In most grantee sites, community service agencies have taken the initiative in organizing services programs for NORC residents. Each grantee site is connected in some way to the local Jewish Federation, a fundraising umbrella organization for Jewish community services agencies. But services are not limited by religious affiliation. The grantees typically include a Jewish community center (JCC) and a Jewish social services agency that serves families, but other organizations, such as community housing organizations in Baltimore and St. Louis, are frequently involved. In each site, one agency has taken responsibility for forming a planning group to coordinate services.
In taking the lead in developing services programs, the agencies faced challenges that might not have arisen if the services programs had been internally driven. Some early challenges included securing the cooperation of building managers in program development and service delivery, gaining resident participation and support, and communicating with and getting to know the needs of the NORC residents. In many cases, the current program is an extension of the grantee's earlier activities in the community. In some sites, the residents' familiarity with the grantee agencies and some of the service providers has helped reduce program development challenges. For example, in Pittsburgh, many residents who participated in assessments also participated in JCC activities or frequently called ElderLink, an information and referral service that is a collaborative effort of the three sponsoring service agencies.
At two of the five grantee sites, program staff contacted building managers and owners to secure their cooperation in setting up services programs, with varying degrees of success. The attitudes of building managers and owners toward NORC services programs in the study sites could be either positive or negative, respondents reported. One group considered the services programs valuable because they help older tenants remain in place; older tenants are valued because they generally pay their rent on time, have long tenancy in their apartments, and are considerate neighbors. In contrast, other building managers or owners feared that their property would come to resemble a nursing home if services programs were provided to residents. In this group's view, older tenants limit the marketability of the building, keeping younger potential residents away. Building owner or management attitudes affect the implementation of the services programs over time. Management cooperation can range from sharing contact information on older building residents to facilitating program start-up to providing office space and other resources, as in Baltimore and Cleveland, making program implementation and management much easier.
A principal goal of the program's contact with the community organization is to establish a communication channel between the program and the residents. The service agencies have employed various communication methods with building residents, with the method depending in part on the level of cooperation of the building managers and the stage of the program. In the initial stages, identifying where in the community older residents live, introducing the program, and determining their interest in participating take priority. After program start-up, establishing a two-way communication between program staff and residents is critical, allowing staff to identify resident needs and residents to provide feedback on how well program activities are meeting those needs. Some building managers supply the ages, phone numbers, and locations of elderly residents, allowing agency staff to call residents or knock on their doors to introduce themselves and the program. Resource coordinators in Cleveland, for example, contact each new senior resident to introduce the program and inquire about resident's interests. Grantee staff generally consider face-to-face contact the most effective, albeit the most labor-intensive, method of introducing the program and fostering ongoing communication with residents. Other methods, such as articles in newsletters, flyers, and postings on bulletin boards, are considerably less expensive in terms of time, but are seen by program staff as less effective.
At most sites, program staff have either developed an internal entity that represents residents, as in Baltimore's SFN Advisory Council, or used an existing internal structure, such as Philadelphia's co-op boards. These internal structures provide a point of contact for staff to give residents information and hear their concerns. In St. Louis, program staff formed an external advisory committee made up of service providers, residents, religious organizations, and state representatives to help develop the services program and to serve as the vehicle for communication with residents. In Baltimore and Cleveland, the resident advisory councils developed by program staff are how residents become involved in and contribute to the program. In Pittsburgh, much of the organizational energy went into developing collaborative management arrangements among the three agencies running the services program; no organization internal to the community was used as a regular part of the services program.
Suburban areas present particular challenges to agencies trying to start services programs. Existing neighborhood organizational structures rarely represent the views of older residents, and no information about elderly households is readily available. Suburban decentralization also makes identifying a communal space for programs difficult. In Baltimore and Cleveland, program staff have tried to surmount these obstacles and start programs in suburban areas with row houses and single-family homes, but with little success. In neither city could staff find an easily accessible activity center, central space, or home to host neighborhood events, particularly one that was accessible for people with disabilities. Lack of transportation and inclement weather present other obstacles to organizing in dispersed neighborhoods that do not arise when all program participants reside in one building. Program staff have not given up on the idea of organizing in suburban neighborhoods, but are unsure how best to proceed.
The program in St. Louis is under development. The grantee decided to study various aspects of the community before initiating a program, using its grant funding to partner with researchers at Washington University in St. Louis's Center for Aging to conduct seven studies. Community service agencies will use the results to develop services programs. The center and the agencies intend to seek additional funding to track program outcomes and conduct longitudinal research to determine how residents and the community change over time.
The impetus for most of the services programs we studied came from an agency serving the NORC, rather than from the NORC residents themselves. The one exception was in Philadelphia, where residents of a cooperative contacted a community service agency to start a services program. The Philadelphia program is based in several cooperative apartment buildings and a condominium, each with a resident board. This type of housing may attract residents who have an interest in working together to address community needs. Alternatively, the experience of residents working together in co-op or condominium management may have engendered the more proactive stance. The program has strong support, as evidenced by the fact that each cooperative pays a building fee to participate in the program. The availability of social services has also attracted people to the buildings; three of the five buildings have waiting lists.
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