Supportive Services Programs in Naturally Occurring Retirement Communities. METHODS

11/01/2004

We base the findings presented in this report on information derived from three sources--a review of the literature, discussions with subject matter experts, and site visits to supportive services programs in NORCs in the five AoA demonstration sites. We first reviewed the published literature on NORCs and their associated services programs up to September 2003, focusing on how NORCs were defined, how they were formed and evolved, and the different types of services programs. Because the literature on services programs in NORCs was sparse, we also looked at studies on services linked with congregate housing that was "purpose-built" for seniors to broaden our understanding of services programs. An annotated bibliography of the literature we reviewed is provided in appendix 1.

Following our review of the literature, we held directed discussions with seven subject matter experts identified by the literature. Before the conversations, we sent each expert a discussion guide that included a review of the definitions of NORCs in the literature, information on the structure of their services programs, and questions designed to elicit the experts' opinions on these topics. In addition, we sent a draft of our conceptual model for comment and as a structure for observations on NORCs, their services programs, and the policies that might support them.

The discussion guide focused on the following research questions:

  • What is a NORC?
  • What factors affect the evolution of a NORC?
  • What organizational structures are associated with services programs in NORCs?
  • What services do NORC residents want or need?
  • What services are typically available in NORC services programs?
  • What factors affect resident participation in NORC services programs?
  • How are NORC services program outcomes defined and measured?
  • What are the principal funding sources for NORC services programs?

For each research question, the experts were asked to consider both the processes involved and the policies that might affect the processes. Finally, they were asked to consider the broader policy questions that might arise in researching the demonstration projects.

These research questions were also the basis for the discussion guide used for site visits to NORC services programs in Baltimore, Cleveland, Philadelphia, Pittsburgh, and St. Louis between May and September 2003. These five sites were the first recipients of AoA grant funding to start new NORC services programs or expand existing ones. The primary contact at each site received a copy of the discussion guide before our visit.

At each site, we talked with staff from the organizations running the NORC services programs and, when available, NORC residents. We held discussions with six people in Baltimore, seven in Cleveland, 16 in Philadelphia, 13 in Pittsburgh, and 18 in St. Louis. Because the Cleveland site turned over a significant proportion of its grant to subgrantees, the seven people we interviewed included four subgrantees, reached by phone. We sent a summary of the site visit findings to the primary staff at each site to correct any factual errors or omissions. After receiving their comments, we revised the reports. Copies of the revised site visit reports appear in appendix 2.

Our methodology has two notable limitations. First, although the literature we considered covers a wide range of NORCs and NORC services programs, and the subject matter experts we consulted have broad experience in these areas, the core of this report is based on our site visits to the five AoA grantee programs. As would be expected given the small number of programs, there is less variation across these NORCs and their programs than there is in the universe of NORCs and NORC supportive services programs. Where appropriate, we extend our discussion to consider the implications of the issues for NORCs and related programs not in our grantee sample. Such extrapolation, however, does not allow us to consider the issues for such NORCs as fully as we can consider them for the NORCs and NORC programs we actually visited. Second, owing to the nature of the AoA grants, the funded programs were not directed at clearly delineated program outcomes. Our study was also exploratory rather than evaluative. Therefore, our discussion of outcomes is not based on the reported progress toward the objective goals of the programs we visited. Rather, we focus on illuminating the contributions to the well-being of their participants that program staff attribute to program activities and the lessons that can be learned from these accomplishments.

 

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