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27–586 PDF 2006

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

Printed for the use of the Committee on Health, Education, Labor, and Pensions

(

Available via the World Wide Web: http://www.access.gpo.gov/congress/senate 

COMMITTEE ON HEALTH, EDUCATION, LABOR, AND PENSIONS 

MICHAEL B. ENZI, Wyoming, Chairman 

JUDD GREGG, New Hampshire 

BILL FRIST, Tennessee 

LAMAR ALEXANDER, Tennessee 

RICHARD BURR, North Carolina 

JOHNNY ISAKSON, Georgia 

MIKE DEWINE, Ohio 

JOHN ENSIGN, Nevada 

ORRIN G. HATCH, Utah 

JEFF SESSIONS, Alabama 

PAT ROBERTS, Kansas 

EDWARD M. KENNEDY, Massachusetts 

CHRISTOPHER J. DODD, Connecticut 

TOM HARKIN, Iowa 

BARBARA A. MIKULSKI, Maryland 

JAMES M. JEFFORDS (I), Vermont 

JEFF BINGAMAN, New Mexico 

PATTY MURRAY, Washington 

JACK REED, Rhode Island 

HILLARY RODHAM CLINTON, New York 

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 

ORRIN G. HATCH, Utah 

JEFF SESSIONS, Alabama 

PAT ROBERTS, Kansas 

MICHAEL B. ENZI, Wyoming (ex officio) 

BARBARA A. MIKULSKI, Maryland 

JAMES M. JEFFORDS (I), Vermont 

JEFF BINGAMAN, New Mexico 

HILLARY RODHAM CLINTON, New York 

EDWARD M. KENNEDY, Massachusetts (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) 

(1)

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 

2

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 

3

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 

4

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, inVerDate 0ct 09 2002 09:58 Jan 11, 2007 Jkt 000000 PO 00000 Frm 00008 Fmt 6633 Sfmt 6633 S:\DOCS\27586.TXT SLABOR3 PsN: DENISE
5

cluding reauthorization and home repair. Preservation of this housing stock not only benefits current owners but helps assure a highquality 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 intergenerational 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 

6

have a critical mass of program experience in both the housingbased 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 

7

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 UJAFederation 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 

8

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 longtime 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 modiVerDate 0ct 09 2002 09:58 Jan 11, 2007 Jkt 000000 PO 00000 Frm 00012 Fmt 6633 Sfmt 6621 S:\DOCS\27586.TXT SLABOR3 PsN: DENISE
9

fications 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 unitsof-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 infraVerDate 0ct 09 2002 09:58 Jan 11, 2007 Jkt 000000 PO 00000 Frm 00013 Fmt 6633 Sfmt 6601 S:\DOCS\27586.TXT SLABOR3 PsN: DENISE
10

structure 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 

11

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. 

12

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 

13

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 

14

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. 

15

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. 

16

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. 

17

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 FaithBased 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. 

18

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. 

19

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 selfdetermined 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 evaluVerDate 0ct 09 2002 09:58 Jan 11, 2007 Jkt 000000 PO 00000 Frm 00023 Fmt 6633 Sfmt 6601 S:\DOCS\27586.TXT SLABOR3 PsN: DENISE
20

ated 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. 

21

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. 

22

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 privatepublic partnership. 

23

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-in10, 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 mid80’s. They live independently in a market rate apartment within a NORC building 

24

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. 

25

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 

26

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.

27

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 

28

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. 

29

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 introVerDate 0ct 09 2002 09:58 Jan 11, 2007 Jkt 000000 PO 00000 Frm 00033 Fmt 6633 Sfmt 6621 S:\DOCS\27586.TXT SLABOR3 PsN: DENISE
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duction 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 

31

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 mobilityimpaired 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:

32

• 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. 

33

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 facilitybased 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 oneschedule-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. 

34

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 publicprivate 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 

35

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 (‘‘feefor-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 

36

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 

37

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. 

38

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 adVerDate 0ct 09 2002 09:58 Jan 11, 2007 Jkt 000000 PO 00000 Frm 00042 Fmt 6633 Sfmt 6601 S:\DOCS\27586.TXT SLABOR3 PsN: DENISE
39

ministrative 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. 

40

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 

41

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.] 

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