Supportive Services Programs in Naturally Occurring Retirement Communities. INTRODUCTION

11/01/2004

Policymakers are considerably interested in learning how best to encourage successful aging in place by supporting people at home and in the community. Health and social services to assist the elderly not only offer individuals the support they might need to maintain their independence in their own homes for as long as possible, but may also forestall early or unnecessary institutionalization in an acute or long-term care facility.1 In addition, surveys have consistently shown that older people want to remain in their own homes as long as possible.2

The population of those age 65 and over is expected to double over the next 30 years.3 Developing successful models to organize and deliver supportive services for this cohort will have important policy implications for the structure of long-term care services in light of the potential increased demand, the preference for services in the home, and the availability of public funding to pay for services for those most in need.

One possible delivery model involves establishing an integrated system of supportive services for residents of "naturally occurring retirement communities." A naturally occurring retirement community, or NORC, is a community with a large proportion of older people within a defined geographic area. It is distinguished from other areas that also have high concentrations of older residents, such as assisted living communities or continuing care retirement communities, in that it is "naturally occurring." In other words, the area was not designed specifically as a community for older people but rather has evolved in such a way that a large proportion of its residents are older. A service delivery model that targets NORCs may be able to meet the needs of a large group of older people in a community so more of them are able to maintain their independence and continue living at home. The concentrated population of older people in a NORC may allow economies of scale or scope in the organization and delivery of services.

Federal policymakers support the concept of NORCs as a potential focus for delivering long-term care services. As part of the Administration on Aging's (AoA) fiscal year 2001 appropriation, Congress earmarked over $3 million in grants for demonstration projects in five cities with NORCs. The five demonstration projects are organized around Jewish social services organizations that were already providing supportive services for the aging in Baltimore, Cleveland, Philadelphia, Pittsburgh, and Saint Louis. The grants promote, test, and develop site-specific service models that could, in turn, be used as possible frameworks for national models.

Because the NORC supportive services program model fits well with the federal policy shift away from institutional models of care and toward community-based and consumer-driven models, policymakers hope to learn important lessons about what does and does not work and why. Since the demonstration projects are organized and delivered by faith-based organizations, policymakers also hope to understand the perspective of stakeholders who play a key role in the current administration's faith-based and community-based initiatives. By examining existing programs providing support to NORC residents, policymakers can identify issues that might arise during program implementation. Studies of individual programs could also illuminate the broader policy implications using the NORC supportive services programs to organize community-based care for an aging population.

Here, we examine NORCs and NORC supportive services programs through a review of the literature, discussions with national experts on NORCs, and case studies of NORCs and their associated services programs in the five AoA demonstration sites. Following a brief background section, we describe our methods. We then present findings from the literature and our interviews with experts. Based on our review of the literature and refined through our discussions with the experts, we developed a NORCs conceptual model, which is presented in the fourth section. In the fifth section, we use the model to structure our exploration of the characteristics of the NORCs and NORC services programs in the five demonstration sites. Finally, we highlight policy issues related to aging in place that arise in NORC supportive services programs for consideration by stakeholders and policymakers at the federal, state, and local levels.


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