30 Years Later, Promising Aging in Place Program Faces Growth Stall

Nearly 30 years since an extensive home- and community-based care model made its debut in New York City, the program risks seeing its future growth stalled without greater attention and investment from policymakers and the public and private sectors, according to a recent report from the Gerontological Society of America.

Since its 1986 creation in Manhattan, the Naturally Occurring Retirement Community-Supportive Service Program (NORC-SSP) has provided older adults with health care and a variety of social support programs to help them age in place for as long as possible.

A NORC is a demographic term used to describe an age-integrated housing development or neighborhood that was originally built for families, but has over time become home to large concentrations of older adults, typically those age 60 and older.

A NORC-SSP, on the other hand, is a programmatic response to this natural occurrence of graying communities. Usually, the result is a partnership between a housing development or a neighborhood, its residents, along with health and social service organizations — all collaborating to help older adults age in place.

The program has come a long way in its 29-year existence. Today in New York, $13 million in public financing, and approximately 50% more in matching community support, fund over 50 housing- and neighborhood-based NORC-SSPs in New York’s moderate- and low-income communities.

By 2002, the NORC-SSP model had spread to other parts of the country with the help of $40 million in time-limited Congressional earmarked appropriations to develop the program in more than 50 communities across the country.

But with further growth comes a set of challenges barring the program from even more widespread adoption, according to the GSA report authored by Fredda Vladeck, director of United Hospital Fund’s Aging in Place Initiative, and Anita Altman, deputy managing director of government affairs and external relations at the UJA-Federation of New York.

“The NORC-SSP model’s potential to strengthen age-integrated communities to support people as they age in place has yet to be fully realized,” write Vladeck and Altman. “There is no question that a public policy agenda is needed to build on the strengths of communities and make place-based programs in aging a reality.”

Professionally staffed by nurses and social workers, NORC-SSPs aim to harness community resources with the main goal of maximizing the health and well-being of its seniors in such a way that “reweaves the social fabric of the community, and fosters new roles for older adults as shapers of and contributors to their community.”

In order to achieve these goals, policymakers are charged with having to overcome certain obstacles. The first and foremost of which includes identifying communities as NORCs and what defines them as such. Considering how many older adults are needed to constitute a NORC, and the boundaries that define a community, must also be taken into account.

“State and local governments will need to define the term aged-in community to reflect their locality-specific demographics and where older adults live,” write Vladeck and Altman.

Health care reforms have touted the necessity of demonstrating outcomes across all provider types. And even though they are not necessarily providing care, this is equally as important for NORC-SSPs, which have largely reported to their public and private funders metrics like consumer satisfaction surveys and anecdotal stories that highlight the importance and value of what they do. But that is not enough.

“Although evidence-based health prevention and promotion programs have spread across the aging network, it is difficult to demonstrate that they are targeted to the right individuals and thus producing the outcomes promised,” Vladeck and Altman write. “While such outputs are substantial and important, they do not tell us much about outcomes.”

Perhaps one of the most critical drivers for large-scale program adoption, the report’s authors suggest, is the need to establish a national vision—one that shifts from individual service to place-based programs that transform communities into supportive environments for all older adults.

“It always comes down to this: without the appropriate public investment, developing the conceptual framework and corresponding metrics, as well as building the infrastructure necessary to demonstrate outcomes, real change cannot happen,” write Vladeck and Altman.

While the nation continues to invest billions of dollars into redesigning the health care system to achieve the Triple Aim under the Affordable Care Act, the report’s authors argue that no such investment—or anything close to it—is being made in the aging field, despite the looming demographic swell of the senior population in the coming years.

“The question is twofold: whether this country is willing to make the conceptual leap to embrace the critical role of community in sustaining older residents as they grow older and frailer and whether it will make the financial investment necessary to realize this vision,” write Vladeck and Altman.

Written by Jason Oliva