Enhancing the Ability of Seniors to Age in Place: Research and Evaluation of a NORCs

Supportive Services Paradigm as a Model for Home and Community-Based

Services for Seniors

2005 Joint Conference of the American Society on Aging and the National Council on the Aging

March 10-13, 2005

Barbara Joyce Bedney, Ph.D., M.S.W.United Jewish Communities, Washington, D.C.

Special thanks to Robert Goldberg, Esq., and David Schimmel, M.S.W.

Live Generously. It does a world of good.

Aging Demographics• 2000: 34.8 million seniors aged 65 and older

in the U.S., an 8-fold increase from 1900 (U.S. GAO/AoA 2002).

• 2020 Projections: 20 million more seniors 65 and older than there are today (U.S. GAO, 2002).

• 2040 Projections: the number of seniors 85 years and older will more than triple to 14 million (U.S. GAO. 2002).

• 2050 Projections: 850,000 people aged 100 and older in the U.S. (U.S. Census Bureau, 1999).

A New Vision of Aging

According to AoA, more meaningful home and community-based options for elder care are essential to contend with the aging of the baby boom population (AoA, 2004).Long-term care services are not just another set of traditional health care services. They encompass services to maintain quality of life, preserve individual dignity, and satisfy preferences in lifestyle (GAO, 2002).

NORCsA NORC is a naturally occurring retirement community – “a housing development that is not planned or designed for older people, but which over time comes to house largely older people” (Hunt and Gunter-Hunt, 1985).

Of the approximately 35 million Americans 65 years of age and older, as many as 8 million may currently be living in NORCs (Hunt, Merrill, and Gilker)

Aging in Place• Nine in ten seniors want to age in place

as they grow older (AARP, 2000).• Most will do so, whether they want to

or not (Callahan and Lanspery, 1997).• In the late 1980s and into the mid 1990s,

Robert Wood Johnson Foundation and Brandeis University created a model to promote healthy, safe, independent aging in place in senior housing(Callahan and Lansperry, 1997).

The RWJ/The RWJ/Brandeis Brandeis ModelModel

The model had four core components (Callahan and Lansperry, 1997):The focus is on service coordination.Housing developers and managers are involved from the beginning and, with consumers, share the cost.Services are flexible and responsive to customer needs and preferences.Consumers help shape services.

Aging in Place and NORCsIn a study of health providers and community

development, senior housing, and aging representatives, RWJ/Brandeis found that adapting the model to NORC settings could potentially lead to opportunities to:Deliver health and supportive services cost efficiently and increase service availability.Organize cooperative health promotion, crisis prevention, and community involvement initiatives.Develop human, financial, and neighborhood resources for the benefit of older residents.

NORCs and the Jewish Federation System

Jewish federations have taken a lead role in adapting supportive service programs (SSPs) within NORC settings:Early work, by UJA-Federation New York. In 2002, through the establishment of a federally funded, multi-site NORC-SSP Demonstration Initiative by United Jewish Communities, the umbrella organization of 155 Jewish federations which serve, support, and lead a nonsectarian network of agencies providing health and supportive services at the local level.

The UJC National NORC-SSP Demonstration Initiative

UJC’s National NORC-SSP Demonstration Initiative, administered by the U.S. Administration on Aging, is designed to develop and test theNORCs supportive service model as an innovative approach to helping seniors age in place.There are 41 projects currently involved in the demonstration.

Conceptual Model – The Social Ecological Framework“In the ecological paradigm, behavior, the physical and social environment, and health dynamically connect individuals, households, buildings, and communities…it is likely that interventions that combine activities to make changes at several of these levels will be more effective than those working at single levels” (Saegert et al., 2003).

Sample NORC-SSP Logic Model

PROBLEM TARGET OF INTERVENTION

INTERVENTION ACTIVITIES

INTERVENTION GOALS

NORC-SSPGOAL

Older Adults RecreationalActivities

Decreased Isolation

Social Isolation Improved

efficiency of services and increased ability of seniors to age safely in place in their own homes and communities

Organizations CollaborationsLack of Service

Coordination

IncreasedCoordination & Utilization

CommunitiesSenior

Advisory Councils

Senior Engagement/

Empowerment

DisempoweredSeniors

PolicymakersIncreased Options

for CommunityBased Care

NORC-SSPEvaluation

Dissemination

Unbalanced Long Term Care

System

Goals of the UJC National NORC-SSP Evaluation

To document and define the common To document and define the common elements, challenges, and strategies elements, challenges, and strategies associated with planning and associated with planning and implementing NORCimplementing NORC--SSPsSSPs. . To develop a descriptive model of To develop a descriptive model of NORCNORC--SSP service delivery. SSP service delivery. To create a historical record of lessons To create a historical record of lessons learned and add to the body oflearned and add to the body ofknowledge about aging services and knowledge about aging services and communitycommunity--based longbased long--term care.term care.

Methods of the National Evaluation

Telephone interviews with NORC-SSP program staff. Review of background and implementation materials (brochures, survey instruments, etc.).Review of programs and services grid. Qualitative analysis of interview data.First interviews with initial NORC communities are presented here.

Findings

Know Your Community: Assessment and Community Asset Mapping are KeyOlder adults – interests and service delivery needs, strengths, resources, etc.Social service agencies.Health care providers.Other aging services providers. Building owners and managers.Foundations and local funders.

FindingsKnow Your Community (con’t)

Volunteer/civic groups.Fire and police departments.Local officials.Universities.Businesses.Other community stakeholders and interested parties.

Findings

Build Your Community: Partnerships and Collaborations are KeyEngage seniors early in the process. Use your resources in the community to know who to partner with.Develop a common mission statement.Initiate and maintain open communication with all partners.

Findings

Build Your Community(con’t)Be willing to negotiate, and be flexible enough to address partner concerns.Be aware of demands on other’s time, energy, resources, etc., and plan accordingly.Have partners take ownership of the project. Know that partners and partnerships may need to change over time.

Findings

Impact of NORC-SSPs: On Older Adults“The seniors feel empowered. They really own the program.”“Our seniors are better connected to the system now.”“It really gives them something to look forward to.”

FindingsImpact of NORC-SSPs: On Organizations

“We are using NORCs to examine how we provide services now, and how we will in the future.”“We are using it as a model for other populations we serve – it could impact all our health and social services.”“We are looking to partner with other organizations on grant opportunities.”

Findings

Impact of NORC-SSPs: : On Communities“This has become a way for community members to express their pride in their community.”“We’re building the infrastructure of the community to be able to provide services.”

Summary

The NORC-SSP paradigm is an innovative approach to helping older adults age in place according to their own interests and desires. NORC-SSPs empower seniors, promote interorganizational collaborations, and mobilize communities to support seniors in new and exciting ways.

Next Steps

Ongoing interviews with NORC-SSP program staff. Ongoing review and modification of the national evaluation to ensure that results are maximally useful to communities and aging services providers.Public Website - WWW. NORCS.COMWWW. NORCS.COM