., “A Conceptual Framework.”