Editor’s note: This article is part of a year-long project about aging well, planning for the changes that aging brings and shaping how society thinks about aging.
“Home” is a beautiful word, evoking the comfort of close-knit neighborhoods where people settle down and raise children. But later in life many seniors find themselves in a different kind of home — a naturally occurring retirement community, or NORC, where older people age in place long after their kids are grown.
The term NORC — coined in 1984 by Michael Hunt, a professor of urban planning at the University of Wisconsin–Madison — denotes any geographically defined community in which at least 40 percent of the population is 60 or older and live in their own homes. With such a broad definition, NORCs can take many forms, ranging from vibrant communities that encourage seniors to stay engaged to sad places where the elderly live in isolation, fearful that they’ll die alone.
In 2010, some 40.3 million Americans were 65 years or older, according to the U.S. Census Bureau, but estimates of how many live in NORCs vary widely. Although AARP has reported in recent years that 25 to 36 percent of seniors live in NORCs, the Administration on Aging puts the figure at 17 percent.
Whichever estimate is accurate, some NORCs clearly thrive while others wither — and what makes the difference are Supportive Services Programs, or SSPs, usually the result of partnerships between local organizations and vetted providers. As NORCs evolve into NORC-SSPs, they typically begin by offering social services, health care management, education, recreation and volunteer opportunities. To those core components, many have added adult day care, meals, transportation, home care, legal and financial advice, home safety improvements, mental health counseling and disease management.
Viewed as a cost-effective aging-in-place model and favored by more than 80 percent of seniors, NORC-SSPs benefited early from widespread support. From the outset, advocates in New York and other areas scattered around the country cobbled together subsidies from federal, state and local government as well as partners in housing, charity groups and local businesses. According to Robert Goldberg, senior director of legislative affairs at the Jewish Federation of North America, the JFNA’s New York chapter produced a template for NORC-SSPs as early as 1985, when it partnered with federal, state and local agencies to provide start-up and operational funding. Today, that partnership covers more than 50,000 seniors living in more than 40 NORC-SSPs throughout New York State.
Blueprint for Aging, another NORC-SSP innovator, operates in northern Michigan. Its researchers have studied urban, small town and rural communities in Leelanau County — with various income levels and ethnic makeups — to determine what enables a NORC to flourish. Among the key components, they found, are centers for physical activity (like exercise centers); a full, year-round calendar of events; effective communication between service providers and the community; and a strong sense of trust in those providers.
Of course, personal care services are critical for seniors who want to remain at home as they become older and frailer, but they can be a challenge in areas where seniors live in single-family houses. Andrea Cohen, chief executive of HouseWorks, a Boston-based home care agency, notes that communities of apartment dwellers are more cost-effective because they reduce her employees’ travel time and permit more flexible scheduling. “It’s a complex business,” she says, “because we’re dealing with seniors and their adult children, who are smart consumers with high expectations.”
Cohen’s clients want a choice of providers and control over how much home care they receive. For that reason, HouseWorks offers a low, one-hour service minimum — significantly less than the four-hour minimum that’s customary in the home care field. “If a client only wants someone to shower and dress them, and not interfere with the rest of their day, we do it,” she says.
Interacting with the clients’ adult children provides information that will be useful in the not-too-distant future, when NORC-SSPs are “occupied by the boomers themselves,” Cohen adds. “Boomers want good information, a guide to what’s likely to happen next as a disease or frailty progresses, and completely reliable caregivers to devise instant solutions to problems.”
As the need for NORC-SSPs grows, financing has begun to dry up. JFNA’s Robert Goldberg explains that the prolonged economic malaise has forced the Administration on Aging, the lead federal agency that supports aging-in-place initiatives, to pull back. “Today’s NORCs sink or swim on grass-roots support,” he says. Without governmental and philanthropic subsidies, many NORC-SSPs have disappeared.
But anyone who questions whether NORC-SSPs make economic sense should look to Israel. The catalyst for its model, created by the nonprofit JDC-ESHEL and supported by the Israeli government and the American Jewish Joint Distribution Committee, was simple research. With the elderly population soaring, the AJJDC compared the initial and annual costs of placing a senior in a nursing home with the costs of NORC services. The difference was dramatic: A nursing home spot for one senior required tens of thousands of dollars to build and maintain, while a NORC-SSP-style program — known in Israel as a “supportive community” — could be set up with a per-capita investment in the hundreds. Israel chose the vastly less expensive supportive community model over costly institutional care.
Through experimentation and research, JDC-ESHEL developed a generous basket of services that each community adapts to its individual needs. The government provides three years start-up financing to the communities; after that, each one finances itself. By 2003, there were 103 urban and 18 rural supportive communities, with studies indicating 95 percent member satisfaction.
Given that America’s 78 million baby boomers will place massive demands for care on a stretched economy, it may be time for politicians to revisit the NORC-SSP — perhaps adding a dash of Israel’s “supportive community.” The result could be an aging-in-place model that won’t bust governmental, philanthropic and personal budgets.