[Senate Hearing 109-599]
[From the U.S. Government Publishing Office]
S. Hrg. 109-599
NATURALLY OCCURRING RETIREMENT COMMUNITIES: A MODEL FOR AGING IN PLACE
=======================================================================
HEARING
BEFORE THE
SUBCOMMITTEE ON RETIREMENT SECURITY AND
AGING
OF THE
COMMITTEE ON HEALTH, EDUCATION,
LABOR, AND PENSIONS
UNITED STATES SENATE
ONE HUNDRED NINTH CONGRESS
SECOND SESSION
ON
EXAMINING NATURALLY OCCURRING RETIREMENT COMMUNITIES AND WHAT IMPACT
THEY MAY HAVE ON THE ABILITY TO CREATE LIVABLE COMMUNITY OPTIONS FOR
ALL AMERICANS
__________
MAY 16, 2006
__________
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COMMITTEE ON HEALTH, EDUCATION, LABOR, AND PENSIONS
MICHAEL B. ENZI, Wyoming, Chairman
JUDD GREGG, New Hampshire EDWARD M. KENNEDY, Massachusetts
BILL FRIST, Tennessee CHRISTOPHER J. DODD, Connecticut
LAMAR ALEXANDER, Tennessee TOM HARKIN, Iowa
RICHARD BURR, North Carolina BARBARA A. MIKULSKI, Maryland
JOHNNY ISAKSON, Georgia JAMES M. JEFFORDS (I), Vermont
MIKE DeWINE, Ohio JEFF BINGAMAN, New Mexico
JOHN ENSIGN, Nevada PATTY MURRAY, Washington
ORRIN G. HATCH, Utah JACK REED, Rhode Island
JEFF SESSIONS, Alabama HILLARY RODHAM CLINTON, New York
PAT ROBERTS, Kansas
Katherine Brunett McGuire, Staff Director
J. Michael Myers, Minority Staff Director and Chief Counsel
______
Subcommittee on Retirement Security and Aging
MIKE DeWINE, Ohio, Chairman
JOHNNY ISAKSON, Georgia BARBARA A. MIKULSKI, Maryland
ORRIN G. HATCH, Utah JAMES M. JEFFORDS (I), Vermont
JEFF SESSIONS, Alabama JEFF BINGAMAN, New Mexico
PAT ROBERTS, Kansas HILLARY RODHAM CLINTON, New York
MICHAEL B. ENZI, Wyoming (ex EDWARD M. KENNEDY, Massachusetts
officio) (ex officio)
Karla L. Carpenter, Staff Director
Ellen-Marie Whelan, Minority Staff Director
(ii)
C O N T E N T S
__________
STATEMENTS
TUESDAY, MAY 16, 2006
Page
DeWine, Hon. Mike, Chairman, Subcommittee on Retirement Security
and Aging, opening statement................................... 1
Mikulski, Hon. Barbara A., a U.S. Senator from the State of
Maryland, opening statement.................................... 2
Ginzler, Elinor, Director of Livable Communities, AARP,
Washington, DC; and Fredda Vladeck, Director, Aging in Place
Initiative, United Hospital Fund, New York, New York........... 4
Prepared statement of Fredda Vladeck......................... 7
Clinton, Hon. Hillary Rodham, a U.S. Senator from the State of
New York, opening statement.................................... 12
Prepared statement........................................... 15
Keller, Joyce Garver, Executive Director, Ohio Jewish
Communities, Columbus, Ohio; Ann Sutton Burke, Program Director
of Options Cincinnati, Senior Adult Services, Cincinnati Jewish
Family Services, Cincinnati, Ohio; Julia Pierson, Director of
Senior Home Services, Senior Friendly Neighborhoods/CHAI,
Baltimore, Maryland; and Beth Shapiro, Manager, Community
Partners, Jewish Federation of Greater Washington, Rockville,
Maryland....................................................... 18
Prepared statements of:
Ann Sutton Burke......................................... 23
Julia Pierson............................................ 27
Beth Shapiro............................................. 34
Letter to Senator DeWine from Ann Sutton Burke................... 25
(iii)
NATURALLY OCCURRING RETIREMENT COMMUNITIES: A MODEL FOR AGING IN PLACE
----------
TUESDAY, MAY 16, 2006
U.S. Senate,
Subcommittee on Retirement Security and Aging, Committee on
Health, Education, Labor, and Pensions,
Washington, DC.
The subcommittee met, pursuant to notice, at 10:39 a.m., in
room SD-430, Dirksen Senate Office Building, Hon. Mike DeWine
(chairman of the subcommittee) presiding.
Present: Senators DeWine, Mikulski, and Clinton.
Opening Statement of Senator DeWine
Senator DeWine. Good morning. We apologize for being late.
The Senate had a vote that was originally scheduled at 10
o'clock. Then it was scheduled at 10:15. Then it was scheduled
at 10:20 and so here we are.
We welcome all of you to the Subcommittee on Retirement
Security and Aging's first hearing on the topic of naturally
occurring retirement communities.
Let me thank Senator Mikulski. She will be here in just a
moment. Barbara and I just voted on the floor. I know that
NORCs are of great interest to her and I have had many
discussions with Senator Mikulski about this topic.
They are a growing phenomenon really in the always evolving
aging network. Older Americans are an important and rapidly
growing segment of our population, so the issue of aging in
place, in the home, becomes even more important.
We know that over 36 million people living in the United
States are over the age of 65, accounting for about 12 percent
of the current population. The Census Bureau projects that 45
years from now people 65 and older will number nearly 90
million in the United States and comprise about 21 percent of
the population.
As Senator Mikulski and I work on the reauthorization of
the Older Americans Act, we are continually reminded of the
needs of the aging baby boomer population. We know that our
current infrastructure will not be able to handle the magnitude
of this growing population. That is why we need to look to new
models which will allow older persons to thrive while remaining
in their own homes.
There are real, important issues that come with the aging
of a population. We are all aware of the needs of older
Americans, which includes adequate nutrition, medications,
accessibility of doctors, transportation to those appointments,
opportunities to take part in social activities, the ability to
care for themselves and, if they cannot, the ability to have
someone help them care for themselves.
Naturally occurring retirement communities occur across our
Nation and can be excellent models for aging in place. As
people age together, it makes sense to provide services to help
them remain in their homes for many reasons, the most important
being that they usually want to remain in their own homes.
Also, this arrangement is better because it is cost-effective
and minimizes the disruption in their lives. We can all
understand how an older person would want to remain in his or
her home for as long as possible. Family members cannot always
be there to make sure that you are taking your medication or
have a nutritious meal, but the supportive services offered in
many NORCs can do just that.
I look forward to our testimony today and I want to thank
those of you who have arrived from out of town, including two
witnesses from Ohio who will be on our second panel.
Let me now turn to Senator Mikulski for any opening
comments that she would like to make.
Opening Statement of Senator Mikulski
Senator Mikulski. Thank you very much, Mr. Chairman, for
convening this very important hearing on something called
NORCs, the naturally occurring retirement communities.
I have really been excited about this hearing and I have
been excited over the fact that since 2001 we have been really
funding local social demonstration projects to see what are the
best ideas and the best practices to help people who are aging
in place. This hearing, I think, will tell us then what is it
that we have learned? What can we do to be both socially
responsible in this area, fiscally responsible? Do we need a
national program? Or should we keep on doing it the way we are
doing it and leave it to local flexibility and initiative?
These programs have been very important in helping people
remain in their own communities, the community of a lifetime,
to remain in a community where they feel part of an extended
family offering the very important service and social
infrastructure needed.
I first learned of NORCs when I was either the Chair or the
Ranking Member of the VA HUD Appropriations Committee.
Through HUD, we heard about in our housing programs in both
Baltimore and in the Washington suburbs sponsored by the United
Jewish Communities, whether it was the Associated Jewish
Charities in Baltimore or the Federated, about this compelling
human need, people aging in place, people living in the same
ZIP code.
But it is not so much where they live. It is how they live.
And because they were part of a community, they wanted to stay
part of that community, close to family, close to doctors,
close to friends. And therefore, while they had their social
and medical network, what they needed was a social
infrastructure to support that.
That is what the NORCs did, but before I get into some
national program and let us spend a lot of money, I knew that
by turning to the UJC--in my case the Associated and the
Federation--this would be a way of coming up with what really
works, what really helps people, and how can we do it in the
most cost-effective kind of way.
We knew that through turning to the considerable expertise,
and I know that there are over 22 projects that are going on.
Senator DeWine, my very able colleague, is outlined what
are NORCs and I will not go into that, and why there are these
supportive models around social work, services, health,
transportation, and access to health as well as those other
social issues.
For me, it has been about what I have seen in Baltimore.
Run by the Baltimore Associated Jewish Community, we served
over 1,500 seniors in 22 apartment buildings but all are almost
contiguous to each other, and have been able to provide core
services from information and referral, health services and
important transportation. Baltimore focuses on a warm house
concept and we are going to be hearing about how a warm heart
got translated into a warm house concept and what this means.
Also, then, when we look to Silver Spring/Rockville they
were again serving 800 seniors, helping them with their
doctor's appointment, the shopping. And again, that was in, I
think, about all 11 apartment buildings.
But again, it is not about buildings and programs. It is
about people. Because of this intervention, people were better
off. They were in compliance for their medical appointments,
very important to remaining independent. They were able to
maintain that access to friends and to family, very important,
because there is more than one way to help a heart to stay
well.
And number three, they could do it knowing that they were
not alone and that we dealt with the issues of loneliness,
depression and isolation, a leading impediment to good health.
So we look forward to hearing from the people who actually
did the hands-on and the helping hand and to learn from their
experiences.
I want to thank you for the hearing.
Senator DeWine. We turn to our first panel. Elinor Ginzler
is our first witness. She is the Director of Liveable
Communities in the Office of Social Impact at AARP. She is
responsible for the development of strategic plans to achieve
social impact goals for AARP in the areas of mobility and
housing.
Since joining AARP in 1998, Ms. Ginzler has been
instrumental in overseeing programmatic work in these areas.
She has over 20 years experience in service delivery systems to
the elderly and worked collaboratively with public, private,
nonprofit, and community-based organizations. She is also an
expert in long-term care issues and served on several boards
and task forces.
She also co-authored the book Caring For Your Parents: The
Complete AARP Guide.
Our second witness will be Fredda Vladeck, who is the
Director of the United Hospital Fund's Aging in Place
Initiative. This initiative works to further the development of
new service delivery models that address the critical issues
presented by the growing number of people who are aging in
place.
She has been a certified social worker for almost 30 years
and an advocate for the needs of older people and other
vulnerable populations. She was the founding Director of the
first comprehensive NORC Supportive Service Program at Penn
South and has worked with others to replicate the program.
There are now 33 such programs in New York City.
Let me now turn to Ms. Ginzler. Thank you very much for
joining us.
STATEMENTS OF ELINOR GINZLER, DIRECTOR OF LIVABLE COMMUNITIES,
AARP, WASHINGTON, DC.; AND FREDDA VLADECK, DIRECTOR, AGING IN
PLACE INITIATIVE, UNITED HOSPITAL FUND, NEW YORK, NEW YORK
Ms. Ginzler. Good morning, Chairman DeWine and Ranking
Member Mikulski.
I am Elinor Ginzler, AARP's Director for Liveable
Communities in the Office of Social Impact.
On behalf of AARP, I thank you for the opportunity to
discuss AARP's views regarding aging in place and what impact
naturally occurring retirement communities may have on our own
ability to create livable community options for the 50-plus
population and all Americans.
In AARP's landmark 2005 study, A Report to the Nation on
Livable Communities: Creating Environments for Successful
Aging, we define livable communities as having affordable and
appropriate housing, supportive community features and
services, and adequate mobility options, which together
facilitate personal independence and the engagement of
residents in civic and social life.
Naturally occurring retirement communities were generally
built many decades ago and originally served a mix of ages.
Over time longtime residents grew older, fewer young families
moved in. And except for age composition, there are few other
defining characteristics of NORCs. They are frequently urban
but they are also found in the suburbs. Many rural areas also
have NORCs as younger residents have moved away for job
opportunities and older residents have stayed.
We know from AARP surveys that the vast majority of older
adults want to stay in their homes and their communities.
According to AARP's 2005 State of 50-plus America Survey, 89
percent of those polled reported that they want to stay in
their current residence for as long as possible and 85 percent
want to stay in their community for as long as possible.
And we also know, from Census data, that their behavior
matches their words. Older persons move much less frequently
than younger people. Only about 5 percent of people over age 55
move in any given year, and about half of those move within the
same county.
AARP believes people should be able to age with
independence, choice and control, and the ability to stay in
their communities helps them do just that. NORCs offer a unique
opportunity to develop service delivery methods that take
advantage of efficiencies of scale. That is, providing services
where concentrations of seniors are aging in place may make it
possible to serve more older individuals at a lower cost,
enhancing their ability to stay in their homes and avoiding
expensive institutionalization.
Also of interest, as a complement to supportive services,
are programs that assist residents with maintaining the housing
stock, including reauthorization and home repair. Preservation
of this housing stock not only benefits current owners but
helps assure a high-quality supply of housing for future
residents.
Understanding NORCs and the value of providing supportive
services can help public and private policymakers plan more
livable communities. When it comes to livability, most of our
communities are now playing a frantic game of catch up and many
others do not even realize what lies ahead.
Expanding research on seniors living in NORCs should
provide a broader picture of the significant contributions
seniors make in their communities as volunteers, community
leaders, mentors and teachers, and help demonstrate the many
ways that intergene-
rational living enhances the community as a whole.
Because NORC residents represent many types of people,
research on NORCs should provide a more accurate picture of the
status of healthy active seniors. This data could provide a
valuable counterpoint to much of the current research which
often focuses on the frail and homebound elders. The challenge
then is to create livable communities with appropriate and
affordable housing, adequate options for mobility, and the
community features and services that can facilitate personal
independence and continued engagement in civic and social life.
The community-based services and NORC-related research grants
funded by the Older Americans Act are critical to making this
happen.
But while increased resources are needed to explore the
potential of NORCs and to better serve their residents, along
with all older Americans, more money is not enough, and enough
money is not likely to be made available in the current
budgetary climate.
In this light, AARP believes the enactment of S. 705, the
Meeting the Housing and Service Needs of Seniors Act of 2005 is
essential. As proposed, S. 705 would establish a Federal
interagency council to not only coordinate service delivery but
also monitor, evaluate and recommend improvements in existing
programs and services that assist seniors in meeting their
housing and service needs at the Federal, State and local
level.
We note for the record that the Senate passed this
legislation by unanimous consent last November and we encourage
you both to do all you can to encourage House passage before
the end of this Congress.
In sum, AARP applauds the Chairman and Ranking Member for
their leadership regarding NORCs, as well as many other health,
economic security and livable communities issues. We look
forward to continuing to work together with you to ensure a
healthy, secure and independent future for America's older
population.
Senator DeWine. Ms. Ginzler, thank you very much.
Mrs. Vladeck.
Mrs. Vladeck. Thank you, Mr. Chairman, Senator Clinton,
Senator Mikulski. My name is Fredda Vladeck and I am the
Director of the Aging in Place Initiative at the United
Hospital Fund of New York.
In 2005, there were more than 80 NORC supportive service
contracts supported by funding. This is definitely a growing
phenomenon. Approximately 43 contracts in 25 states were the
result of congressional earmarks. And we are fortunate in New
York to have a critical mass of program experience in both the
housing-based model and the neighborhood-based model approach
as a result of deliberate legislation and financing now at $10
million enacted by both the city and the State. More than
50,000 older adults live in multi-age communities served by New
York's 43 NORC programs.
I would like to emphasize three things that underlay the
NORC supportive service program approach, distinguish them from
other senior services, and make them a particularly important
avenue of needed change to our system of service.
The ultimate goal of NORC programs is, as we have said, to
help transform communities into good places to grow old.
Communities that support healthy, productive, successful aging
and respond with calibrated supports as individual needs
change. This means building these programs from the ground up
so they are integral to the community and reflect not only the
needs of residence which evolve over time but also their
aspirations.
Second, unlike many existing programs and services,
eligibility for NORC program participation is on the basis of
residential status, not on functional deficits or economic
need. We know how to target a specific service to someone with
a specific problem. I call it the one hip fracture at a time
approach.
But we are less good at shoring up the natural supports in
a community, weaving and reweaving the social fabric or
empowering older residents to take on positive roles in shaping
the kind of community they think will be most supportive to
them.
Given these first two principles, successful programs must
be partnerships that bring together the social capital,
businesses and services in a community to effectively harness
and target its resources to address the physical, social,
emotional, health and environmental structural challenges faced
by a community as it ages in. No single provider can do it all.
In New York, these partnerships include at a minimum
government, a housing entity where one exists, the residents,
and health and social service providers. Often other leaders or
community stakeholders are involved in the programs.
As this committee deliberates ways to address the growing
phenomenon of NORCs I offer the following recommendations. The
term naturally occurring retirement community needs to be
clearly defined and delineated for purposes of eligibility for
funding. The original definition had some key elements that
spoke to a geographic coherence, multiage or age-integrated
buildings or neighborhoods, a specific density of older people
in the community in order to achieve economies of scale. In New
York, we define it both in terms of absolute numbers and
percentages.
New York State's legislation can be a starting point, but I
think modifications will need to be made to reflect the density
differences and types of communities found in other parts of
the country.
Second, we need to be clear about the purpose of a NORC
supportive service program and how it differs from existing
services. NORC funding should be value-added, not used for
duplicating existing services or shoring up through a different
funding stream our woefully underfinanced service systems. To
be sure, they need money as well, but NORC programs are
something entirely different.
Third, we need to establish a set of standards that are
enforceable and that get us to our goal of building community
infrastructure to support aging in place. We should expect
programs to produce improvements on a range of quality of life
indicators for community dwelling seniors. Such things as level
of connectedness to one another and to a program; improvement
in key health indicators for older people; supporting new roles
for older people; and establishing strong and consistent
linkages with the primary health providers in a community are
some important indicators of a community's ability to support
aging in place.
The Fund is working with the city of New York's Area Agency
on Aging to develop a set of community health indicators for
advancing healthy aging in place that will help us measure the
program's impact and I would be happy to share the results once
they are available.
We need to also establish and fund a national research
agenda that helps us understand the overall efficacy of this
approach. Some have tried to claim that NORC programs prevent
nursing home placement, as if nursing homes were the opposite
of community living. But given the purpose of NORC programs, I
think the lens through which we need to evaluate the NORC
supportive service program approach is less about long-term
care and much more about long-term living.
I thank the members of this committee for the opportunity
to testify and I am happy to answer any questions.
Senator DeWine. We thank both of you very much.
[The prepared statement of Mrs. Vladeck follows:]
Prepared Statement of Fredda Vladeck
Mr. Chairman, members of the committee, my name is Fredda Vladeck.
I am the director of the Aging in Place Initiative at the United
Hospital Fund, a research, policy, and philanthropic organization
focused on strategies to improve the delivery of services to vulnerable
people in New York.
It is a special pleasure to be here today. I have been involved
with NORCS and the development of Supportive Service Programs since
1985 when, along with UJA-Federation of New York, the residents of Penn
South, and others, I developed and then directed the first NORC-
Supportive Service Program (NORC-SSPs). Since then, I have been
involved in the evolution of NORC-SSPs in New York State and New York
City, which together provides $8 million to support 42 public-private
partnership programs in New York, with another $2 million in the works.
I've also had the pleasure of working with the Administration on Aging
and the Office of the Assistant Secretary for Planning and Evaluation
as efforts have been made to disseminate this approach in other
communities across the country. And with the support of the Daniels,
the Weinberg, and the Samuels Foundations, we at the Fund are now
working with program leaders and developers in seven states to
establish a NORC Action Blueprint guide that will inform the future
development of successful programs.
In 2005, there were more than 80 NORC Supportive Service Programs
receiving public funding. Approximately 43 programs in 25 states were
the result of congressional earmarks. We are fortunate in New York to
have a critical mass of program experience. There are 42 programs in
New York State and New York City because beginning in 1995 and 1999,
respectively, they each promulgated legislation and financing to
support the development of NORC-SSPs. Today, $7.9 million in State and
City tax levied dollars help support 33 classic (housing-based with a
common ownership/management structure) NORC-SSPs and 9 neighborhood-
based programs in communities in which more than 50,000 older adults
live.
These programs reflect the city's range of low- and moderate-income
housing and are located in 4 out of the 5 boroughs. Eight programs are
in multi-family public housing developments; twenty (20) are in
moderate income cooperatives; three are in moderate and low-income
private rental developments; and two are in neighborhoods where there
is no common housing ownership. NORC programs are in communities large
and small--from a single building with 259 seniors among the residents,
to a housing development with 8,000 seniors in 171 different buildings
spread over a vast geographic area, and now in neighborhoods that are
approximately 2 square miles.
New York's NORC-SSPs are collaborative partnerships between
government, housing, the residents, health care, and social service
organizations. Participating organizations include 42 different housing
developments, 15 different social service agencies, and 12 different
healthcare organizations (including hospitals, homecare agencies,
nursing homes, and an ambulatory care clinic).
These programs are true public-private financial partnerships. Five
million dollars in city awards to 33 programs annually leverages
another $5 million in private support from philanthropy ($1.5 million);
housing developments ($1 million); health provider partners ($1.5
million in contributed nursing time); and in-kind contributions from
housing entities of close to $1 million. (A good Place To Grow Old
provides a detailed description of New York City's NORC Supportive
Service Programs and can be accessed at www.uhfnyc.org)
Inevitably, as models such as NORC Supportive Service Programs get
broadly disseminated, underlying principles can become foggy. So in my
testimony this morning, I would like to emphasize the 3 things that
underlie the NORC-SSP approach, distinguish them from other senior
services, and make them a particularly important avenue of needed
change to our system of service to seniors.
1. The ultimate goal of NORC Supportive Service Programs is to help
transform communities into good places to grow old--communities that
support healthy, productive, successful aging and respond with
calibrated supports as individual needs change. This means building
programs from the ground up so they are integral to the community
(rather than being imposed from a distant office) and reflect not only
the needs of residents--which evolve over time--but also their
aspirations. Successful NORC-SSPs connect to the traditional range of
services, but they must also develop other kinds of supports and
services in order to be responsive to changes in their communities and
their residents.
2. Unlike many existing programs and services, eligibility for
participation by seniors in NORC-SSPs is on the basis of residential
status, not on functional deficits or economic status. We know how to
target a specific service to someone with a specific problem (the one
hip fracture at a time approach), but we are less good at shoring up
the natural supports in a community, weaving/re-weaving the social
fabric, and empowering older residents to take on positive roles in
shaping the kind of community they think will be most supportive to
them. In most communities in this country the older residents are a
heterogeneous group, with 40 years between the oldest and the youngest
and individuals experiencing oscillating, changing states of health as
chronic conditions become acute and then get brought back under
control. These realities necessitate a broad range of services and
programming with an ability to respond flexibly to address the
heterogeneity of the older population in a community.
3. Given these first two principles, successful programs must be
partnerships that bring together the social capital, businesses, and
services in a community to effectively harness and target its resources
to address the physical, social, emotional, health, and environmental/
structural challenges of a community as it ages in. No single provider
can do it all. In New York, these partnerships include, at a minimum,
government (the local Area Agency on Aging and the State Unit on
Aging); a housing entity, where one exists; the residents; and health
and social service providers. Often other leaders or community
stakeholders are involved in the programs.
For a generation, we have been preoccupied with specialized
facilities or housing for the elderly--but in fact most older people
want to and do remain in their long-time homes in communities not built
for seniors. Many of these communities have or will evolve into NORCS.
As this committee deliberates on how to address the growing phenomenon
of NORCs, I offer the following recommendations:
1. The term Naturally Occurring Retirement Community needs to be
clearly defined and delineated for purposes of eligibility for funding.
The original definition described an apartment building or buildings
not built for seniors in which 50 percent of the heads of household
were 60 years of age or older. Key elements of this definition are (a)
geographic coherence; (b) buildings or neighborhoods that are multi-age
or age integrated; (c) a specific density of older people in the
community (which New York defines in both absolute numbers and
percentages) to achieve economies of scale. New York State's
legislation can be a starting point, but modifications will need to be
made to reflect the density differences and types of communities found
in other parts of the country.
2. We need to be clear about the purpose of NORC-Supportive Service
Programs and how they differ from existing services. NORC funding
should be value added, not used for duplicating existing services or
shoring up, through a different funding stream, our woefully
underfinanced service systems. To be sure, some of our existing
federally funded programs are in need of shoring up. But NORC-SSPs are
something entirely different from what already exists.
3. We need to establish a set of standards that are enforceable and
that help get us to our goal of building community infrastructure to
support aging in place. We should expect NORC-SSPs to produce
improvements on a range of quality of life indicators for community-
dwelling seniors. Such things as level of connectedness to one another
and to a program; improvement in key health indicators for older
people; supporting new roles for older people as community leaders and
doers; and strong and consistent linkages with the primary health
providers in a community, are all important indicators of a community's
ability to support aging in place.
NORC-SSP contractors ought to be able to tell us what it is they
expect to accomplish each year and how they plan on getting there, and
then tell us what the outcome is. (For example, working with the city
of New York's Area Agency on Aging, the Fund is developing a set of
community health indicators for advancing healthy aging in place that
will help programs measure their impact. I'd be happy to share the
results with this committee once they are available).
This is a fundamental change in the world of aging services,
shifting from a units-of-service reporting system to one that is
outcome-oriented. It will require new skill sets of a workforce that is
by and large underpaid and undervalued.
4. We need to establish and fund a national research agenda that
helps us understand the overall efficacy of this approach. Some have
tried to demonstrate that NORC programs prevent nursing home placement
(as if nursing homes were the opposite of community living). But, given
the purpose of NORC programs, the lens through which we need to
evaluate the NORC-SSP approach is less about long-term care and much
more about long-term living.
I thank the members of this committee for the opportunity to
testify. I'd be happy to answer any questions.
Senator DeWine. Ms. Ginzler, you talked about the
efficiency of scale. Mrs. Vladeck, you talked about the economy
of scale. Would you both like to explain how that is achieved,
and what kind of actual savings are we actually talking about?
Ms. Ginzler. I will go first and then let my colleague fill
in the blanks.
You can easily get to an economy of scale notion when you
think about the density issue that was described. You have a
whole lot of older people who are in need of services in a
close geographical area who do not need full-time services but
need a few hours of care potentially on a daily basis.
You can provide a series--one care worker, for example,
could provide a full day's worth of work literally by walking
down the hall of an apartment building and providing 2 hours to
the resident on one floor, 2 hours to a resident who lives a
few doors down. And in that way the actual scale is reached,
the individual needs of several hours, a provider can give that
care in an incredibly efficient way, cutting down on travel
time, cutting down on overhead costs, and really meeting the
needs of the individual where they are to the degree that they
need.
Mrs. Vladeck. I think that description applies both to
social work services and case management services, as well as
chronic care nursing services. Right now when these services
are delivered in a traditional model, they are sent from a
distant office. So you are really doing this one hip fracture
at a time.
But I think there is another piece to it, which is that
when you are onsite in a community and you are building
community infrastructure you are also looking for other
resources in the community, the social capital. And it is
amazing the kind of mutual support that goes on in a community
that is hidden from us professionals.
And so it is a real blending of both the revenue streams as
well as the social capital to really build the support systems
that you need in a more cost-effective way.
Senator DeWine. Ms. Ginzler, the NORCs that I have seen in
Ohio have demonstrated that density. And you can certainly see
the efficiency of scale.
But you mentioned that NORCs do occur or can occur in a
rural setting. How does that work? And do you not lose that
economy of scale when you get into a rural area?
Ms. Ginzler. Certainly the dynamics are different in a
rural setting. I think perhaps the most important feature to
think about in those cases is that these are individuals who
want to stay in their community and they have lived there most
of their lives, if not all of their lives. And they are, to
some degree, the backbone of those community settings.
If we cannot provide them with the assistance that they
need through the supportive services, they actually might be
forced to leave their community and move out of that rural
setting to potentially a facility in another location that
would clearly be not supportive of their desire to age in
place.
Senator DeWine. Which is a very traumatic experience. I
mean, they are totally gone from their community.
Ms. Ginzler. Absolutely.
Senator DeWine. Senator Mikulski.
Senator Mikulski. Thank you very much.
First, Ms. Ginzler, I want to be clear when I complimented
the UJC, the important role the AARP has played. The UJC has
actually run some of the demonstration projects. As a social
worker, I have seen more of the hands-on. But we want to thank
AARP for what they have done.
And of course, Mrs. Vladeck, you are viewed as kind of the
godmother of NORCs, and I think one of the original kind of
social architects.
Let me go first to AARP and then to you, Mrs. Vladeck.
We have either one of three models to pursue. One, do
nothing, say ``okay this is great to know.'' No. 2, to think
about a new national program. Or to do a reformist model in
existing programs and an incremental approach.
You are talking, Ms. Ginzler, and I am going to ask you
about reform and then also rural. You talk about S. 705 that
Senator Sarbanes designed. I am a cosponsor, and it has passed.
That is really an interagency coordinating model since it is no
new money, no new services and so on.
One of my questions would be: Is this just a new layer of
bureaucracy that will not mean a ginger snap or a glass of
Ensure to helping the senior population remain independent and
happy about remaining independent?
Ms. Ginzler. I do not think it is a ginger snap or a glass
of Ensure. I think it is an important step. And I think the
ability to coordinate, I do not think we can lose track of the
importance of that and the reality that will be able to come
about with this interagency council that will address this
whole issue of duplication of services. If people across the
spectrum at the Federal, State and local levels are doing a
better job of knowing what each other are doing and dividing up
the work that is going to be done and the purview that is
needed. I think we are going to be better able to serve our
elders. It does not take the place of supportive services
available.
Senator Mikulski. Along with kind of reforming and seeing
where we go?
Ms. Ginzler. Yes.
Senator Mikulski. You also mentioned research and also Mrs.
Vladeck mentioned it as well, and talk about how research
focuses usually on the frail elderly or the homebound. Could
you tell me where you think research ought to be done? In other
words where, if we wanted to do that?
Ms. Ginzler. I will go so far as to say that I think what
we need to be continuously doing, and I know we are doing, is
researching and evaluating those models that are on the ground
now and figuring out the best way to assess them.
Senator Mikulski. Where? Here is the question, is it at
HUD? Is it at the Office of Aging at HHS? We have a National
Institute of Aging at NIH. Where would you see this being done?
Ms. Ginzler. I am actually not able to give you that kind
of a direction at this point. I would be delighted to go back
to my office and talk to our staff and be able to contribute
back to you.
Senator Mikulski. I think that would be good because what
we are concerned about is--and each one will look at it from
their perspective, as you know, and that determines the
perspective of the research. But if you could ponder that,
because I think we do need to know about these communities.
Another question about the rurals. When I think of rural, I
think of my Eastern Shore and my Western Maryland. And it is
difficult than the way I think about NORCs. In NORCs I think
about my urban and my suburban concentrations of elderly. You
could actually see where they lived after World War II. Often
it is where they moved first-generation into the suburbs. In my
own community, inner beltway communities, etc. Then they moved.
They downsized. They moved into apartment houses which became
senior housing by proxy.
But the rurals, my gosh, it is spread out, it is all over.
How do you have a naturally occurring community when everybody
lives 20 miles from each other?
Ms. Ginzler. I think this absolutely speaks to what Mrs.
Vladeck was referencing when we have to look at the issue of
definition and come to some kind of congruence so that either
density or population or percentage, so that we can use those
definitions across. Because we are a wide country and we have
so many different models to draw from.
Senator Mikulski. But is it not true that the NORCs, as we
talk about almost in the broad sense that we are using it now,
are primarily an urban and suburban phenomenon?
Ms. Ginzler. I am actually not able to give you a
statistical analysis if you look across all the United States.
Senator Mikulski. I am not asking you about statistics. I
am asking about broad brush here.
Ms. Ginzler. I think most of us, and I came out of the
aging service delivery system before I came to AARP, and I
agree with you 100 percent. I think all of us in the aging
network, when you think NORC, we often go to the apartment
complex where people have stayed and they have literally aged
in place.
Senator Mikulski. So the idea of the rural needs to be
further dressed and conceptualize.
Ms. Ginzler. Absolutely. It is out of sight, out of mind.
Senator Mikulski. Thank you. Thank you very much. I see my
little red light is on and I know it will be Senator Clinton's
turn.
Mrs. Vladeck, do you think that these programs are best run
by faith-based organizations and nonprofits, as compared to
State or essentially the local office on aging?
Mrs. Vladeck. I think that our experience in New York is
that----
Senator Mikulski. Faith-based or a nonprofit.
Mrs. Vladeck. These programs need to be part of the
community. Faith-Based organizations are a major focus on a
community. They need to reflect who that community is. Then
that would make sense.
The State units on aging, the Area Agencies on Aging, in
our experience, are the administrative agencies for the public
dollars. And the challenge is how to integrate the services
provided through those agencies with the homegrown and building
from the ground up services that you need to develop in a NORC
program.
Senator Mikulski. That is very interesting.
My last question is should there be a new national program
included in the Older Americans Act? Should we continue to do
this through congressionally designated mandates and get more
information? And what would be the key components?
Mrs. Vladeck. I think there are those who say these are
local efforts, this should be a locally driven process. But I
think the issue of aging in place and NORCs is something that
we are facing as a country. It looks different in different
States, in different localities. But I think there needs to be
some Federal policy that is driving the impetus or creating the
impetus across the country to start rethinking and rebuilding
communities to support aging in place and really key to NORCs
in general.
So I think it is broad brush policy. How that gets
interpreted at the local level is really, I think, where the
challenge is going to be.
Senator Mikulski. Thank you, Mr. Chairman.
Senator DeWine. Senator Clinton.
Senator Clinton. Thank you very much, Mr. Chairman. I would
ask consent to submit my entire opening statement to the
record.
Senator DeWine. Without objection.
Opening Statement of Senator Clinton
Senator Clinton. Thank you.
I want to thank Chairman DeWine and Ranking Member Mikulski
for convening this hearing. I think this is one of the most
important issues that we have to confront and the Subcommittee
on Retirement Security and Aging is at the forefront of trying
to help us do it.
Of course, I am very proud of the pioneering role that New
York has played in developing and expanding NORCs and NORC
supportive service programs. As has already been pointed out,
Fredda Vladeck is the godmother of NORC-SSPs. And Mrs. Vladeck
and her husband have been wonderful citizens, not only of New
York but of our country with the work they have done on behalf
of health care and its expansion and the coverage of the
uninsured and, of course, the work about the aging.
I am also very pleased that we have with us Ron Saloway and
Anita Altman from the United Jewish Appeal Federation of New
York, the UJA Federation. They have made a great contribution
in supporting the good work of New York's NORC supportive
service programs and I wanted to thank them.
The questions that have been asked really go to the heart
of the issue. We know we have got to figure out how to deal
with the aging of our population as the baby boomers turn 60
this year and continue to age. The good news is it appears that
people will be healthier. The not so good news is that they
will be chronically ill longer. So the combination of that
means that this effort to create aging in place and help to
ease the cost of providing care to this growing group is
absolutely essential.
That is why I do think it is critical we include language
in the Older Americans Act to make NORCs a permanent part of
our strategy for helping older adults age with dignity.
I think we have to have that Federal framework because, as
Mrs. Vladeck said, one hip fracture at a time is just not going
to be an acceptable strategy. We have to get smarter and we
have to get out ahead of what is happening.
I would like to ask Mrs. Vladeck, in your testimony you
mention you are currently developing a set of community health
indicators for the evaluation of NORC-SSPs. Can you talk more
about the status of this? I know you will share it with us as
it develops. But what are you looking at? What are the
indicators? What are the lines of improvement that you are
trying to catalog?
Mrs. Vladeck. Drawing on much of the work done in Healthy
People and the public health approach, the framework that we
have devised says that in order for healthy aging or to advance
healthy aging in a community, you have to have access to health
care, you need to have promotion prevention and wellness, you
need to address those issues. And you need to figure out what
the health risks are in a community. You first have to get
those baselines. And under each of those is a set of measures,
indicators.
What we are trying to do is establish some baseline data in
all of the programs in New York City for each of these
indicators. So for example for access, everyone needs a
physician, should have a primary care physician. In one of our
NORC programs in public housing, when it opened its doors, only
30 percent of the residents, of the older adults, had a primary
care physician. Today that number is over 90 percent.
So those are the kinds of things that we need to be looking
at and we need to be looking at it across how it relates to the
city as well as nationally. Those benchmarks are around but we
need to get the programs starting to work toward those
benchmarks.
Senator Clinton. I think that is very important because if
we do move on this in the Older Americans Act I would hope we
would have some sense of evaluative criteria, even if we are
still in the process of developing them.
You know, it has only really been in recent years that the
concept of neighborhood NORCs had evolved. I know we talk about
it being 40 years and that is, as I get older, very young. But
the questions that both Senators DeWine and Mikulski asked
really go to the heart of whether this can be a national
program or not because they started in areas of great density.
They have grown there. And New York City is particularly
conducive to aging in place. I mean, people can get around
easily. They can walk places. They have access to mass transit.
So we have to think about how to create a model or several
models that will take us to a point where suburbia and rural
areas can also access that. And we have to think differently
about it. We may need to do some demonstrations and try to
figure out what works and what does not work.
I also just wanted to ask both of you, just briefly, as I
end my time here, how do we think about this concept of long-
term living instead of long-term care, Ms. Ginzler? I love that
idea. And I think it is really important that we start re-
imagining what it is we are talking about when we talk about
aging.
And how would you both kind of give us advice here on this
committee to sort of reconfigure our thinking, to move more
toward long-term living as opposed to long-term care? Ms.
Ginzler first and then Mrs. Vladeck.
Ms. Ginzler. Thank you, Senator Clinton.
Two things come to mind and it clearly is a reaction to
your first observation. We are living longer and we will live
with chronic conditions.
So I think our whole notion of it is, at the very end of
your life, that you need what we used to call long-term care,
that notion is going to go away as people are going to live for
decades with conditions that years ago would have severely
compromised your ability to maintain engagement in the world
around you. That is not going to happen anymore. We have
delightful advances in pharmacology and people can live with
disabling conditions with a much higher quality of life. And
that is all going to contribute to the notion of long-term
living, not long-term care.
I think the other term that I think we might want to think
about is the concept of independent living. Maybe we need to
think about it as interdependent living and that is a phrase I
think that fits all through life. We are all dependent upon and
working with each other as we go through all of our life's
phases. And as one is in the older age spectrum, it does not
mean you are only receiving care, you are also giving back to
the community. And this ability to think about it as long-term
living also can then shed the light a lot better on the
contributions that our older citizens make in their roles as
volunteers, as engaged in their civic community on both a
formal and informal basis.
And then at the same time they are going to need some
assistance as well, as is true all throughout life.
So I love the concept of long-term living and I think we
might want to think about interdependent living, as well.
Senator Clinton. Mrs. Vladeck.
Mrs. Vladeck. What I might add to that, I straddle several
worlds, including the long-term care world. And I can tell you
that our policies right now, when you look at Medicare, when
you look at Medicaid, when you look at some of our services
under the Older Americans Act, the focus is on providing a very
specific service and then leaving. There is no focus. No one is
responsible for re-integrating that person back into community.
And given that people move in and out of acute states of
health and dishealth, there is an unfinished piece of business
that needs to be done. And often, the older person is left to
do it on their own. Some succeed. But more often than not, they
do not.
Additionally, if you look at our homecare policy and the
issue of homeboundedness, that homeboundedness means you are
entombed, as one older woman put it, you are entombed behind
your front door, behind your apartment door because you must be
homebound in order to receive a Medicare homecare service.
Which means that you are separated from the community at the
very time that community is probably the most important thing
to sustain you.
So I think we need to start looking at some of those
policies.
The third piece that I would add is--this is the hardest
thing in the world to do--is really sort of change a mindset
about how we think about and deliver service. I say this very
humbly, that for us professionals, we are used to thinking of
the client as the dependent individual. And changing that
mindset is really going to be a phenomenal challenge for us.
Senator Clinton. Thank you very much.
[The prepared statement of Senator Clinton follows:]
Prepared Statement of Senator Clinton
First, I would like to thank Chairman DeWine and Ranking
Member Mikulski for convening this important hearing on
Naturally Occurring Retirement Communities (NORCs). As a strong
supporter of NORCs over the years, I am very proud of the
pioneering role New York has played in developing and expanding
NORC Supportive Service Programs to help seniors successfully
``age in place.''
Let me also thank Fredda Vladeck, the founding Director of
the first NORC Supportive Service Program (NORC-SSP) in New
York City and the current Director of the Aging in Place
Initiative at the United Hospital Fund, for coming here today
to share her knowledge and experience. It is great to have you
join us, Fredda. I am so grateful for your leadership and
tireless work in this area.
I also want to note that Ron Soloway and Anita Altman from
United Jewish Appeal-Federation of New York (UJA-Federation)
have made the trip down here today and are in the audience.
Thank you for the critical role you have played in advancing
the good work of New York's NORC Supportive Service Programs.
This year marks the first year that the baby boom
population turns 60. With a rapidly expanding older adult
population, it is critical that we focus attention on the
increasing needs of this elder boom and the demands placed on
our local, State, and Federal health care and social services
systems. NORC Supportive Service Programs play a significant
role in helping to address this very real challenge.
Since 1986, when Fredda Vladeck helped found the first
professionally staffed NORC Supportive Service Program in the
Penn South Houses in New York City, the number of publicly-
funded programs has grown to more than 40 in New York and
approximately 80 across the Nation.
NORC Supportive Service Programs have been invaluable in
helping seniors stay in their homes where they have long
resided and which many prefer. As I talk with seniors in New
York and across the country, this is what I hear they most
want.
The NORC model of care not only respects seniors'
overwhelming preference to age in place--to remain at home in
the neighborhoods where they have lived for years--but also
values their active participation in shaping their communities
as ``good places to grow old.''
This paradigm shift recognizes the importance of community
for positive and healthy aging. For example, NORC-SSPs promote
healthy aging by engaging seniors in preventative care before a
health crisis occurs and by responding to their changing needs
as they age over time. As a result, this approach helps prevent
the premature or unnecessary institutionalization or
hospitalization of seniors in short- and long-term care
facilities. A cost savings to Medicaid and local taxpayers.
Another important ingredient of NORC Supportive Service
Programs is the partnerships they forge between the public and
private sectors--uniting housing entities and their residents,
health and social service providers, government agencies and
philanthropic organizations. Through these partnerships, NORC
Supportive Service Programs are able to offer a range of
services--from social and health programs to educational,
recreational and volunteer opportunities--that are diverse,
flexible, and designed to engage as many community residents as
possible.
All these characteristics help support the residents of
NORCs and benefit the communities in which they reside,
reducing the overall burden on our health care and social
service delivery system, saving money.
As the baby boomers continue to age, our current
infrastructure for delivering services needs to adjust to
reflect the preference for aging in place and to help ease the
cost of providing care to this burgeoning group. NORC
Supportive Service Programs do just this.
That is why I think it is so critical, and why I have made
it a top priority to include language in the Older Americans
Act . . . to make NORC's a permanent part of our strategy for
helping older adults age with dignity. And I am hopeful that
the work that is currently going on in this subcommittee . . .
my efforts with Senator Mikulski, who has been a real champion
for NORC's, and Chairman DeWine, will accomplish this goal.
I am proud that New York has been such a leader on this
issue and we need to give more communities in my State and
around the Nation the opportunity to develop NORC-SSPs.
As we face a long-term care crisis in our country resulting
from the baby boom and the growing longevity of Americans, we
must look for solutions to this mounting problem. A permanent
grant program for NORC Supportive Service Programs in the Older
Americans Act is a critical and common sense approach for
investing in services and supports for our aging population.
NORC Supportive Services Programs offer an exemplary model
of care that respects our seniors' strong desire to remain in
their homes and in their neighborhoods, values their strengths
and contributions, and takes advantage of social networks and
public-private partnerships to provide a myriad of cost-
effective services that foster positive aging.
This innovative approach empowers older Americans to be
actively engaged in a win-win solution to their long-term care
needs. We owe it to our seniors to support these creative and
invaluable programs.
Again, I thank you for holding this hearing today and look
forward to hearing from our witnesses and working with Chairman
DeWine and Senator Mikulski to ensure inclusion of NORC
language in our upcoming Older Americans Act reauthorization.
Senator DeWine. Great panel. Thank you very much. We
appreciate it. We appreciate your testimony.
Let me invite our second panel to come up now, as I am
introducing you.
Joyce Garver Keller joins us today from Ohio where she has
served for 16 years as Executive Director of the Ohio Jewish
Communities. As head of the Ohio Jewish Communities, she has
been at the center of efforts across the State to implement
supportive services within NORCs.
She has won numerous community service and civil rights
awards. She has also been named by the Ohioan Magazine among
the top five nice but effective lobbyists in Ohio. Joyce, that
is quite interesting. I know you are nice and I know you are
effective, so I guess that works.
She has served on the Governor's Advisory Committee on
Faith-Based and Community Initiatives, the Ohio FEMA Advisory
Board and Chair of the Ohio Refugee and Immigration Advisory
Committee of the Ohio Department of Job and Family Services.
We are also joined today by Ann Sutton Burke from
Cincinnati. She is currently the Program Director of Options
Cincinnati, the supportive service program at Jewish Family
Service.
Ms. Sutton Burke also serves on the Best Practices
Committee of the Ohio Valley Appalachia Regional Geriatric
Education Center for the Office of Geriatric Medicine at the
University of Cincinnati. She is Chairwoman of the Advisory
Committee for Home Health Services for the city of Cincinnati's
Health Department.
She has over 25 years of experience working in the field of
aging. Her background includes program planning and
organization of senior centers, case management, home health,
adult day care services and corporate elder care.
Thank you both for joining us. Let me now turn to Senator
Mikulski to introduce our other two panelists.
Senator Mikulski. Thank you very much, Mr. Chairman.
I too, have two Marylanders who have actually run hands-on
with these NORC programs, of which I am very proud.
I would like to present to the committee Ms. Julia Pierson,
who is the Director of Senior Home Services at CHAI, which is
our community housing association, which is part of the Jewish
Federation of Washington. She is a graduate of the University
of Maryland School of Social Work, my school of social work.
She has worked as the Executive Director of Govans Ecumenical
Services, a neighborhood corporation.
She has over 20 years of experience in nonprofit management
and now she is the Director of Senior Home Services at CHAI
where she is coordinating its naturally occurring retirement
project.
And then we have Beth Shapiro. Beth is the Manager of the
Community Partners Federation of Rockville. She has a masters
degree of social work from the Shiva University, a graduate
with a specialty in community organization, my field.
For the past 6 years, Ms. Shapiro has been on the board of
directors of a group called Grassroots Organization of Well-
Being for Seniors. Before taking her current position, she
managed the Holy Cross Adult Day Care Center in Silver Spring
and has now worked for over 20 years with developmentally
disabled adults and seniors.
Now she is heading up the Jewish Federation of Greater
Washington's NORC supportive services in Rockville.
Ms. Pierson is doing the job in Baltimore. Ms. Shapiro is
doing the job in our Washington suburbs. I think, in doing the
job, we are going to learn how better to do ours, and we
welcome them enthusiastically.
Senator DeWine. We thank all of you very much. We have a 5-
minute rule. We are going to have a vote apparently before 12
o'clock, so we are going to run out of time here, so we are
going to need you to keep right to your 5 minutes.
Joyce, we will start with you.
STATEMENTS OF JOYCE GARVER KELLER, EXECUTIVE DIRECTOR, OHIO
JEWISH COMMUNITIES, COLUMBUS, OHIO; ANN SUTTON BURKE, PROGRAM
DIRECTOR OF OPTIONS CINCINNATI, SENIOR ADULT SERVICES,
CINCINNATI JEWISH FAMILY SERVICES, CINCINNATI, OHIO; JULIA
PIERSON, DIRECTOR OF SENIOR HOME SERVICES, SENIOR FRIENDLY
NEIGHBORHOODS/CHAI, BALTIMORE, MARYLAND; AND BETH SHAPIRO,
MANAGER, COMMUNITY PARTNERS, JEWISH FEDERATION OF GREATER
WASHINGTON, ROCKVILLE, MARYLAND
Ms. Keller. Good morning. I am Joyce Garver Keller,
Executive Director of Ohio Jewish Communities. I want to thank
Chairman DeWine and Ranking Member Mikulski and the Senate
Subcommittee on Retirement Security and Aging for the
invitation to participate in this hearing today.
As this hearing coincides with the subcommittee's
consideration of the Older Americans Act reauthorization, I
commend you for the timeliness of today's hearing.
The NORC movement in Ohio commenced specifically to assist
seniors and aging baby boomers to maintain their lifestyles and
social support networks without having to move out of their
neighborhoods. The Jewish Community Federation of Cleveland has
been in the forefront of seeking solutions to the looming
crisis of caring for an ever-growing elderly population in
Ohio.
Today Ohio is home to more than 1.5 million residents 65
years and older. Ohio, in fact, ranks 14th in the country for
this aging population.
Community Options, established in 1997, is one of the first
NORC programs based outside New York State and it is the first
program established in Ohio and one of the founding Older
Americans Act Title IV demonstration projects that were
commenced in 2002.
Recognizing that loneliness and barriers to available
services exist, Community Options was developed to better
connect with seniors living independently and linking them to
targeted community supports. The following are key factors to
understanding the Community Options NORC supportive service
model. The program is located in vertical NORC buildings at
five sites in Cleveland's Mayfield Heights, University Heights,
Beachwood and Lyndhurst neighborhoods and serves approximately
700 residents a year. The typical NORC resident served by the
program is female, widowed, in her early 80's, and has resided
in her home for more than a decade. The program serves a
diversity of ethnic and religious groups including Eastern
European Jews, African-Americans, Italians, Protestants,
Catholics, and Orthodox Jews.
The Community Options program is structured around
community organizing and senior empowerment. The seniors direct
the program through advisory councils, volunteerism, cost-
sharing for the activities they participate in, and social
service selection through a large referral system. A database
of more than 1,400 providers is maintained and monitored
frequently.
Resource coordinators ensure a community infrastructure is
in place through the development of partnerships with
landlords, vendors, residents, and community service providers
in many areas. Services and activities focus on health and
wellness, education, recreation and, most importantly perhaps,
transportation.
The coordinators maintain a regular presence in the
buildings and are recognized by the residents as the first line
of support and only a phone call away. Unlike a housing complex
with an employed service coordinator, the service activity
developed by Community Options is consumer driven and based
upon individual self-determined need and preference.
The program operates on an annual budget of approximately
$200,000 from income derived from the Jewish Community
Federation of Cleveland, from their annual Campaign for Human
Needs, other charitable contributions, landlords, activity fees
and Federal grants.
The seniors served by Community Options remain active,
engaged and living at home longer. In 2004, the program was
evaluated by Dr. Georgia Anetzberger, a renowned expert in the
field of gerontology. Dr. Anetzberger's research found that as
a result, Community Options participants are better able to
control their lives and access assistance and activities. They
are more connected to their neighbors. They feel that they have
choices and are able to live independently with self-
confidence. In her report, Dr. Anetzberger wrote that Community
Options fosters caring communities in which individual choice
making is promoted and encourages seniors to thrive.
In 2002, Community Options used its Older Americans Act
Title IV demonstration grant to test the replicability of its
NORC model in different Ohio regions. Through an RFP process it
had four recipients selected for this demonstration. They
included the Area Agency on Aging in Canton; Jewish Family
Service in Cincinnati; the Western Reserve Area Agency on Aging
in Cleveland; and Wexner Heritage Village in Columbus, a
continuum of care campus with a 200 bed skilled nursing
facility, two group homes for adults with developmental
disabilities and mental retardation, subsidized housing for 164
seniors, hospice care, end of life programming, and senior
transportation and other supportive services.
The four agencies launched 13 program sites and adhered to
the consumer-directed community building empowerment model
developed by Community Options in Cleveland.
Internationally recognized Dr. Eva Kahana, Ph.D., Director
of Elderly Care Research at Case Western Reserve University in
Cleveland was contracted to assess the emerging programs within
the demonstration project. Her report: Effects of Service
Options Program in Naturally Occurring Retirement Communities
articulated four central findings.
Results support the value of Community Options' program's
philosophy to give older adults a greater say in services to be
marshaled.
No. 2, significant improvements in reporting quality of
life for residents of housing sites with newly instituted
service and activity programs.
No. 3, researchers propose that for populations with
compromised access to basic services, tools should be developed
that embrace a community model of empowerment rather than a
clinical model of standardized assessments to determine
comprehensive social and medical needs.
And No. 4, the Community Options program has successfully
developed social capital in the community by providing
infrastructure to address the needs of community dwelling
elders.
Although the four participating agencies were able to
successfully initiate programs, future sustainability of the
NORC demonstrations became a significant challenge and only two
of the programs--Cincinnati Jewish Family Service and Western
Reserve Area Agency on Aging--were able to obtain funding
beyond the grant period to continue operations in their
respective regions.
Cleveland's Community Options, whose Federal grants with
HUD and AOA will soon be finished is in the process of
assessing how it will address the funding shortfall of
approximately $50,000 annually once these grant resources are
terminated.
While the Canton program could not continue, the experience
provided an opportunity for the AAA to strategically target
existing programs and resources in NORC locations and found
that, as a result of the demonstration, residents are more
connected to available community-based services in the area.
The Columbus agency was the only one of four that chose to
test the model in a horizontal setting, garden-type apartments.
The visible impact of the program took longer to achieve than
the others and, as a result, it was found that the landlords
did not have sufficient time to become engaged in the program
and receptive to making a long-term commitment. Should a
favorable funding environment emerge, Wexner Heritage Village
would pursue reestablishing a NORC program.
Retaining familiarity of home remains an utmost priority
for older adults. Yet for many seniors living alone with
limited mobility and difficulty in assessing socialization,
companionship and services become a major challenge to the
quality of life and independence. The Community Options NORC
supportive services program provides onsite activities, access
to social service referrals, wellness activities and community
building. The relationships developed through the resource
coordinators enable seniors to trust more quickly, learn about
and utilize community resources. Community Options'
demonstration project found that replicability was possible,
but sustainability was a significant challenge to fledgling
programs.
As supported by the findings of Drs. Anetzberger and
Kahana, communities with high concentrations of older adults
could gain tremendously if Congress were to establish a
national NORC supportive service program through the Older
Americans Act reauthorization process.
On behalf of Ohio Jewish Communities, I want to thank the
subcommittee for acknowledging the growing interest in NORC
supportive service programs and for holding this hearing within
the context of the Older Americans Act reauthorization.
I personally appreciate the opportunity to come before the
committee today and I would be happy to answer any questions.
Senator DeWine. Thank you very much. Very good.
Ms. Sutton Burke, thank you for joining us.
Ms. Burke. Thank you for having me.
I am pleased and honored to be here in my capacity as
Program Director for Options Cincinnati, the Jewish Family
Service NORC Supportive Services Program.
With over 25 years of experience serving the aging network
in community-based care, what I found innovative about the NORC
Supportive Services Program is its preemptive nature. With most
of the programs I have worked with, we wait for the phone to
ring, we wait for a crisis to happen. With Options Cincinnati,
we have turned that around with an approach that identifies
clusters of seniors, NORCs, establishes a comfortable presence,
engages residents in one-on-one and through programming, builds
relationships and creates a sense of community.
Through this program, we build trust with seniors and
together we head off potential problems. NORC Supportive
Services Programs like Options Cincinnati are responsive to
trends in aging. We have already heard that today from the
representatives, but research tells us that 9 in 10 of us want
to age in place. And for those of us like myself that are over
45, we also, a vast majority of us, want to age in place.
NORC-SSP programs on a large-scale could help seniors
throughout the country, perhaps up to one-third, receive
services to successfully age in place.
Locally, we have created a supportive environment to
prevent situations from deteriorating to a point where a move
out is the only option. In that vein, I want to share a story
of a couple we work with. They have been married 58 years and
are in their mid-80s. They live in a market rate apartment
within a NORC building we serve. Bernice uses a walker and most
of her care falls to Albert, her husband. All of their children
reside at least a day's drive from Cincinnati.
Bernice began attending programs that we would hold in her
building and Albert would stop by our office onsite to make her
reservations for the program. Over time, Albert started to stop
in regularly to chat with our social worker. And in time, that
developed into supportive counseling for him.
That is important because Albert was injured and was
confined to bed with a back injury. Although their privacy was
very precious to them, Bernice and Albert allowed our social
worker to come into their apartment and talk to them about what
might be their next step.
After completing an assessment, our social worker suggested
homecare services and together they arranged those services.
Albert recovered from his injury but, what was important was
that their positive experience with Options Cincinnati
continues to enrich their lives.
Bernice, who relied completely on Albert for all of her
transportation needs, now utilizes the services of one of our
business partners to take her out to do her errands. This
reprieve has greatly reduced the care giving burden on Albert
and it has enhanced both his and Bernice's independence. Any
worries about a need to move to a more restrictive setting are
now nonexistent.
Options Cincinnati operates in two NORC buildings, both are
nondenominational programs, and one site is home to a
significant African-American population, 22 percent. To date,
the programs have served more than 200 residents combined.
Property owners, CMC and Towne Properties in Cincinnati,
welcomed our programs into their buildings. They understood the
merits of our programs and the perspective of building
stabilization. Emergencies are reduced and a caring network is
in place. Both properties provided Options Cincinnati with
donated space for our use as offices and also support us
financially.
The business community embraces our model, as well.
Bethesda North and Good Samaritan Hospitals of the TriHealth
System, Comfort Keepers, Mullaney's Pharmacy Plus Home Care and
Arden Courts have helped support our local matching requirement
in exchange for advertising and display space and opportunities
to present programs to our residents. Despite no exclusivity
for referral to their services, they have seen the benefit of
such a private-public partnership.
Scripps Gerontology Center at Miami University of Ohio is
partnering with Options Cincinnati on program evaluation. Some
of their project work has revealed that residents living in
Options Cincinnati NORC sites were more likely to feel
connected to their community, be age integrated, and have
higher assessments of their health than residents living in
similar buildings not served by the program.
In Cincinnati we have a well-regarded aging network with a
range of services thanks to our Jewish Federation, United Way,
and Area Agency on Aging, Council on Aging of Southwestern
Ohio. This great network has been made even better through the
opportunity Senator DeWine has afforded us--the Options
Cincinnati grant.
Our project has shown that NORC Supportive Services
Programs are a natural complement to services and providers
already existing in our community.
If NORC Supportive Service Programs were part of the Older
Americans Act, it could significantly help reposition aging
services to better serve those aging in place.
I applaud Chairman DeWine and Ranking Member Mikulski and
the subcommittee for holding this morning's hearing on
innovative NORC Supportive Service Programs. As you fashion
your reauthorization of the Older Americans Act, I hope you
will provide an opportunity for further development of NORC
Supportive Services Programs throughout the country.
Thank you again for the opportunity to contribute to this
discussion. And I look forward to answering any of your
questions.
Senator DeWine. Thank you very much. Very good.
[The prepared statement of Ms. Burke follows:]
Prepared Statement of Ann Sutton Burke, MPA
I am pleased and honored to be here in my capacity as Program
Director for ``Options Cincinnati'', the Jewish Family Service of
Cincinnati's NORC Supportive Service Program.
I have 25 years of experience serving the aging network, with the
vast majority of that time focused on community-based care. From this
perspective, I have embraced the NORCs service concept for its
innovative preemptive nature in community-based supportive services.
The vast majority of programs serving older adults are ones where we
wait for the phone to ring. We wait for a crisis. With Options
Cincinnati we've turned this around by developing an approach that:
Identifies clusters of seniors: NORCs.
Establishes a comfortable presence.
Engages residents one-on-one and through programming.
Builds relationships.
Creates a sense of community.
Through this program, we have built a trust with the older adults,
who now turn to us to head off developing problems together.
NORC Supportive Service Programs, like Options Cincinnati, are
responsive to the trends in aging--research tells us that older adults
want to age in place (9-in-10, according to AARP). This trend is not
fleeting, as AARP research also indicates that the vast majority of the
45 and older population wants to age in place and receive the services
that will allow them to do so. NORC programs, on a large scale, could
help a great many older adults throughout the country, perhaps as many
as one-third of the senior population, according to the research. In
our local experience, we have created a supportive environment to
prevent situations from deteriorating to a point where a move out is
the only choice left.
In this vein, I want to share with you a story of a couple we work
with, Bernice and Albert Kaplan. They have been married 58 years and
are both in their mid-80's. They live independently in a market rate
apartment within a NORC building we service. Bernice uses a walker and
most of their care falls to Albert to provide. All of their adult
children reside at least a day's drive from Cincinnati.
The Kaplan's established their relationship with Options Cincinnati
when Bernice began to attend events we would hold in their building and
Albert would stop by our office, located on the premises, to sign her
up for programs. Albert then began to drop by on a regular basis simply
to ``chat'' with our social worker. These visits over time became
supportive counseling for Albert. This relationship became critical
after Albert injured his back and was confined to bed. Although their
privacy was precious to them, the Kaplan's allowed our social worker
into their home to help them figure out what they were going to do
next.
After completing an assessment our social worker recommended
homecare and she worked with the Kaplans to arrange the services.
Albert has since recovered from his injury, but the positive experience
with Options Cincinnati continues to enrich the Kaplan's lives in other
ways. Bernice, who previously relied on Albert for all of her
transportation needs, now utilizes services of one of our business
partners to run errands and outings outside of the building. This
reprieve has greatly reduced Albert's caregiver burdens and enhanced
both his and Bernice's independence. Any worries about Albert and
Bernice's need to move to a more restrictive setting are now
nonexistent.
Currently JFS operates in two NORC buildings. Both are non-
denominational programs, and one site is home to a significant African-
American population (22 percent). To date, the programs serve more than
200 residents combined.
Property owners, CMC and Towne Properties, both openly welcomed
locating our programs in their buildings. They understood the merits or
our program from the perspective of building stabilization (rents get
paid, apartments are safe and accessible, emergencies are reduced and
crises avoided, and a caring network is in place). For their part, both
properties provide Options Cincinnati with donated space (converted
apartments) for our use as offices. They also contribute financial
support.
The business community has also embraced our model. Businesses that
cater to older adults, such as Bethesda North and Good Samaritan
Hospitals (TriHealth), Comfort Keepers, Mullaney's Pharmacy, Home Care,
and Arden Courts, have helped support our local matching requirement in
exchange for advertising space, display space and opportunities to
present programs to our residents. Despite there being no exclusivity
for referral to their services they have seen the benefit of such a
private-public partnership.
Additionally, the Scripps Gerontology Center at Miami University of
Ohio is partnering with Options Cincinnati on program evaluation. Some
of their project work has revealed that residents living in the Options
Cincinnati NORC sites were ``more likely to feel connected to their
community, be age-integrated, and have higher assessments of their
health,'' than seniors living in similar buildings not served by the
program.
If there was an opportunity to expand the NORC-SSP model, Options
Cincinnati has received interest about collaboration from several
community partners in our aging network, including Clermont Senior
Services (whose interest is a rural NORC in Felicity, Ohio), Community
Services West in western Hamilton County and Senior Citizens, Inc.
about the African-American community in Hamilton, Ohio. JFS and the
Jewish Federation is looking at how to use the NORC-SSP model to better
serve resettled New Americans.
If NORC Supportive Service Programs were to become a part of the
Older Americans Act, it could significantly help reposition aging
services to better serve those aging in place. As the NORC model has a
flexible approach to programming and service development--in order to
respond to the specific wants, as much as perceived needs of the
service recipients--the model is adaptable and well suited for the
changing continuum of care required as older adults age in the
community. Additionally, the model promotes choice, as the older adults
contribute to the direction services and activities take and foster the
program through their engagement. With so many independent minded baby
boomers on the cusp of retirement, NORC Supportive Service Programs
that foster their empowerment and self-determination would add to their
well-being and quality of life.
In Cincinnati we have a well-regarded aging network with a range of
services available thanks in large part to support by our Jewish
Federation, United Way and our area agency on aging: Council on Aging
of Southwestern Ohio. This great network has been made even better
through the opportunity Senator DeWine has afforded us with, the
Options Cincinnati grant. Our demonstration project has shown that NORC
Supportive Services Programs are a natural compliment to services and
providers already existing in our community. It has also shown that a
program designed to be proactive, rather than reactive, can help reduce
the burden on limited resources and improve the health and social
outcomes of the seniors served.
I applaud Chairman DeWine, Ranking Member Mikulski and the
subcommittee for holding this morning's hearing on innovative NORC
Supportive Service Programs. As you work to fashion your
reauthorization of the Older Americans Act, I hope you will provide an
opportunity for further development of NORC Supportive Service Programs
throughout the country.
Thank you, again, for this opportunity to contribute to this
discussion, and I look forward to answering any questions you may have.
[Editor's Note--Due to the high cost of printing, previously
published material submitted by witnesses may be found on the Program's
website at www.jfscinti.org.
Council on Aging of Southwestern Ohio,
Cincinnati, OH,
May 10, 2006.
Hon. Mike DeWine, Chairman,
Subcommittee on Retirement Security and Aging,
United States Senate,
Room 140, Russell Senate Building,
Washington, D.C. 20510.
Dear Senator DeWine: As the Area Agency on Aging that serves the
five county region in Southwestern Ohio, we appreciate the partnership
and work with Jewish Family Services on their NORC project ``Options
Cincinnati.'' They are an important link in the system of services
available to seniors that provide low-cost options for their long-term
care needs.
Part of our new Strategic Plan for Southwestern Ohio is to enhance
service options and supports to prepare for the rapidly growing
population of older adults. Most older Americans want to remain in
their homes and communities where they are familiar, and lead a good
quality of life. Developing a network of services and options that
allows seniors to remain independent is good for families, and makes
prudent use of limited long-term care resources.
If you have any questions about naturally occurring retirement
communities, or programs and services available to seniors, please feel
free to contact me at 513-345-8616.
Sincerely,
Suzanne Burke,
Chief Executive Officer.
______
Senator DeWine. Ms. Pierson, thank you.
Ms. Pierson. Thank you. Thank you, Chairman DeWine and
Ranking Member Mikulski.
First of all, Senator Mikulski, I want to thank you on
behalf of the Associated and CHAI for continuing to fund our
programs over several years.
Senior Friendly Neighborhoods operates in the Northwest
section of Baltimore. It is a low- and moderate-income post-
World War II urban area and there are seniors living in market
rate and subsidized apartments, in condos, in single-family
houses and in duplexes.
I am going to keep my remarks short in the interest of
time. A lot of the themes said by my colleagues are similar in
Baltimore.
What I really want to focus my testimony on are four
characteristics that make a NORC program distinctive and more
effective than other senior programs. First of all, we offer
programs and services where people live. For example, instead
of having a case manager in a central office, our social worker
has an office in apartment buildings where seniors live. This
allows staff to see how people are functioning in their home
environments and foster stronger relationships, which is so
key.
That leads to our second characteristic, which is having a
prevention focus. When you establish a high level of trust,
then people are more likely to accept help and ask for it. Our
staff suggests changes to help remedy a problem before it
becomes a crisis. This is key. It is a safety net of
information and support essential to the NORC paradigm.
The third characteristic that I want to point out is that
Senior Friendly and other NORC programs are collaborative
partnerships. All too often, agencies work independently
without the knowledge of others who also provide services to an
older adult. At Senior Friendly, we have brought together all
of the major community partners into our--all of the community
providers into our partnership. We hold regular
interdisciplinary team meetings. We provide cross training so
all staff know how to identify at-risk seniors and what to do
about it. As a result, we are able to avoid overlapping,
duplicative and less effective services.
The fourth characteristic is we have a community
orientation. You have heard it again and again. NORCs are
programs that start in the neighborhood and in the communities.
Our participants are key players in determining what services
are offered, how they look, and how they are delivered. We
conduct a community assessment before we start working in a
building. We conduct regular open forums to solicit feedback
from our clients. Consequently, we have a high attendance and
utilization rate because we provide what people want.
Now I am going to talk about warm houses, which the Senator
had asked us about before. One of the biggest challenges for
NORC programs are to reach people who would normally be
isolated because they live in single-family houses or they live
in an apartment building where there are not many seniors, or
they live in a rural area, frankly. So our Warm House
Initiative is a cost-effective way to reach these populations.
For instance, we have brought together eight homeowners in
a two-block area who did not really know each other well. We
have also brought together an intergenerational warm house in
an apartment building that has seniors and college students so
that the college students get cookies but the seniors also have
someone looking out for them.
Another warm house meets in a small apartment building
where there are about seven seniors and most of them are frail
and isolated. These warm houses meet monthly for a social
activity in a senior's homes. The participants develop a
network of neighbors that become a new support system for them.
It really works. They also develop a relationship with a staff
person who can connect them to services that they may not need
this month but they may need next year.
I wanted to finish my testimony by speaking from the voice
of one of our participants. I thought that was really important
because of this woman, Mary, who lives in an apartment
building. Maybe about half of the people in the building are
seniors. She is wheelchair-bound. Before Senior Friendly, she
spent 2 years--she did get out of her apartment for 2 years.
This is what she writes:
For someone who depends on a wheelchair to get around, Senior
Friendly Neighborhoods is a true blessing. Every Friday, Senior
Friendly provides me with a shuttle bus with a ramp which
allows me to go to the Meyerberg Senior Center for lunch and
then to shop for groceries and go to the bank.
Ms. Pierson. She makes three stops.
Aside from a good inexpensive meal, I eat with a group of
seniors who also have become my friends.
At my apartment building, we are also fortunate to have two
eating together meals a week.
I have been there. People are enjoying themselves and they
are actually very hungry. This meal is very important to them.
Ms. Pierson. As she says, she has developed special
friendships as well as having a good meal.
Both a nurse and a social worker visits regularly and are a
great help. Without Senior Friendly, I would be confined to my
apartment and would not have such a productive existence.
Ms. Pierson. So there are Marys all over America. They are
unhappy, they are isolated, they are inactive, and they have
chronic conditions. And they need and deserve long-term living,
as Fredda said. They deserve joy, friends, and a healthy and
productive existence.
So I think that the national NORC program would be very
helpful for people all over the United States. And I hope that
we are able to find a way to implement that.
Thank you.
Senator DeWine. Thank you very much.
[The prepared statement of Ms. Pierson follows:]
Prepared Statement of Julia Pierson
Thank you Chairman DeWine, Ranking Member Mikulski, and
subcommittee members for this opportunity to raise awareness on an
innovative and important paradigm of community-based services,
Naturally Occurring Retirement Communities (NORC). The NORC program I
represent is called Senior Friendly Neighborhoods (SFN). The Senior
Friendly Neighborhoods program is exactly what its name implies--it
provides services that make a neighborhood a friendly place for seniors
to live in. SFN is targeted to older adults living in the Naturally
Occurring Retirement Communities in the Upper Park Heights and Milbrook
neighborhoods of Baltimore. Our goal is to enable older adults to ``age
in place'' in their own homes. The program is operated by a partnership
of agencies with Comprehensive Housing Assistance, Inc. (CHAI) as the
lead agency. I am the director of the SFN program.
CHAI did not set out to create a NORC supportive service program.
As community development corporation, CHAI set out to stabilize and
revitalize an area of Northwest Baltimore in order to make it a viable
and attractive community for its residents. As the agency began to
renovate and develop housing, what it found was a large number of older
adults who were aging in place, often vulnerable, and having difficulty
maintaining their residences. The area of Baltimore City and County
that we serve has:
A total population of 12,490 of whom 62 percent are
Caucasian, 33 percent African-American, 2 percent are Latino, and 3
percent are other races.
Of this population, over 2,600 are older adults.
35 percent of the households are headed by an older adult,
and
30 percent of the households headed by people over age 65
live below the poverty level.
Services for seniors existed in this community of private homes,
condominiums, and garden style and high-rise rental apartments. There
was an assortment of services through the city and county Area Agencies
on Aging, a local Senior Center, a Jewish Community Center, a local
medical complex with a hospital, nursing home, and out-patient
services, and a Jewish Family Services agency with an older adult
division. But, older residents were not necessarily making optimal use
of these services, nor were these agencies working together to serve
the older residents.
The Federal demonstration grants provided to CHAI beginning in
2002, and secured for us by Senator Mikulski, allowed CHAI to create
Senior Friendly Neighborhoods, to test out a new approach to providing
services in this Naturally Occurring Retirement Community. We chose not
to begin a new agency, but rather to draw together some of the existing
community service providers into a collaborative. SFN is a partnership
of the seniors themselves, the apartment building owners and managers,
CHAI, the Jewish Community Center, Jewish Family Services, LifeBridge
Health Systems, and the Edward A. Myerberg Senior Center. The project
could not work with one agency. We needed to bring together the
talents, expertise and resources from many agencies to provide the
comprehensive services we currently offer. Each month we work with
about 1,000 seniors. Services are provided to everyone over age 62 in
the catchment, but are concentrated in several apartment buildings and
in ``warm houses''--where groups of homeowners gather together for
socialization.
We sponsor activities and programs like trips, art
classes, exercise, games, movies, speakers, music and social events,
and ``Eating Together'' meals. Over 1,000 activities were offered last
year in 2 hubs and 8 apartment buildings.
We have created a program we call ``Warm Houses,'' which
are monthly gatherings of culturally similar residents who live in
close proximity to each other and meet in each other's homes. There are
9 such programs currently serving 140 individuals.
We offer health education about medical issues that affect
older adults. This includes taking blood pressures, clarifying
medication directions, and having workshops about preventing falls.
Additionally, the nurse follows up individually with people who have
multiple and complex medical needs. She monitors their conditions,
provides individualized education, and acts as a liaison with their
medical providers.
We offer social work services that help older adults
connect to the services they need such as: energy assistance to help
with fuel bills, homecare, and a volunteer to take them to the doctor.
We offer support groups for issues like living with low vision,
caregiver support, and coping with grief.
We provide transportation to shopping centers, medical
appointments, and recreational activities.
We help older adults with minor and major home repairs as
well as home adaptations like installing grab bars. More than 500 home
repair services were provided last year.
And we provide a safety net of information and support
when our members need help.
The services that are offered by SFN are not unique or
revolutionary. Health education, social service assistance, activity
programs, and transportation programs for seniors have been in
existence for years. What is unique is the delivery system created to
bring these services into the community. It's a delivery system that is
effective and efficient in getting people the help that they need.
There are four main ways that SFN, and NORC supportive service
programs are different from the existing service delivery system for
seniors. These differences are: a community orientation, a
collaborative partnership, services onsite where people live, and a
focus on prevention.
COMMUNITY ORIENTATION
When planning services for older adults, sometimes professionals
are paternalistic; they sit down in a room and presume to decide what
is best for the seniors. The NORC supportive service program, instead,
presumes that it is critical for residents to design and take ownership
of the program themselves. The older adults should be key players in
determining what services are offered, how they look, and how they are
delivered.
Since the SFN service area is so large and culturally diverse,
multiple approaches to empowerment have been implemented to gain
community input. When we first started, we did community assessments.
This included doing an inventory of the services that were already
available in the area. We also did assessments of smaller areas where
we considered providing services, i.e., apartment buildings and
neighborhoods. We talked with resident leaders, apartment managers, and
other key community members. We conducted formal written surveys and
focus groups with residents, as well as canvassing them informally--we
came to their activities, we knocked on doors and we sat in their
lobbies and chatted. The Upper Park Heights neighborhood is
multilingual. Key to conducting outreach in a multicultural community
is having bi-lingual staff available and translating materials into
other languages. In our case, a large proportion of our older adult
population is recent immigrants from the former Soviet Union.
Once programs are established in a building, activity participants
routinely help determine the substance and programming for their
meetings. Activity programs, since the residents themselves determine
their content, often reflect the cultural diversity of the community.
For example we sponsored a trip to the newly opened Reginald R. Lewis
Museum of Maryland African American History and Culture, a concert
featuring Russian music and dance, and a celebration for Israeli
Independence Day. Also, ``Open Forum'' meetings are held in 8 of the
apartment buildings. These are meetings where participants can share
feedback on existing services and suggest ideas for new programs.
Forums occur several times a year in each building, depending on the
building's size.
The open forum process then feeds into a formal Advisory Council.
The SFN Advisory Council is a group of volunteers who help guide the
SFN staff in making decisions about the future of the program. The
Council currently has 20 members who meet every other month to discuss
current issues of concern for SFN. A chairperson and a steering
committee of four members guide the group.
Council membership is designed to represent the diversity of the
community. Members are representatives from the SFN apartment
buildings, condominium residents, warm house participants, and
homeowners. Additionally there are individuals on the Council who are
not necessarily SFN participants, but who represent other community
organizations and stakeholders.
One project of the Advisory Council was a community-wide conference
held in June 2004, when SFN was undergoing a strategic planning
process. The conference was an effort to include the older adults in
the planning process. About 100 older adults participated with staff in
small group sessions to learn the participants' priorities.
One of the priorities that came out of this conference was an
interest in creating a ``caring community'' where residents look out
for each other. Basically, residents were concerned about having a
medical emergency in their apartment, and being unable to call for
help. SFN staff researched various strategies to address this concern,
presented them to residents, and the residents decided which one to
pursue.
The residents decided to create a door tag system to check on each
other. The way this works is participating apartments are issued a
brightly colored tag that hangs on the handle of their apartment door
entrance. The residents place their tags on the outside handle of their
front doors each morning, and take it inside in the evening. A floor
captain checks to make sure the tags are out. If a tag has not been put
out or taken in, the floor captain knocks at the resident's door. If
they do not answer the door, then the floor captain calls the
individual. If there is still no response, then the floor captain
contacts a program coordinator or building manager. The building
management then enters the apartment to check on the resident and
arrange for help, if necessary.
This system has allowed the residents in participating buildings a
low-cost means to address their fears. Initially, the process required
staff involvement to implement, but is now run solely by resident
volunteers. In the process, residents have gotten to know each other
better and created more connections and involvement among themselves.
COLLABORATIVE PARTNERSHIP
The second concept critical to the NORC supportive services model
is the provision of services in a collaborative partnership. All too
often in the existing system of services for older adults, agencies
work independently without the knowledge of the others to provide
services to a client. This often leads to overlapping or duplicative
service provision. Also, when a worker from a single agency assesses a
client, the worker often creates a one-dimensional evaluation of the
client. This can lead to a very narrow response or solution to the
problem.
A NORC collaborative partnership allows a program to avoid these
pitfalls. Different agencies, and the workers within them, who come
from different educational backgrounds, offer a unique perspective on
the individual's circumstances. These perspectives come together to
form an interdisciplinary team that guides the service for the older
adults. In SFN our team members consist of a nurse, four social service
staff, three activity workers, an outreach worker, the coordinator of
our Senior Home Repair Program, and our transportation/membership
coordinator.
Typically, it is the activity worker who first becomes aware of an
individual who may need extra assistance. In SFN the activity programs
are designed to be the public face of the program and then to make a
connection to the greatest number of people possible. Residents are far
more likely to connect to SFN through an exercise class, party, or a
trip out to dinner than by entering the social worker's office to
acknowledge that they have a problem and need help. The activity
workers are the eyes and ears of the program, and they bring their
concerns back to the social service and nursing staff.
For example, an activity worker staffing an arts program may notice
an individual who is no longer caring for their appearance and hygiene
properly and who forgets what time to come for the program. She brings
this to the attention of the nurse or social worker, who then stops in
at the next class to meet the individual. The activity worker, whom the
resident is already comfortable with, facilitates the introduction of
the new team member. The connection to the clinical services is much
smoother and occurs more readily because the activity worker has
already established a trusting relationship.
In the existing service delivery system, an activity worker might
not know whom to go to ask for help with this individual. Even if she
did, the social service worker may not be able to come if the client
did not request the meeting herself. Certainly, the worker would not be
able to come to the activity program and receive such a facilitated
connection to the client. The worker would be a stranger calling on the
phone and offering assistance--an offer that is then likely to be
refused.
The SFN team members work together to provide a coordinated service
plan for the residents. This work happens on an informal basis in the
office and during a formal Interdisciplinary Team meeting each month.
The meetings are facilitated by a clinical social worker. We discuss
situations that require guidance from the whole team's perspective. At
a recent meeting we discuss a frail depressed woman that many of the
staff had interacted with and were concerned about. Because so many
people were present, we were able to get a more complete picture of her
circumstances, and decided on a strategy to get her help. We have found
that Interdisciplinary Teams:
Give staff the tools they need to handle difficult and
complex cases,
Improve service delivery,
Provide cross-training for staff, and
Help us replicate best practices in working with seniors.
In addition to the managing partners involved in SFN, the program
is always looking to work collaboratively with governmental and other
community service providers around short- and long-term issues. We
regularly hold meetings, dialogues, and informational sessions with
both Baltimore City and County agency representatives in the
departments of aging, social services, housing, planning, and police
around issues facing the older adults in our community. These
collaborations often ultimately enhance CHAI's larger goal of
stabilizing and enhancing the entire neighborhood. Finally, there are
numerous projects where SFN engages with other agencies to enhance
specific services for seniors. For example, SFN has worked
collaboratively with the University of Maryland School of Pharmacy to
provide medication screenings, a local bank and a Catholic Charities
youth group to provide volunteers for a Senior Home Repair Day, and a
Russian membership organization to offer a special event honoring
immigrants who recently became U.S. citizens.
At SFN we have found that the team approach is an invaluable one
that offers a tremendous enhancement to the service provision to our
clients. It should be noted, however, that partnering and collaborative
work can be a time consuming effort. Like a marriage, inter-agency
partnering takes nurturing and hard work. Bringing together multiple
interests and viewpoints is critical, but adequate staff time needs to
be allocated to bring these viewpoints together.
ONSITE SERVICES
The third unique difference about SFN, and NORC supportive service
programs in general, is that they are offered right onsite where people
live. Instead of having a case manager in a central office, the NORC
social worker's office is right in the buildings where people live. The
social worker can schedule formal office or home visits, but they also
have the opportunity to monitor residents in an informal way--riding
the elevator, getting their mail, sitting in the lobby, attending an
activity--like the case detailed above. The primary benefit of this
close contact is that it can result in a high level of trust between
workers and clients.
A second benefit of the onsite location of staff is an economy of
scale. The nurse may have a home visit scheduled in a particular
building. She may use the time before and after this visit to check on
other individuals she is concerned about, or stop and sit in the lobby
for a moment to converse with residents there. In this way more people
get to know her and become familiar with what she does. This leads to a
third benefit, which is that residents begin to be familiar with the
entirety of the SFN's services, even before they may need them.
Once residents trust staff and have seen what they can do, we find
that residents share concerns about themselves and their neighbors more
readily. For example, residents in one SFN building became more and
more concerned about Mrs. B., an 83-year-old widow whom they had seen
wandering in the neighborhood at odd hours. Mrs. B. also began knocking
on doors saying that she was hungry. One neighbor, who had been helped
by the SFN nurse, introduced the nurse to Mrs. B. The nurse was able to
readily establish a relationship with Mrs. B. to evaluate her needs.
The nurse arranged for a system to help her remember to take her
medications. The nurse also brought in the SFN social worker, who saw a
need for Meals on Wheels and homecare services. The social worker
worked with Mrs. B. and her family to arrange for these services so the
client could remain at home safely and have her needs met.
The fourth benefit to being onsite is that it is easier to access
and assist residents who are more frail and isolated. There is no need
to transport frail and mobility-impaired individuals out of the
building, because services are right there. Such individuals might only
be able get out of their buildings with great assistance, and thus only
venture out for large occasions or medical appointments. In SFN
activities are created right in the building, making transportation a
nonissue.
One 91-year-old SFN member lives in a small apartment building
where there is no community space to gather. Mrs. D. has Parkinson's
disease, which severely limits her mobility. She requires a walker and
even with this device she has great difficulty walking long distances
or getting in and out of a car. SFN created a ``warm house'' where
programs occur in the building by rotating them in different resident's
apartments. Without these programs offered right in her building, Mrs.
D. would remain isolated and without regular social connections. One
other senior said, ``My house is like a prison. I have just myself, and
these walls. I would love to have others come to my house.'' We were
able to start a warm house for her and her neighbors that met in her
house.
PREVENTION FOCUS
NORC programs have a major focus on prevention. When you establish
a high level of trust with residents, you can often catch problems
early on, and suggest changes to remedy problems before they become a
crisis. The regular onsite contact allows staff to observe changes in
residents over time, and suggest services that can prevent an emergency
from happening. And finally, even when crises do occur, residents are
getting help from people who know them.
Let's use the example of an older man who develops hypertension. If
he does not come into contact with a health care establishment or
social service provider early, he may become dizzy and fall. The fall
may result in a hip fracture, leading to hospitalization, surgery, and
a lengthy rehabilitation from which he may or may not return home.
When the SFN nurse discovered a similar situation the results were
quite different. The SFN social service staff learned from neighbors
that a participant's wife had recently died. Mr. G., an 80-year-old
recent immigrant from the former Soviet Union, had multiple medical
problems and his wife had always managed his care. The social worker
assessed the situation along with the nurse. When the nurse found Mr.
G's blood pressure unusually high, she helped him contact his doctor
who then ordered the proper hypertension medications. The blood
pressure stabilized and Mr. G. was connected to services to help him
with his meals and personal care. The nurse continues to monitor his
condition due to his multiple medical needs and because he has no
family nearby to assist. This approach allowed Mr. G. to remain at home
safely and averted a potential further medical complication.
SFN also offers a significant number of preventative health
programs. The nurse conducts regular health education programs in many
of the buildings. These efforts focus on offering and encouraging
preventative health care tips, and offer the nurse a means to get to
know the residents in the buildings in a non-threatening fashion.
Additionally, the nurse is always looking to bring in representatives
from other disciplines to augment the SFN interdisciplinary team. Last
year, SFN engaged in a partnership with the University of Maryland
School of Pharmacy. A pharmacy professor and her students conducted
outreach programs in SFN buildings that caught a number of crises
before they happened. Mrs. J., a 78-year-old African-American resident,
brought medication down to the pharmacist. She handed the pharmacist a
bottle and proudly said that she took only one pill a day. When the
pharmacist opened the bottle out spilled medications of every different
sort. The pharmacist and nurse immediately contacted her physician, who
resolved the medication error and now monitors his patient much more
closely.
EVALUATION
Evaluation in order to document our success and best practices is
an important part of this demonstration grant. SFN commissioned from
University of Maryland Baltimore County, a study to find out the impact
of SFN's services to its members. We did a baseline sample of 108 SFN
members, and then reinterviewed people the following year. This study
measured our success--we had made improvements in people's lives in
almost every area studied:
90 percent of members turn to SFN to learn about services
that they need, up from 69 percent in the first survey; only 11 percent
reported that there are services they need but cannot get, down from 35
percent in the first survey.
Respondents reported an increase in social involvement; 83
percent-89 percent got together and/or talked on the telephone with
friends, neighbors and/or family in the 2 weeks prior to the interview,
up from 65 percent-72 percent in the first survey.
77 percent of respondents feel more involved in their
building or neighborhood since becoming a member of SFN, up from 56
percent in the first survey.
Only 2 percent of respondents said they have no one to
help them if they were sick or disabled, down from 9 percent in the
first survey.
Only 2 percent of respondents said that there were health
services that they needed, but could not get, down from 13 percent in
the initial survey.
50 percent of respondents are participating in on-site
preventative health services, up from 19 percent in the initial survey.
SFN transportation services are used by 74 percent of
survey participants, up from 51 percent in the first survey.
99 percent of members responded that they are satisfied or
very satisfied with the SFN program.
With results from surveys like these, SFN can proudly say that we
have assisted people to know where to go for help, decreased social
isolation, increase resident's connections to their neighbors, helped
facilitate access to health service, gotten people where they wanted to
go, and helped them age in place.
There are many additional evaluation efforts we would like to
undertake at SFN. We see daily anecdotal examples of the positive
impact that SFN is having on our community, but it is difficult and
expensive to regularly undertake the kind of extensive evaluation that
we conducted with the initial Federal demonstration grant. We recognize
that further work into demonstrating the measurable outcomes that NORC
supportive service programs make is needed to better document our
critical work.
In closing, the story of Mrs. L. demonstrates the true benefits
that SFN has been able to achieve. Mrs. L. was a 75-year-old African-
American widow who was a founding member of an SFN warm house. After
participating for several months, Mrs. L. had to bury her last living
son. Several weeks after her son's death, the warm house activity
coordinator met Mrs. L. who was reluctant to attend that month's warm
house on a cold snowy winter day. Despite her hesitations, Mrs. L.
decided to come. Once inside, all the members offered their
condolences. Mrs. L. lamented, ``What will I do now?'' This was the son
who shoveled my walk for me and took me shopping.'' Immediately, the
other participants came to her aide. One woman said that her husband
would help shovel the walk. Another woman who still drove offered to
take her shopping on a regular basis.
The SFN professional staff stepped in to offer support to Mrs. L.
as well, but this help pales compared to the generous offers made by
her neighbors. The connections between neighbors never would have
existed without the groundwork laid through the SFN program. We do not
simply provide services to seniors, we partner with them. We bring them
together to create their own safety net for each other, which allows
them to age in place with a greater sense of security and well being.
What is left now is to keep critical programs like SFN sustainable
into the future. Other communities should have the opportunity to
develop their own programs. We believe that NORC supportive service
programs should be included in the Older Americans Act. This would be a
tremendous step in helping to sustain existing programs, like SFN, and
in assisting other communities in developing similar resources for
their communities.
Thank you to all the committee members for convening this hearing
on NORC supportive service programs, and for inviting me to share the
experiences of SFN with all of you. I welcome the opportunity to answer
any questions you may have.
Senator DeWine. Ms. Shapiro, thank you for joining us.
Ms. Shapiro. Thank you.
Good morning, Chairman DeWine, Ranking Member Mikulski.
Senator DeWine. You need to turn that on.
Ms. Shapiro. Is that better?
Senator DeWine. That is good.
Ms. Shapiro. Good morning, Chairman DeWine and Senator
Mikulski. It is a true honor to testify before you today.
My name is Beth Shapiro. I am the Director of Community
Partners, CP, for the Jewish Federation of Greater Washington's
NORC demonstration project in Montgomery County, Maryland. On
behalf of the 800 seniors whose lives Community Partners has
touched, I want to express my sincere appreciation to Senator
Mikulski for her well-established commitment and support of
Maryland seniors and for sponsoring Community Partners.
Community Partners provides over 100 programs a month in
the NORCs that we serve. We are testing transitioning from a
facility-based model where the client must go out to receive
services, to a community-based model where staff provide
services where seniors live. We have found NORC supportive
service programming to be an effective public-private
partnership that successfully leverages expertise and
resources.
We have collaborated with seven agencies to provide four
cornerstone services: recreation, transportation, social work
and health. We come together in support of seniors'
overwhelming desire to age in place by simplifying their access
to services. Our program invests in keeping seniors healthy and
active by offering services that prevent and delay disability
and disease. We provide professional intervention before,
during and after and preempt isolation with active physical,
intellectual and socially focused programming.
It is critical that NORC service models like Community
Partners be tested now in order to successfully serve seniors.
The benefits of CP's NORC model include extending the length of
time a person can live in their community, helping seniors
apply for public and private services for which they were
eligible, such as Medicare Part D and getting new wheelchairs,
serving resident's adult children by providing them a peace of
mind, supporting building managers and front desk staff with
difficult or at risk seniors and residents.
The diversity of our program partnerships include
successful public-private partnerships with county, State and
Federal Governments, philanthropic foundations, the seniors
themselves, and a growing number of their families, building
management and staff, a social work agency, a recreation
partner, a home health agency, a transportation partner, a
research partner and an information and referral partner.
Sustainability is a challenge. This is why we are testing
an individual membership model. Later we will expand membership
to include adult children and the business community. In our
preliminary baseline survey of senior's needs and interests,
transportation ranked high. However, seniors are not
enthusiastic with a one-schedule-fits-all model. As a result,
we are currently testing a ride coordination service which
would customize rides to the individual's needs.
We have learned a great deal from the NORC demonstration
experience. The most critical is the importance of working
proactively instead of reactively to support seniors to age in
place.
The following examples illustrate the supportive nature of
Community Partners.
After a NORC resident was involved in a car accident,
Community Partners reacted by providing social work services,
thus decreasing the woman's anxiety and that of her husband and
adult children.
After another NORC resident fell, she was very resistant to
getting medical treatment. A CP social worker talked to her
about the importance of medical treatment. Because the woman
was a CP program participant and had an established
relationship with the social worker, she agreed to speak to our
CP nurse, who was actually in the building that same morning.
The nurse assessed her and successfully encouraged her to go to
the emergency room.
Many seniors tell us that before Community Partners came to
their building, they dealt with daily isolation and loneliness.
This is what some have told us:
``CP has helped me alleviate the loneliness that comes with
living in a big apartment complex.''
``CP helped me stay in my apartment during my building's
conversion to a condominium. I went from being told by the
condominium management that I did not qualify for an extended
residency to receiving a 2-year extension.''
There are significant challenges facing today's seniors and
the providers who serve them. Seniors have limited information
about services. Many experience transportation barriers when
accessing services. Many face caregiving and aging issues
without available support. And many lack basic access to
socialization and recreational opportunities.
Our demonstration has been an overwhelmingly positive
experience for the older adults it serves and for the
partnering agencies who, without this grant, would not have had
the impetus to provide services in this manner.
In this context, I hope that my experience and those
related by my fellow panelists provide you with an
understanding of new ways to serve the country's aging
population.
I look forward to answering your questions. Thank you very
much.
Senator DeWine. We appreciate your testimony. All of you
have been very, very helpful.
[The prepared statement of Ms. Shapiro follows:]
Prepared Statement of Beth K. Shapiro
Good morning Chairman DeWine, Ranking Member Mikulski and respected
members of the committee. It is a true honor and privilege to testify
before you today. My name is Beth Shapiro. I am the director of
Community Partners (CP), the Jewish Federation of Greater Washington's
naturally occurring retirement communities demonstration project in
Montgomery County, Maryland.
On behalf of the 800 seniors whose lives Community Partners has
touched, I want to express my sincere appreciation to Senator Mikulski
for her well-established commitment to and support of Maryland's
seniors and sponsoring Community Partners.
CP brings services and programs to seniors living in NORCs.
Frontline staff are in the buildings we serve providing 1:1 support,
interesting social programs, blood pressure clinics and health
education programs. Community Partners provides over 100 programs a
month in the NORCs. This is our way of transitioning from a facility-
based model--where the client must go out to receive needed services,
to a community-based model where staff provide services where the
senior lives. We like to think of ourselves as the ``advance team''
providing support based on strong trusted relationships.
We have found NORC Supportive Service Programming to be an
effective public-private partnership to successfully leverage community
expertise and resources. To make this possible in our own catchment
area, Community Partners has created a successful collaboration of
seven agencies providing four cornerstone services that include
recreation, transportation, social work and health services. County and
State governments have joined us in this endeavor along with two
philanthropic foundations, the managements of 5 apartment and
condominium properties, (with a waiting list of 4 more), and other
critical community partners. We have all come together in support of
seniors' overwhelming desire to age in place by bringing a variety of
professional services to NORC's thus, logistically simplifying access
to the services they want and need.
ASSESSMENT & PROGRAM DEVELOPMENT
Our program invests in keeping seniors healthy and active. It is
critical that NORC service models like Community Partners' be tested
now in order to successfully serve the future demographic of seniors.
We spent the first few months of our grant completing 268 in-depth, 1:1
surveys with seniors to determine their interests and needs. The top
services requested were:
Educational programs;
Memory improvement programs;
Onsite medical services;
Exercise activities;
24-hour emergency call service for medical needs;
Coordination of services;
Curb to curb transportation;
Volunteering to help operate this program; and
Recreational activities and events.
As the result of critical partnerships including with the seniors
themselves, we are now providing all of these services.
A PREVENTION-BASED APPROACH
These programs and services comprise a pro-active system designed
to prevent and delay disability and disease. As such, our programs and
services strive to:
Eliminate and prevent isolation by aggressively pre-
empting it with active physical, intellectual and socially focused
programs;
Provide emotional support;
Provide new avenues for conversation that promote respect
by family and friends;
Provide health services such as blood pressure checks and
24-hour emergency alert services (many are using this service because
it was recommended by one of our staff whom they know and trust); and
Provide professionals that are there before, during and
after a crisis.
THE COMMUNITY BENEFITS OF CP'S NORC MODEL
Making it possible for greater numbers of seniors to age
in place;
Supporting building managers with difficult or at risk
residents;
Directly and indirectly serving resident's adult children
by reducing stress and improving family relationships;
Extending the length of time a person can live in their
community;
Maintaining community in a resident's building for an
extended time thus supporting longer-lasting friendships and more
physically and mentally active lives; and
Helping seniors understand and apply for the government
services for which they are eligible to receive, such as the new
Medicare Part-D program.
THE DIVERSITY OF PROGRAM PARTNERSHIPS
Our successful public-private partnership is one in which
funding is supported by all 7 agency partners, the local county
government, the State Government, the Federal Government, and
philanthropic foundations.
Currently we have active partnerships with the seniors,
building managements, a social work agency partner, a recreation
partner, a home health partner, a transportation partner, a research
partner, and an information and referral partner.
We are actively working on partnering with a local
hospital, a grocery delivery service, a prescription delivery service
and we are developing a shelter-in-place program with Montgomery
County.
PROGRAM CHALLENGES EXPERIENCED
Sustainability is a particular challenge to launching new
programming. This is why part of our demonstration will be geared
toward testing a Membership (``fee-for-service'') model this summer.
The model will include program subsidies based on an assessment of
ability to pay. Moving forward, CP services will be available only to
the NORC residents through a ``membership program.'' Later, we will
expand the concept to incorporate a ``family membership'' program for
adult children to support their parents through CP services. We also
plan to develop a program to engage the business community in financial
support of the program.
Devising a workable transportation program has also been a
challenge we are working toward rectifying. Transportation ranked very
high in our baseline survey with the older adults, but ridership
associated with our initial transportation model was low. This model
was premised on a set route according to a set schedule. Through
evaluation of the program, we found that the seniors were not
enthusiastic with a one-size-fits-all transportation model that did not
allow for deviation. We are now testing a ride coordination service we
call Smooth Riding, which arranges rides for participants to medical
and social appointments for a nominal fee. So far, we have found the
service to be attractive to seniors because all arrangements for their
rides are made for them, they get a reminder call, and providers are
matched with the passenger's needs such as access to an escort or
wheelchair lift. Seniors are thrilled to let the program staff handle
issues such as rides that do not show up and paying the bill for them
from their Smooth Riding account. In the future we will be looking at
providing subsidies for medical appointments as this can be a proactive
way of supporting aging in place. Transportation is very expensive and
a frequent necessity for seniors with numerous medical appointments and
limited access to transportation options.
LESSONS LEARNED FROM THE NORC DEMONSTRATION EXPERIENCE
In this process we have learned many things along the way. The most
important thing we have learned is the importance of working
proactively instead of reactively. Of course we respond to the
immediate and more obvious needs of NORC residents. However, our focus
is on building ``pre-existing professional friendships.'' These are
relationships that are established and maintained between a
professional senior service staff member and a NORC resident. Such
relationships allow for a different kind of intervention that creates
opportunities for prevention. The following three examples illustrate
the supportive nature of the CP program.
CP has played an important role in helping several women
after they lost their husbands. One woman lost her husband this past
winter. Her life was directly affected as the result of CP staff making
regular visits to her apartment the week following her husband's death.
As a result of this relationship, although she had not regularly
participated in CP programs previously, the woman now attends almost
EVERY event. We believe her participation provides vital stability and
structure in her life, especially during the difficult transition to
living alone after 50-plus years of marriage.
CP recently provided social work support after a NORC
resident had a car accident. CP staff coordinated support services with
her husband and adult children, visited her in the hospital and
assisted with arranging for rehabilitation. This process went very
smoothly because this woman and her husband had an existing
relationship with CP staff. They had attended social excursions,
discussion groups and health programs in their building. The couple
felt comfortable and trusted the CP staff and, as a result, so did
their children. In this case the entire family was able to benefit from
the pre-existing relationship.
One participant fell at the grocery store and made her way
home alone. A CP staff member happened to run into her later that
morning in her building. The woman was resistant to getting medical
treatment but because she knew and trusted the staff member, she agreed
to see one of our nurses who happen to also be in the building. The
nurse did an assessment and convinced her to go to the Emergency Room,
which she did. At the ER the woman received information about how to
care for the bruising on her face. Had she been more seriously injured,
the trip to the hospital would have been even more critical.
PROGRAM'S GREATEST BENEFIT
Many seniors express they feel forgotten by the communities in
which they were once actively involved. Seniors tell us that before
Community Partners came to their building, they had to deal with daily
isolation and loneliness. In combating isolation, this is what some
have told us:
``The in-building discussion groups have helped. I was
severely depressed about 6-8 months ago. Then I saw the big CP monthly
calendar and attended a discussion group. I enjoyed it and started
attending regularly because they significantly lifted my spirits and
enabled me to become friends with more neighbors. I now attend almost
all of CP's activities each month.''
``CP has helped me alleviate the loneliness that comes
with living alone in a big apartment complex. The program has really
helped transform my life and I am so thankful to CP. I go on every
museum trip and to every lecture and to the social work groups. I love
volunteering to help with the monthly mailing because it helps the CP
program and gives me a chance to talk with a circle of friends as we
work together.''
``CP helped me stay in my apartment during my building's
conversion to a condominium by connecting me to the right person in the
County who could help me. I went from being told by the condo
management that I did not qualify for an extended residency, to
receiving a 2-year extension!''
CONCLUSION
There are significant challenges facing today's seniors and the
providers who serve them:
Seniors have limited information about services and other
helping organizations;
Many experience barriers in accessing existing programs
because of distance and transportation issues;
Many face caregiving and aging issues without support and
guidance; and
Many lack basic accessibility to socialization and
recreational opportunities.
NORCs are a national aging phenomenon that are the manifestation of
the desires or consequence of the fact that the majority of older
adults want, or by necessity, will age in place, even as they grow
frail. Our demonstration has been an overwhelmingly positive experience
for the older adults it serves and for the partnering providers, who,
without this grant, would not have had the means or impetus to approach
community services in such an innovative way. In this context, I hope
that my experience and those relayed by my fellow panelists have
provided you with insight and understanding into what I believe is an
incredibly important model to serve the country's aging population. I
look forward to answering any questions you may have regarding my
testimony, Community Partners, or NORC Supportive Services.
Thank you.
Senator DeWine. Let me ask all of you this question. How do
you coordinate with the Area Agencies on Aging? How does that
work? Are you able to cooperate with them? Do they cooperate
with you? What is the coordination? How do you deal with any
kind of duplication of services? Anyone want to jump in, just
go.
Ms. Burke. I will be glad to start.
The Council on Aging of Southwestern Ohio, which is our
Area Agency on Aging, is really a cornerstone in our community
when it comes to aging services. And we are working with them
right now to educate them further about the NORC concept and
see how it can work well with their services they already
offer.
We have local tax levies in Hamilton County and our
surrounding counties that help support aging services. And that
makes, I think, our program even more crucial because we can
help direct the right person to the right program.
Senator DeWine. Anybody else?
Ms. Pierson. Actually I sit on the Baltimore City
Commission on Aging, which is our AAA. So we have a close
relationship with them. I also straddle Baltimore County and we
have a good relationship with that AAA.
For instance with Medicare Part D, they were very involved
in coming to our sites and we coordinated with them to have
their SHIP counselors explain Medicare Part D.
So AAA has a lot of services that our clients can partake
in but they do not get involved in the day-to-day local
community programs that we offer.
Senator DeWine. Anybody else?
Senator Mikulski? We are running out of time so I want to
give you a chance to question.
Senator Mikulski. Know that I am suspicious of national
programs. That might come as a surprise, oh big Democrat, big
Government. But my observation of national social programs are
this: money goes to the State. A chunk out of that for State
overhead. Then money goes to local, chunk out of that for
overhead, two layers of bureaucracy to apply. Third, there is
always research and then training. And then when it comes to
the service, it is usually the fifth thing.
What has been so great about what has been done here is
money went directly to the locals, in coordination with the
Offices on Aging, etc.
If you were doing a national program, how could we avoid
the trickle-down but be able to do kind of the freshness,
creativity, dedication that obviously was in each one of these
programs that have been described?
This is not about programs. It is what you said, it is
about people. And the effectiveness has obviously been because
small amounts of money were leveraged for more money. But most
of all, leveraged volunteerism, other things. It was not a lot
of overhead.
Could you offer your thoughts? Ms. Pierson, you have worked
for a variety of nonprofits and so on.
Ms. Pierson. I am sitting here thinking, and thinking about
the Older Americans Act and senior centers. As you went through
the trickle-down I saw the money going like this, and I know
how hard it is in Baltimore City for senior centers. So I
really have to think about that.
I had not thought that you would have that viewpoint but I
think you are absolutely right, that programs end up getting
very structured over time. And this program has to be very
fluid to be able to react to a neighborhood.
Maybe it is more like community development block grants,
where jurisdictions have some leeway in how they provide the
money to the local entity.
Senator Mikulski. Let me suggest a model and get the
reaction, No. 1, for those who would want to do a NORC. Not
everybody wants to and everybody has the social or
administrative capability to do it. There are a variety of
reasons to do something in the Older Americans Act, maybe even
under the demonstration program. I am not sure, again I look
for advice.
But where money is applied for for a local NORC, rather
than going through a lot of administrative arms. And then to
meeting certain Federal standards around exactly what you said,
prevention, community-based, local partners in both providing
service and additional funds, etc.
But would allow for the creativity and the flexibility to
handle the wide geographic and other profiles that you
presented to the committee.
Ms. Keller, Ms. Burke, do you think about that?
Ms. Keller. I appreciate how you laid out----
Senator Mikulski. And maybe you think I am wrong.
Ms. Keller. No, I think you are right, it is disturbing to
us. We understand that the State does need some administrative
money and the county or city needs some administrative money,
and obviously the agency whose administering the program needs
some administrative money. But obviously, at the end of that
stream, there is less money available to deliver programming to
the people who really need it.
The other side of what we have now is a hit and miss
situation where starting a program means putting some money in
the front end to create it and then having to come back to
generous and forward thinking Senators like both of you.
Senator Mikulski. We cannot keep doing this on earmarks. It
is too unpredictable.
Ms. Keller. Exactly, and what happened last, of course, it
was unpredictable or perhaps predictable. But all of us who
were looking forward to that money and that commitment ended up
sitting empty-handed and having to figure out how they could
stretch money or find some short-term funds. And now sit again
this year and hope for the possibility of continuing their
programs.
What a designated funding stream would mean is better
ability to plan for a program, to do some real strategic
planning, to be able to get past that front end. And I would
support something that would set up a designated funding stream
for these programs.
Senator Mikulski. I am going to offer another model. You
know, we have 202 housing programs at HUD. And recalling when I
was a HUD appropriator and I believe Senator DeWine, I do not
know if you were on housing and banking, I seem to feel you
were.
But organizations apply to do 202. It does not come through
a lot of layers at HUD. And then often it is done through
nonprofits like your Govans Ecumenical. It was the churches
coming together for that wonderful new stadium place endeavor
that is underway, Ms. Pierson.
Often it is the Associated. Very often it is faith-based
that know programs, know how to do it, etc.
But the money to do the 202 housing does not go through a
lot of organization, a lot of layers.
And I wonder if that is something that is a model?
Ms. Burke. I think definitely that is a possibility. I
think the Older Americans Act, in a lot of ways, is a natural
place for this program.
Senator Mikulski. Oh no, we would not put it at HUD. No,
no, because HUD does what HUD does and they have their own, the
housing for the elderly. And I have a feeling Ohio is a lot
like Maryland. A lot of that housing for the elderly were built
in the 1970s and the 1980s. That, in and of itself, the
buildings are aging. That is a whole another issue.
Ms. Burke. I think though in our case what you are saying
is the idea is how it is structured, to keep that flexibility
and be true to the original principles of the NORC movement. A
big part of that is that it is driven by the older adults that
are in these NORCs.
In our case, I know the early speakers, there was some talk
on the first panel about rural NORCs. In our community, we have
been collaborating with other agencies such as ourselves,
Claremont Senior Services, about Felicity, Ohio and Senior
Citizens Incorporated about the African-American community in
Hamilton, Ohio. And although their NORCs would look very
different, I think that is the key to structure so that people
can have that flexibility.
Senator Mikulski. See, that is what we want. I know one of
the things that Senator DeWine and I share, which is big
outcome, not necessarily big government. And then also a look
to use the nonprofit and faith-based networks, who seem to know
how to leverage other money and other resources and often deal
with suspicion.
A lot of what you have talked about is people letting them
in homes. Certainly we see that in the rural areas. In the
rural parts of my State, people will work with an ecumenical
housing effort where they would never work with a Government
effort. They would shun it.
And so that is what we are looking for, big outcome, not
necessarily big government. I think you have given us some
ideas.
Can I just ask this, and this is my last question. It was
about lessons learned and best practices. But out of what you
did, what was your biggest surprise about what worked and what
might not have worked? Mrs. Shapiro?
Ms. Shapiro. What was our biggest surprise?
Senator Mikulski. Yes, when you actually ran the program
now for a couple of years, about what worked from your regional
conceptual model to what maybe did not work?
Ms. Shapiro. I think what worked the most and the way we
are influencing people's lives on a daily basis is bringing
people together and we do a building model. And they are now
getting to know their neighbors that they have lived with for
20 years and never really knew except for going up and down the
elevator and sitting in the lobby and passing by. Now they
really know them. They know their names. They know their
hobbies. They know their interests. They know about their
families.
And when there is a crisis, they have an existing community
that really was not there before.
Senator Mikulski. So it will be neighbor helping neighbor
because neighbor now knows neighbor.
Ms. Shapiro. Yes, absolutely. Absolutely.
Ms. Pierson. One of the biggest surprises I had recently, I
looked at demographics and 30 percent of the people in our area
have incomes below $7,500 a year. Seniors are living on just
SSI and poverty. I think one of our biggest successes is
providing those people with joy and good living within their
means. That is no small achievement for that group of people.
Senator Mikulski. No.
Ms. Burke. We have had similar experiences, but I would say
the biggest surprise to me is how open our property managers
were to us. These are people----
Senator Mikulski. The private sector.
Ms. Burke [continuing]. In the business community. They
want to keep their apartment buildings or condominium
complexes, whatever it is they own, full. This is an
alternative to them to help them do that. They welcomed us with
open arms.
Ms. Keller. And I will end on the biggest challenge, and
that is a secure funding stream.
Senator Mikulski. We were surprised that the money got
canceled last year.
Ms. Keller. I think that has been the greatest difficulty.
The successes are there. I think the program speaks for itself.
Nobody opposes it. But we need to find some sustainability to
the funding to move forward.
Ms. Shapiro. Can I make one very quick comment, in just the
time? One sentence.
What was very surprising to us was when we went to approach
building managers and board of directors of condominiums. At
first, many were very resistant and they turned us down. And
others jumped on board right away and were willing to play
guinea pig, if you will.
Those folks that turned us down are now banging down our
door, please come serve us. The word-of-mouth is out there. I
have got people from other States calling me, saying, ``Can you
come?'' ``When are you coming?''
I think that was a very telling surprise to us.
Senator Mikulski. Thank you.
There is a saying, all politics is local. But truly, all
social services is. We have come up with some new language
here.
But many people talk about assisted living. You have
obviously taken hard to reach populations and you have helped
them with assistance with living. So we are very proud of what
you have done and you have given us a lot to ponder.
Thank you very much for your dedication and creativity and
resourcefulness.
Senator DeWine. Let me thank all of you very much. I want
to thank both panels. Very good testimony, very helpful. We
really, really appreciate you all coming in. It has been, I
think, a very informative hearing for this committee. And you
can tell that Senator Mikulski and I are both very interested
in this subject.
Thank you very much.
[Whereupon, at 12:05 p.m., the subcommitee was adjourned.]