NORC supportive services model implementation and community capacity

Identification and engagement of naturally occurring retirement communities to support healthy aging in Canada: A set of methods for replication

Background

Naturally occurring retirement communities (NORCs), unplanned communities with a high proportion of older adult residents, offer a model to support older adults to age well in place. The aim of this paper is to provide a comprehensive description of the methods used to identify and engage NORCs appropriate for the development of supportive service programming in Canada.

Methods

Three steps were used to identify and select NORCs in which to develop supportive service programming including: 1) identification of potential NORCs using Canadian Census Dissemination Areas, the Ontario Marginalization Index and Google Maps, 2) engagement of property owner/manager to determine the availability of common space for communal programming and willingness of the owner to support programming and, 3) engagement of older adult residents within the NORC to co-design programming.

Results

Four cities in the south-east, south-central, and south-west of Ontario, Canada were identified to develop NORCs with supportive service programming. Using the methods described, six NORCs were identified, landlords and older adult residents were engaged, and programs initiated between April 2018 and March 2019. The sites included two private high-rise apartments, a city-owned low-rise subsidized apartment complex, two multi-building private high-rise complexes and a mobile home community. An average of 35 (min 20, max 78) older adult members were engaged in an average of 20.5 unique activity sessions at each site per month. On average, social (54%) and physical activities (30%) were more common than nutritional (10%) and knowledge-sharing (8%).

Conclusions

The increased prevalence of unplanned, geographically-bound NORCs creates an opportunity for governments, social and health service providers and policy makers to support healthy aging in their communities. Our experience with the creation of six new NORCs with supportive service programming provides a tested set of methods that can be applied in other communities.

An Overview of Naturally Occurring Retirement Communities (NORCs) for Ageing in Place

As an alternative to ageing at home in the community, naturally occurring retirement communities (NORCs) have great potential to facilitate ageing in place; however, they have not attracted much research attention. This study conducts an overview of NORCs, aiming to examine the previous research in a comprehensive manner in order to explore how NORCs impact ageing in place, with the goal of guiding future research. The research presented here employs the content analysis method to review prior NORC-related studies and categorise research themes and findings following top-down coding principles. A total of 49 articles were selected from the Scopus and Web of Science databases, and the results show that the “social environment”, which was the most discussed topic (n = 24), provides the necessary mental support and physical motivation for older adults to live actively in NORCs, and that NORCs play a positive role in preserving public resources and promoting individual health. The limitations of this study include the fact that there is little public information on NORC programs and the subjective classification of themes, among others. This study acts as a foundation for future research on NORCs, which serve as a perfect model for healthy ageing in place.

Naturally Occurring Retirement Communities: A Scoping Review (Preprint)

Background

As Canada’s population ages, there is a need to explore community-based solutions to support older adults. Naturally occurring retirement communities (NORCs), defined in 1986 as buildings or areas not specifically designed for, but which attract, older adults and associated NORC supportive service programs (NORC-SSPs) have been described as potential resources to support aging in place. Though the body of literature on NORCs has been growing since the 1980s, no synthesis of this work has been conducted to date.

Objective

The goal of this scoping review is to highlight the current state of NORC literature to inform future research and offer a summarized description of NORCs and how they have supported, and can support, older adults to age in place.

Methods

Using a published framework, a scoping review was conducted by searching 13 databases from earliest date of coverage to January 2022. We included English peer- and non–peer-reviewed scholarly journal publications that described, critiqued, reflected on, or researched NORCs. Aging-in-place literature with little to no mention of NORCs was excluded, as were studies that recruited participants from NORCs but did not connect findings to the setting. A qualitative content analysis of the literature was conducted, guided by a conceptual framework, to examine the promise of NORC programs to promote aging in place.

Results

From 787 publications, we included 64 (8.1%) articles. All publications were North American, and nearly half used a descriptive research approach (31/64, 48%). A little more than half provided a specific definition of a NORC (33/64, 52%); of these, 13 (39%) used the 1986 definition; yet, there were discrepancies in the defined proportions of older adults that constitute a NORC (eg, 40% or 50%). Of the 64 articles, 6 (9%) described processes for identifying NORCs and 39 (61%) specifically described NORC-SSPs and included both external partnerships with organizations for service delivery (33/39, 85%) and internal resources such as staff, volunteers, or neighbors. Identified key components of a NORC-SSP included activities fostering social relationships (25/64, 39%) and access to resources and services (26/64, 41%). Sustainability and funding of NORC-SSPs were described (27/64, 42%), particularly as challenges to success. Initial outcomes, including self-efficacy (6/64, 9%) and increased access to social and health supports (14/64, 22%) were cited; however, long-term outcomes were lacking.

Conclusions

This review synthesizes the NORC literature to date and demonstrates that NORC-SSPs have potential as an alternative model of supporting aging in place. Longitudinal research exploring the impacts of both NORCs and NORC-SSPs on older adult health and well-being is recommended. Future research should also explore ways to improve the sustainability of NORC-SSPs.

Contextualizing Innovative Housing Models and Services within the Age-Friendly Communities Framework

This paper compares and contrasts the characteristics of three models of housing and services for older adults, cohousing, Naturally Occurring Retirement-Community Supportive Services Program (NORC-SSP), and Villages, and links them to the domains of the age-friendly communities (AFC) framework, specifically a) services, supports, and information, b) respect, inclusion, and diversity, c) social and civic participation, and d) affordability. We discuss key barriers and challenges of these models with respect to the AFC domains, as well as implementation and sustainability. Consideration of these models in age-friendly housing policy and practice could help expand and diversify the choices in the housing and services continuum. This aligns with AFC's emphasis on the need for housing and services responsive to older adults' diverse health and social needs, provide options that balance autonomy, choice, and support, and emphasize older adults' participation and involvement in tailoring these options.

Links between social environment and health care utilization and costs

The social environment influences health outcomes for older adults and could be an important target for interventions to reduce costly medical care. We sought to understand which elements of the social environment distinguish communities that achieve lower health care utilization and costs from communities that experience higher health care utilization and costs for older adults with complex needs. We used a sequential explanatory mixed methods approach. We classified community performance based on three outcomes: rate of hospitalizations for ambulatory care sensitive conditions, all-cause risk-standardized hospital readmission rates, and Medicare spending per beneficiary. We conducted in-depth interviews with key informants (N = 245) from organizations providing health or social services. Higher performing communities were distinguished by several aspects of social environment, and these features were lacking in lower performing communities: 1) strong informal support networks; 2) partnerships between faith-based organizations and health care and social service organizations; and 3) grassroots organizing and advocacy efforts. Higher performing communities share similar social environmental features that complement the work of health care and social service organizations. Many of the supportive features and programs identified in the higher performing communities were developed locally and with limited governmental funding, providing opportunities for improvement.

Characterizing Older Adults' Involvement in Naturally Occurring Retirement Community (NORC) Supportive Service Programs

Naturally Occurring Retirement Community (NORC) Supportive Service Programs constitute one of the longest-standing models for age-friendly community initiatives. As a support-focused model, NORC programs typically offer a range of benefits--including direct services, group activities, and broader community development activities--that are intended to engage older adults with diverse needs, preferences, and interests. Moreover, NORC programs are designed to be used according to the needs of the particular participant engaging with them at a particular point in time. This range and flexibility of benefits indicate the importance of more systematically characterizing the ways in which older adults are involved with NORC programs. For this purpose, we used data from in-depth interviews with 35 residents across 6 NORC programs in New York City. Qualitative analysis revealed 6 ordered categories of involvement: (a) consciously no involvement; (b) involved, but not consciously; (c) relationship with staff only; (d) selectively involved with a strong sense of security; (e) NORC program leaders; and (f) dependence on the NORC program. Overall, results indicate how older adults' involvement in NORC programs can be characterized beyond their utilization of specific types of services and by their relationship with the program as a whole. Findings suggest the importance for outcomes research on NORC programs and related models to consider subgroup differences by involvement. Results also provide directions for theory development on engagement in voluntary programs, as well as for practice to enhance older adults' involvement in supportive service programs.

Support from Neighbors and Aging in Place: Can NORC Programs Make a Difference?

PURPOSE OF THE STUDY

There is growing enthusiasm for community-level efforts to strengthen supportive relationships among neighbors to enhance aging in place. However, there is little research on how older adults perceive support from neighbors in terms of helping them to remain in their own homes and communities safely and comfortably, particularly in the face of later life challenges. There also is little systematic study of ways in which community initiatives might influence these relationships.

DESIGN AND METHODS

Qualitative interviews were conducted with 41 older adults from seven Naturally Occurring Retirement Community Supportive Service Program (NORC program) catchment areas in the greater New York City area. A grounded theory approach was used to identify themes and develop an empirically grounded account of NORC programs, support among neighbors, and aging in place.

RESULTS

Participants identified several ways in which NORC programs influenced support among neighbors, such as by serving as a conduit for information sharing and helping older adults to broaden their private networks of social relationships. Overall, however, participants more consistently described limitations of the NORC programs' influence on support within these relationships. Participants also described how other sources of support were necessary in addition to support from neighbors to help people overcome major challenges to aging in place.

IMPLICATIONS

Results suggest the importance of neighbors-helping-neighbors approaches to promote aging in place as a complement, rather than substitute, to other efforts, such as those that focus on enhancing access to formal providers and strengthening care within families.

Community aging initiatives and social capital: developing theories of change in the context of NORC Supportive Service Programs

This study aimed to develop theory on how Naturally Occurring Retirement Communities (NORC) Supportive Service Programs potentially transform social relationships within communities to promote aging in place. Data were analyzed from semi-structured in-depth interviews with 10 lead agencies representing 15 NORC programs in New Jersey. Results indicated that professionals seek to infuse capital within three domains of relationships: lead agency staff's relationships with older adults, formal service providers' relationships with each other, and older adults' relationships with each other. This social capital potentially enhances the amount of community-based services and supports within a residential area, as well as their accessibility, appropriateness, responsiveness, and coherence.

It takes a Village: community practice, social work, and aging-in-place

The US population of older adults will increase significantly in the coming decades. Most of these individuals prefer to age in their homes/communities. However, most communities are not prepared to handle the long-term care needs of an aging population. This article examines one model that communities are using to help older adults age-in-place, the Village. A conceptual lens based in community practice and empowerment theory is offered to explicate this model and critically evaluate social work's role in it. It also presents challenges to social work roles in facilitation and evaluation of the model.