A partnership of the Indiana FSSA Division of Aging &the University of Indianapolis Center for Aging & Community

Communities for Life:Neighborhood Naturally Occurring Retirement Communities

1

One State’s Approach to the Development of NORC Program

Public Policy

Presented by:

Jennifer Bachman, MEd, Senior Projects Director,

University of Indianapolis Center for Aging & Community

LaNita Garmany, MS, Project Director, University of Indianapolis Center for Aging & Community

Mia Oberlink, MA, Senior Research Associate, Center for Care Policy & Research, New York

Fredda Vladeck, LMSW, Director, Aging in Place Initiative, United Hospital Fund, New York

Learning Objectives

1) Learn how two national resources, NORC Blueprint and the AdvantAge Initiative, were used in Indiana to develop and provide community-based services to their aging population.

2) Understand the need for a systematic and comprehensive planning approach to developing community-based programs through the Communities for Life project.

3) Review key lessons learned through the process.

3

4

What is a NORC?

Naturally Occurring Retirement Community

(NORC) – a demographic term used to describe a community:

• Not originally built for seniors

• Significant proportion of its residents are seniors

5

Definition of a NORC ProgramNORC Programs are public-private partnerships of:

• Housing/neighborhood organizations • Residents• Health and social service providers • Community stakeholders• Government agencies

NORC Programs organize and develop services and programs to advance successful aging in place.

6

A Community Change Model

NORC programs are dynamic and aim to be responsive to their communities by:

• Empowering seniors to take on new roles in the community

• Fostering connections within the community

• Maximizing the health and well being of all older adults in the community

7

Elements of Developing Effective NORC Programs

• Understanding the community

• Partnering with the community

• Designing and implementing a NORC program

• Evaluating projects of a NORC program

• Strategic planning for sustainability

8

United Hospital Fund

• New York City public charity, policy, and research center

• Shapes positive change in the delivery of health services in New York City

• Established the Aging in Place Initiative in 1999

• Works with multiple partners Programs Funders Researchers

9

Introduction to the AdvantAge Initiative

10

Promotes Social and Civic Engagement

•Fosters meaningful connections with family, neighbors, and

friends•Promotes active engagement in

community life•Provides opportunities for

meaningful paid and voluntary work

•Makes aging issues a community-wide priority

Addresses Basic Needs

•Provides appropriate and affordable housing

•Promotes safety at home and in the neighborhood

•Assures no one goes hungry

•Provides useful information about available services

An Elder -Friendly

CommunityOptimizes Physical and Mental Health and Well Being

•Promotes healthy behaviors

•Supports community activities that enhance well being

•Provides ready access to preventive health services

•Provides access to medical, social, and palliative services

Maximizes Independence

• Mobilizes resources to facilitate “living at home”

• Provides accessible transportation

• Supports family and other caregivers

11

ACTIONACTION

EVALUATIONEVALUATION

INFORMATIONINFORMATION

DATADATA

The AdvantAge Initiative Planning Process: Data Driven, Participatory Community Development

12

• National Survey

• States– Indiana

• Counties– California

• Contra Costa & Santa Clarita Counties

– El Paso County, TX– Indiana

• Elkhart, Kosciusko, LaPorte, Marshall, & St. Joseph Counties

– Maricopa County, AZ – Newaygo County, MI – Orange County, FL

• Cities, towns, & neighborhoods– Six neighborhoods of

Chicago, IL – Grand Rapids, MI – Indianapolis, IN

• Cities, towns, & neighborhoods (cont’d)

– Jacksonville, FL

– Parsippany, NJ

– Puyallup, WA

– New York

• Upper West Side

• Yonkers

– NORCs

– Indiana

• Gary Midtown, Huntington, Martindale/Brightwood (Indianapolis), Linton, & LaSalle Park

– New York

• Brownsville, Chinatown, Harlem, & Lincoln Square

AdvantAge Initiative Survey Conducted in:

13

Indiana’s Aging Dilemma

Several years ago, Indiana had only 2 choices for its seniors – either receive home health care services (if you qualified) or enter a long term care facility.

– 45th among states for distribution of Long Term Care dollars versus community-based dollars

– Long waiting lists for the CHOICE program

14

15

Individual

Community

Support Services

Institution Based

Healthcare Delivery

Individual

Community

Support Services

Institution Based Healthcare Delivery

SHIFT IN RELATIVE INVESTMENT Phase IV 7/1/09

-Preventative Care Program for Seniors -Long Term Care Insurance Partnership Program

-INShape Indiana (Health Program) -Golden Hoosier Card

Phase III 7/1/08 -Communities for Life (NORC) -Hoosier Youth Providing for Elders (HYPE) -Aging and Disability Resource Center (ADRC) -Adult Guardianship Program Phase II 7/1/07 -Transportation -Affordable and Accessible Housing -Nutrition Services -Service Access (211) Phase I 7/1/06 -OPTIONS

-Assisted Living -Adult Foster Care -Adult Day Services

Community Dashboard

Project Completion

Cost Savings

Healthcare Outcomes

Comprehensive Planning Process

Concerted effort to build the community-based service side to allow people to age in place and have more choices about where and how they do so

– Redistribution of dollars in a more strategic way– Strengthen Information & Referral departments of the

16 Area Agencies on Aging to create a one-stop for information

– Implement state-wide AdvantAge survey to ascertain “elder-friendliness” of communities and establish baseline data to use in state program plan.

16

17

Implementing the Strategy NORC model explored - New York NORC’s and

Elder Friendly Community (Indianapolis)

Aging Director was intrigued by this model. Could this be adapted and applied in both urban and rural settings to provide a network of community-based services locally?

– Shift monies to grassroots level to allow for community-based expansion

– Ask communities to take personal responsibility– Engage a broad range of stakeholders, including senior

residents themselves, to help seniors age in place

18

Implementing the StrategyStatewide NNORCs

• Philosophy of NORC model fit with the concept of multiple geographic and demographic community-based sites

• Communities for Life: 18-month planning grant concept conceived to explore feasibility of developing 5 “horizontal” sites simultaneously in both urban and rural settings

• Multi-layered evaluation of planning grant process by independent evaluator incorporated as well as extensive technical assistance.

Communities for Life Planning Grant

In June 2007, the Family and Social Services Administration Indiana Division of Aging contracted with the University of Indianapolis Center for Aging & Community to develop and implement Communities for Life to:

•maintain neutrality and •maximize efficiency•provide timely and comprehensive technical assistance.

19

Importance of Partnerships

• University reached out to national NORC experts for information, advice, and support:

Fredda Vladeck, United Hospital Fund

• University linked with Indiana University’s Center on Aging and Community, Phil Stafford, to dovetail with state-wide AdvantAge Initiative with the NNORC data collection, and Mia Oberlink, Center for Home Care Policy & Research

20

Communities for Life NNORC Development

Purpose of CFL Project:

Develop a model of an “elder friendly” community

Develop a method to measure community “elder-friendliness”

Help communities interpret and use this information to create action plans to support older residents’ health, well-being, and independence as well as their social and civic engagement

Communities for Life Planning Grant

CFL Program Objectives

• Identifying and assembling community stakeholders• Identifying neighborhood assets and resources as well as

the needs of older adults• Analyzing, evaluating and interpreting the data• Developing a program plan for supportive services for

older adults• Developing a sustainability plan for implementation and

growth

22

23

Using the NORC Blueprint to Inform NNORC Process Flowchart

24

Using the NORC Blueprint to Inform NNORC Process Flowchart

25

Flu Shot in the Past 12 Months Among People Aged 65 and Older

64%

73%78%

56%

0%

40%

80%

Martindale/Brightwood NNORC2,5

Area 82,4Indiana2,3National1

4 Area 8 includes Boone, Hamilton, Hancock, Hendricks, Johnson, Marion, Morgan, and Shelby Counties (Unweighted N=227; Weighted N=182,961).

3 Excludes Area 2 (Elkhart, Kosciusko, LaPorte, Marshall & St. Joseph Counties) which was surveyed in 2006 (Unweighted N=3,337; Weighted N=734,461).

5 Unweighted N=85; Weighted N=1,533.

1 Federal Interagency Forum on Aging-Related Statistics. Older Americans 2008: Key Indicators of Well-Being. Federal Interagency Forum on Aging-Related Statistics. Washington, DC: U.S. Government Printing Office. March 2008. Data for 2006.

2 AdvantAge Initiative Community Survey in Indiana, 2008

Indiana’s Use of The AdvantAge Survey

26

Diabetes1 Among People Aged 65 and Older

18%

22% 23%

31%

0%

16%

32%

1 The AdvantAge Initiative survey asked, “In the past five years, has a doctor told you that you have … Diabetes.” National data are based on a 2-year average (2005-2006).

Martindale/Brightwood NNORC3,6

Area 83,5Indiana3,4National2

6 Unweighted N=85; Weighted N=1,533.

3 AdvantAge Initiative Community Survey in Indiana, 2008

4 Excludes Area 2 (Elkhart, Kosciusko, LaPorte, Marshall & St. Joseph Counties) which was surveyed in 2006 (Unweighted N=3,337; Weighted N=734,461).5 Area 8 includes Boone, Hamilton, Hancock, Hendricks, Johnson, Marion, Morgan, and Shelby Counties (Unweighted N=227; Weighted N=182,961).

2 Federal Interagency Forum on Aging-Related Statistics. Older Americans 2008: Key Indicators of Well-Being. Federal Interagency Forum on Aging-Related Statistics. Washington, DC: U.S. Government Printing Office. March 2008.

Indiana’s Use of The AdvantAge Survey

27

Mammogram1 Among Women Aged 65 and Older

64%60%

56%50%

0%

33%

66%

Huntington NNORC3,6Area 33,5Indiana3,4National2

1 The AdvantAge Initiative survey refers to mammogram in the past 12 months. National figure refers to mammogram in the past 2 years (data for 2005).

4 Excludes Area 2 (Elkhart, Kosciusko, LaPorte, Marshall & St. Joseph Counties) which was surveyed in 2006 (Unweighted N=1,786; Weighted N=423,327).

2 Federal Interagency Forum on Aging-Related Statistics. Older Americans 2008: Key Indicators of Well-Being. Federal Interagency Forum on Aging-Related Statistics. Washington, DC: U.S. Government Printing Office. March 2008.

5 Area 3 includes Adams, Allen, De Kalb, Huntington, Lagrange, Noble, Steuben, Wells, and Whitley Counties (Unweighted N=109; Weighted N=43,306).

6 Unweighted N=45; Weighted N=297.

3 AdvantAge Initiative Community Survey in Indiana, 2008

Indiana’s Use of The AdvantAge Survey

Planning Phase Accomplishments:

Successfully initiated community asset mapping Participated in the state-wide AdvantAge Initiative Survey Developed relationships Developed a structure of governance Organized community-wide advisory committees Launched resident education and community awareness

campaigns Coordinated other localized data collection activities Partnered with local universities/colleges to provide evaluation

and analysis of the data collected Assisted their steering committees in the development of

NNORC work plans and time lines

Communities for Life NNORC Development

28

Shepherd Communities NNORC, Linton

Empowering seniors to take action through

community organizing

29

Huntington NNORC

Providing opportunities for greater socialization, education and awareness

30

Martindale/Brightwood NNORC

Seniors speaking out and voicing

their concerns and perceptions

31

Engaging residents through focus groups and broad-based community-wide forums

Gary Midtown NNORC

32

LaSalle Park NNORC, South Bend

Collaborating with existing community partners to create a forum for informing senior residents of the programs and services already available in their local community

33

NNORC Supportive Services Program Implementation

CFL NNORC programs have received an additional $75,000 to design and implement projects that address a “banner issue” or concern expressed by area seniors.

Communities for Life NNORC Development

34

Banner Issue: Improved mobility through physical wellness, transportation, and home safety assessment

Removing and/or modifying existing safety hazards within and around resident’s homes

Establish a walking program Provide healthy living seminar and EnhanceFitness® class Provide elder-friendly training to current transportation

providers Provide transportation vouchers for seniors in need Partner with faith-based organizations to provide additional

transportation for seniors

Shepherd Communities NNORC Linton, IN

35

Banner Issue: Senior Resource Information and Referral and Home Modification

Develop an information distribution system utilizing direct mail, educational seminars and area business displays

Implement “Neighbors with Neighbors” volunteer neighborhood beautification clean-up program

Establish on-site NNORC Case Management services Provide home modification services to four NNORC

residents

LaSalle Park NNORC South Bend, IN

36

Banner Issue: Neighborhood and Personal Safety

Establish a 24-Hour NNORC Crisis Hotline for emergency intervention assistance

Partner with Gary Police Department to operate a Community Oriented Policing (COP) Program

Implement the “Tree of Three” Network to provide a core support team to monitor senior wellness

Organize a Fix-Up-Clean-Up team of community volunteers to promote beautification initiatives, a safe neighborhood environment and stimulate neighborhood entrepreneurship

Gary Midtown NNORCGary, IN

37

Banner Issue: Senior Resource Information and Referral

Provide home safety assessments to seniors to identify and remedy safety hazards within the home

Establish/stock a Senior Resource Display in the Huntington City Library

Utilize the Huntington County Council on Aging (HCCOA) newsletter to promote senior resources

Partner with Huntington University to develop a senior-friendly website with a link from the HCCOA’s website

Train senior volunteers as resource information guides

Huntington NNORCHuntington, IN

38

Martindale/Brightwood Golden Ages NNORC

Banner Issue: Home modification related to accessibility in and around the home

Provide Home Safety Education and AwarenessPartner with MCHD, CICOA, and MBCDC to perform 30 home safety assessmentsEstablish a home safety products pantry to provide 50 seniors with smoke detectors, night lights, grab bars, outdoor motion-sensor lighting, raised toilet seats, etc.Conduct four fall-prevention educational seminarsEnhance communication and involvement through a quarterly senior newsletter

39

40

Future NORC Development

•Technical Assistance

• Factors that Impact Success

• Long Range Sustainability Strategy

• What’s the Right Way to Grow this Model

Lessons Learned

Jennifer Bachman, MEdSenior Projects Director University of Indianapolis Center for Aging & Community317-791-5936bachmanj@uindy.edu

LaNita Garmany, MSProject Director University of Indianapolis Center for Aging & Community317-791-5941garmanyl@uindy.edu

Communities for Life NNORC Development

Mia Oberlink, MASenior Research Associate Center for Care Policy & Research, New York212-609-1537mia.oberlink@vnsny.org

Fredda Vladeck, LMSWDirector Aging in Place Initiative, United Hospital Fund, New York219-494-0750fvladeck@uhfnyc.org

For more information, contact:

41