According to experts, a NORC supportive services program encompasses supports, services, and activities organized to help meet identified needs and aspirations of residents and the NORC governing structure. However, they noted that it is possible for a supportive services program that provides many things to not meet residents' needs. Therefore, in addition to the range of services provided, a services program's ability to adapt to the changing needs and preferences of residents is critical to the program's success and longevity.
One concern the subject matter experts shared was that too often policymakers think of older people as a collection of deficits that need to be addressed. They felt that, ideally, the individual needs of older people would be examined in the broader context of supporting successful aging for the whole population. Not all older people need or want services, but some will. Supportive services programs, therefore, are just one possible component of a broader approach to meeting the needs of the population as it ages.
The published literature has few studies that focus on what older residents want or need. We found only one study of the service needs of NORC residents, and it emphasized services that should not be provided. In his survey of residents of three Wisconsin apartment-based NORCs, Hunt asked residents what should have been done to help residents who had moved away remain in the community. Most respondents felt that if residents needed more health care they should go somewhere else, and that nothing should have been done for them so they could stay in the community.34 The study does not give the reasons underlying these beliefs. This finding suggests that while residents may have service needs, they do not necessarily feel that it is the responsibility of building management or other community representatives to meet these needs.
For additional insights on service needs, we reviewed the published literature on public housing for seniors and found several relevant studies. Researchers at New Hampshire's Housing Finance Authority interviewed 503 residents in four pilot sites.35Table 1 ranks the services that residents reported they most needed or were most useful, compared with the services they reported as most wanted or desired. (The study did not clarify the difference between "needed" and "wanted.") Where two entries appear in the same box, there was a tie in the ranking.
|Ranking||Most Needed||Most Wanted|
|1||Heavy household chores||Transportation|
|2||Shopping||Heavy household chores
|4||Transportation||Personal emergency response system|
|5||Light household chores||Shopping|
|6||Personal emergency response system||Light household chores
|8||Personal care||Personal care|
|SOURCE: Greenleaf, Lynn, Sheila Malynowski, New Hampshire Housing Finance Authority. Increasing Service Availability to Seniors in Housing: Final Report (Bedford, NH: New Hampshire Housing Finance Authority, 1993).|
In a second study, researchers interviewed residents of a public housing project in New York City where more than half of the heads of households were age 60 and over.36 The study, part of a demonstration project that provided community-based supportive services to older residents with one or more limitations in ADLs, found an unmet need for mental health services, as evidenced by older residents' social isolation and signs of depression. In response, the project hired a bereavement/mental health counselor. The study also found less need for emergency home care and home-delivered meals than project staff had expected. As a result, the staff shifted their emphasis to non-Medicaid covered services.
Hunt highlights the dilemma of meeting the needs of older residents without making the community (an apartment complex in this case) less attractive to younger residents.37 He identifies three approaches from the literature. Residents can leave when their needs exceed what is offered in the complex. Alternatively, the complex can expand services to meet the needs of residents as they age. Finally, in what Hunt terms the balanced model, the complex can expand services slightly and help residents meet their remaining needs by linking them with services in the broader community.
The subject matter experts did not agree on what NORC residents want or need. The experts noted that assessing residents' needs and preferences--through surveys or focus groups, for example--is important for program development and implementation. They also observed that what residents want will vary according to their level of frailty and may change abruptly when they are faced with a crisis. The services that residents might need from a new program will also depend on what services are available to them under other programs.
The lack of consensus on resident needs is not surprising given the many different types of NORCs and varying levels of need among the elderly. It seems likely that, in addition to the disparate needs and wants in any cross-section of older people, the range of services needed by NORC residents could vary depending on the type of NORC in question and its location. Residents who have aged in place will not need orientation to the community that might benefit in-migrants. Transportation might be a more critical need for suburban NORC residents than for residents of apartment-based NORCs in urban areas.
Several experts noted that property managers and residents frequently fear a supportive services program would make their residences look like nursing homes, with wheelchairs in the lobby or uniformed nurses in the building. For this reason, while some residents may favor establishing a services program in their building, others may resist in the interest of maintaining an age-integrated community. This feeling could limit the services that NORC residents say they want until they themselves need help with daily activities and medical care.
In addition, there are services that residents currently need and can readily identify, such as household repairs, as well as services they might need as they age that they might not have considered, such as help with ADLs. Determining the types of services NORC residents want or need and will use, while easier than it might be in the community at large, appears to be one of the most difficult tasks facing supportive services programs.
"NORCssp.pdf" (pdf, 762.02Kb)
"NORCsspA1.pdf" (pdf, 636.12Kb)
"NORCsspA2.pdf" (pdf, 360.82Kb)