Supportive Services Programs in Naturally Occurring Retirement Communities. How are the Outcomes of NORC Services Programs Defined and Measured?

The literature on outcomes associated with supportive services provision in NORCs is extremely thin, both conceptually and empirically. Researchers have identified the potential benefits of providing services in housing for older people, but we found no information on how to measure these benefits. The benefits were described broadly as helping residents remain independent, improving staff and resident morale, allowing managers more time to focus on managing the property, and lowering service costs for all parties.47 Yalowitz emphasizes the importance of including periodic "performance based evaluation" in program planning and evaluating programs for their contribution to the "continued independence of...seniors served by the program."48

Although we found no NORC-specific research on actual outcomes, findings from services programs linked with congregate housing could specify potential outcomes of NORC services programs. The studies of SCPs generally use qualitative methods, such as key informant interviews, case studies, and interviews with program participants. In a study of publicly funded housing for seniors in six developments in Connecticut, Sheehan reported that property managers believed resident service coordinators (RSCs) improved the quality of life for residents, reduced residents' risk of entering nursing homes, and contributed to savings from lower apartment turnover and vacancy rates as well as better upkeep of the apartments.49 The RSCs also freed property managers from trying to meet the support needs of elderly residents. Frail older people in the demonstration sites reported a large improvement in perceived health status as well as in functioning related to ADLs and IADLs between the pre-test and post-test interviews. There were no changes among frail elderly people in comparison sites. The majority of residents said that the RSCs had benefited them through providing emotional support, help with problems, and information and referral. Participation in social activities and housing satisfaction increased substantially for residents, regardless of their level of disability.

The available research on outcomes does not provide rigorous evidence of the effect of supportive services programs, but it points to areas for further research. It suggests that NORC services programs could improve residents' self-reported health status, mental and physical functioning, and quality of life. Changes in self-reported health status and quality of life are subjective and, although suggestive of an effect and relatively easy to measure, they are not a rigorous test of a program's effect. In contrast, changes in mental and physical functioning can be measured using standard screening tools and could provide a more objective measure. However, these screening tools would require a larger commitment of both time and funds to implement.

The subject matter experts believed there was insufficient evidence to characterize the outcomes of NORC services programs. They noted that while some programs are conducting research studies on resident satisfaction, service usage, and costs, most have not developed mechanisms to examine outcomes. The experts also noted that the lack of mechanisms to measure outcomes might reflect a lack of focus on quality assurance. Defining and measuring outcomes associated with NORC services programs is still a largely undeveloped field of inquiry.

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