Fostering Aging in Place: “Healthy Naturally Occurring Retirement Community” (H-NORC) Principles in a Southwest Ohio Suburb

This community assessment uses the concept of “H-NORCs” or Healthy Naturally Occurring Retirement Communities as a framework to analyze supports for aging (Masotti, JohnsonMasotti, Fick, & MacLeod, 2006) in Kettering, Ohio -a first tier suburb of Dayton where the proportion of people over the age of 60 was 23.8% in 2010. In this study, I used focus groups and interviews to collect qualitative data on five H-NORC attributes: (1) economic policies that benefit seniors; (2) types of transportation support for seniors; (3) neighborhood design for physical activity; (4) opportunities for social integration and sense of belonging; and (5) health services. This study finds that Kettering is a regional support center for senior activity. City provision of senior services, volunteer opportunities, and regular exercise locations were perceived as protective of elder health and wellness. Participants perceived community outreach for citizens as a means of promoting health and longevity. Recent municipal projects demonstrate commitment toward improving neighborhoods to increase physical environment supports for aging in place according to H-NORC themes related to Universal design principles such as bicycle paths and sidewalk improvements. Still, it is important to note that although transportation services showed robust regular use by a small number of Kettering seniors, nearly all participants reported a lifelong relationship with driving that influences activity level and ability to participate in senior activities. Overall this study finds strong evidence of H-NORC qualities in Kettering related to economic policy benefits, sense of belonging, access to culture and service provision for seniors in the community. This study also suggests that H-NORC qualities related to physical supports in the built environment might be revised to more closely address Kettering’s suburban context. SUPPORTS FOR AGING IN KETTERING 5 Fostering Aging in Place: “Healthy Naturally Occurring Retirement Community” (HNORC) Qualities in a Southwest Ohio Suburb In North America, a majority of older adults choose to remain in neighborhoods where they have been long time residents. The challenge is that these neighborhoods were designed for young families with children rather than older adults who are “aging in place” after children leave the home (see census data and the American Association of Retired People (AARP) surveys). Aging in place, then, creates public health issues because seniors can have increased vulnerability due to functional, cognitive and psychological decline, and often, this decline can be related to their type of living environment and the available social capital within it (Clarke & George, 2005; Mendes de Leon et al., 1999). In public health, health promoting policies exist further upstream in how they influence health as compared to more proximal risk factors related to specific disease states (Scutchfield, 2011). Several studies suggest that seniors can benefit from health promoting policies (Mendes de Leon, 2003; Seeman, 1996; Berke, 2007). Similarly, policies related to urban planning and community design can provide “upstream” influence on health outcomes such as increased physical activity and nutrition for healthy older adults and people of all ages (McGinnis, Williams-Russo, & Williams-Russo, 2002; Braveman, 2011). Emerging recommendations formulated by the CDC Healthy Aging Network, the Robert Wood Johnson Foundation, Healthy People 2020, AARP, among other local organizations across the country advocate for national, state and local governments to address health needs of all citizens by including health promotion as part of built environment related policy (Miller, Pollack, & Williams, 2011; US Department of Health and Human Services, n.d.). Some argue that collaboration between municipal governments and public health organizations can result in SUPPORTS FOR AGING IN KETTERING 6 improved policies that support health behaviors in older adults such as regular exercise and maintenance of social connections (Masotti, O' Connor, & Fick, 2010). People studying older populations believe that if planners and developers improve accessibility and walkability in areas with a high numbers of older adults outcomes could include decreased long-term care expenditures (Clarke & George, 2005). Policy decisions, then, can positively influence physical function, social support networks, instrumental activities of daily living (IADLs), and mobility and access to services. Municipal supports for the elderly help to foster aging in place where elders remain in their community with greater ease and improved health. This project aims to analyze to what extent one city, Kettering Ohio, can be defined as a community that supports the mobility, health, and lifestyles of older adults. The concept of “HNORC” or Healthy Naturally Occurring Retirement Community, defined by Paul Masotti, provides a framework to analyze supports for aging in place within neighborhoods with high numbers of seniors (Masotti et al., 2006). A comparative analysis of the activities, infrastructure, and community supports within this suburban, mid-western city will be performed based on ethnographic study and conversations with community members. The overall community assessment will be compared to existing recommendations related to “elder-friendly” communities derived from the H-NORC model. One goal for evaluating Kettering in terms of the H-NORC model is to identify what is working well in a community with a higher than average number of seniors. A second goal is to identify and evaluate challenges faced by communities that support older adults, especially in a suburban setting. SUPPORTS FOR AGING IN KETTERING 7