For other versions of this document, see http://wikileaks.org/wiki/CRS-RL34289 ------------------------------------------------------------------------------ ¢ ¢ ¢ Prepared for Members and Committees of Congress ¢ ¢ Naturally Occurring Retirement Communities, or NORCs, are generally defined as communities with a large proportion of older persons residing within a specified geographic area. NORCs differ from purpose-built housing for the elderly, such as assisted living facilities or board and care homes, in that NORC residences were not designed with the provision of services to older persons in mind. As a result, seniors and community providers in some NORCs have sought opportunities to make recreational, health, and social services more widely available to older residents. In doing so, partnerships between these providers and with housing managers have resulted in alternative models of health and social services delivery through NORC supportive services programs (SSPs). The goal of a NORC-SSP is to provide a coordinated array of services and programs that meet both the needs and preferences of the older residents in the NORC. Services may include case management, health care management and prevention activities, recreational activities, transportation, and volunteer opportunities for older residents, among other things. In theory, NORC-SSPs allow health and social service providers to take advantage of economies of scale within the community in order to target home and community-based services toward older individuals in need of assistance and potentially at risk for institutional placement. Congressional interest in NORC-SSPs began in 2002, when House and Senate appropriations legislation included committee recommendations for a number of projects to provide supportive services programs to older individuals residing in NORCs. Between FY2002 and FY2005, the Administration on Aging (AoA) provided a combined $21.4 million in grant funding from Older Americans Act (OAA) Title IV research and demonstration appropriations. These funds assisted in financing a total of 41 NORC supportive services projects across 25 states. Given that the demographic pressure of an aging population is likely to continue to increase demand for health and social services among the older population, Congress will face a decision as to whether to expand the role of the federal government in funding these services to older adults. Policymakers may want to consider funding alternative models of health and social services delivery that target services to older residents in home and community-based settings, such as NORC-SSPs. In order to assist Congress in policy considerations regarding home and community-based services for the older population, this report describes NORCs, NORC-SSPs and Congressional activity related to funding NORC-SSPs. It then provides a brief summary of some issues for Congress to consider with regard to future funding of NORC-SSPs. These issues include determining the target population for NORC-SSPs; establishing program standards and outcomes measures; the extent to which federal financing is appropriate and available; and, support for a national research agenda. This report will be updated occasionally. ¢ Introduction ..................................................................................................................................... 1 What is a Naturally Occurring Retirement Community (NORC)? ................................................. 2 NORC Supportive Services Programs (NORC-SSPs) .................................................................... 3 Congressional Activity .................................................................................................................... 5 Issues for Congress.......................................................................................................................... 8 Program Eligibility.................................................................................................................... 9 Program Standards and Outcomes ............................................................................................ 9 Program Funding..................................................................................................................... 10 Further Research ..................................................................................................................... 10 Table 1. Federal Funding for Supportive Services Programs (SSPs) to Naturally Occurring Retirement Communities (NORCs), FY2002-FY2005............................................... 7 Author Contact Information ...........................................................................................................11 ¢ Naturally Occurring Retirement Communities (NORCs)--communities with a large proportion of older people residing within a defined geographic area--are becoming increasingly identifiable as the U.S. population ages. While research shows that individuals prefer to remain in their own homes as they age, often they need additional assistance to maintain their independence.1 And, as the risk of accident-related injury, such as falls, or chronic illness increases with advancing age, some older residents may require disability-related services and supports to assist them in their homes with long-term care needs. NORCs differ from purpose-built housing for the elderly (e.g., assisted living facilities or board and care homes) in that they were not designed with the provision of services to older persons in mind. Rather, these communities have a large proportion of older residents due to "aging-in- place" and migration. The term "aging-in-place" refers to individuals who have resided in their homes independently for several decades, and now may need a variety of supportive services to assist them to continue to do so. Migration may lead to an older resident demographic as a result of older persons moving into the community or younger residents leaving the community. In many of these communities older residents and health and social services providers have sought opportunities to make social, recreational, and preventive health services more widely available. As a result, partnerships between these entities, as well as with housing managers, have resulted in alternative models of health and social services delivery through so-called NORC supportive services programs (SSPs). Research conducted by Brandeis University found that interest in programs supporting NORCs is increasing. Findings from the same study indicated that NORC-SSPs may provide opportunities for cost-efficient health and supportive services delivery, increased service availability, health promotion and crisis intervention, and community improvement activities.2 The federal government, through the Administration on Aging (AoA), first provided funding for NORC-SSPs in FY2002. However, since FY2005 the AoA has provided no grant funding. With the reauthorization of the Older Americans Act (OAA) in 2006 (P.L. 109-365), Congress required the Assistant Secretary of Aging to award funds to carry out model aging-in-place projects, including NORC-SSPs, under the Community Innovations for Aging in Place initiative. Funding for NORC-SSPs under this broader initiative is contingent on future appropriations. The demographic pressure of an aging population is likely to increase demand for health and social services among the elderly. As a result, policymakers may want to consider expanding the federal government's role in funding alternative models for delivering home and community- based services, such as NORC-SSPs, that target health and social services to older residents in community-based settings. With regard to future funding of NORC-SSPs, Congress may wish to consider several issues including determining whether or not services should be targeted at the frail or those with low-income, or available to all older NORC residents; establishing program 1 AARP, The State of 50+ America 2005 Research Report, AARP Public Policy Institute, April 2005. 2 Robert Wood Johnson Foundation, "Naturally Occurring Retirement Communities Offer Opportunities for Delivering Health Care and Related Services," September 2000, at http://www.rwjf.org/programareas/resources/ grantsreport.jsp?filename=028983s.htm&pid=1142, visited December 11, 2007. ¢ standards and outcomes measures; the extent to which federal financing is appropriate and available to support NORC-SSPs; and, support for a national research agenda. This report provides descriptive information on NORCs and NORC-SSPs, including examples of two NORC-SSPs. It summarizes congressional activity related to funding NORC-SSPs with detailed information on locations that have received federal funding for a NORC-SSP between FY2002 and FY2005. In order to assist Congress in policy considerations regarding home and community-based services for the older population, the report concludes with a discussion of issues with regard to future funding of NORC-SSPs. ¢ ¢ The term Naturally Occurring Retirement Community, or NORC, was first introduced by Professor Michael Hunt of the School of Human Ecology, University of Wisconsin-Madison in the mid-1980s.3 The NORC concept refers to a geographically defined community with a large proportion of older persons. NORCs are distinguished from planned housing communities with high concentrations of older residents, such as senior retirement communities or assisted living communities, in that they are "naturally occurring"; that is, NORCs were not designed specifically as a community for older residents but rather evolved that way over time. NORCs have a large proportion of older residents for a variety of reasons. NORCs may have older long-term residents that have lived in their own homes independently for many years. Some NORCs may have developed as younger residents left while older residents remained, resulting in an older resident demographic. Other NORCs may have developed through an in-flux of older residents migrating to the community. NORCs possess a range of geographic and demographic characteristics. They may be concentrated in one or more buildings within close proximity to each other (e.g., an apartment or condominium complex), or comprised of housing that is more widely dispersed (e.g., a neighborhood of single-family homes or a rural community). NORC residents may live alone or they may live with others, such as a spouse, other family members or friends. While NORCs are identified by a large proportion of older residents, these communities include residents of all ages. Some older NORC residents are active and healthy, while others face the challenges of declining health and mobility. And, while researchers agree that NORCs have a significant proportion of older people residing in a specific geographic area, there is no agreement on what constitutes a "significant proportion" or the age criteria for inclusion (i.e., age 55 and older, 60 and older, or 65 and older).4 Under federal statute, the OAA Amendments of 2006 (P.L. 109-365) included language defining the term "naturally occurring retirement community" to mean: 3 Michael Hunt and Gail Gunter-Hunt, "Naturally Occurring Retirement Communities," Journal of Housing for the Elderly, vol. 3, issue 3/4, pp. 3-21. 4 Barbara A. Ormond et al., "Supportive Services Programs in Naturally Occurring Retirement Communities," U.S. Department of Health and Human Services, Office of the Assistant Secretary for Planning and Evaluation, Office of Disability, Aging, and Long-Term Care Policy, November 2004 (hereinafter referred to as Ormond et al., Supportive Service Programs, 2004). ¢ a community with a concentrated population of older individuals, which may include a residential building, a housing complex, an area (including a rural area) of single family residences, or a neighborhood composed of age-integrated housing--where 40 percent of the heads of households are older individuals; or a critical mass of older individuals exists, based on local factors that, taken in total, allow an organization to achieve efficiencies in the provision of health and social services to older individuals living in the community; and that is not an institutional care or assisted living setting.5 For purposes of the OAA, "older individual" is defined as a person age 60 and older. However, OAA's NORC definition does not clarify who decides whether there is a "critical mass of older individuals" and whether the decision is driven by data or general observation. The lack of a uniform definition and vague criteria for determining NORC geographic boundaries makes it difficult for researchers to estimate how many NORCs exist and how many older residents live in these communities across the United States. One survey conducted by AARP asked respondents living in non-age restricted communities whether most individuals age 50 and older had lived in their community for many years and whether the majority of neighbors were age 55 and older. The survey reported that 36% of seniors indicated they live in such communities, which could be defined as NORCs.6 However, according to AARP, this is a much higher estimate than other surveys. AARP analysis of the 2003 American Housing Survey estimated that 17% of households with individuals 55 and older were in a non-age restricted community where most neighbors were also age 55 and older.7 The NORC Supportive Services Program (SSP) model developed in the mid-1980s through a collaborative effort between New York City residents living in the Penn South Houses, a cooperative housing developing with about 3,000 units and over 6,000 residents, and the UJA- Federation of New York. At the time more than 75% of Penn South residents were age 60 and older and many were experiencing the financial, housing, and health-related challenges often associated with advancing age.8 As a result, the cooperative formed a committee which partnered with several public and nonprofit agencies to provide social services to Penn South residents. Thus, the experiences of Penn South Houses became a model for other NORCs. In the mid-1990s, the New York state legislature approved an initiative to finance and support NORC-SSPs. Similar legislation was also passed in New York City. With the introduction of state and local funding, a number of new NORC-SSPs in New York state and New York City were created. In 2002, the NORC-SSP model was expanded to five sites across the country, in part due to efforts by the United Jewish Communities, which established the NORCs Aging in Place Initiative, and grants funded through the U.S. Department of Health and Human Services (HHS), AoA.9 As of 2005, more than 80 NORC-SSPs received public funding, including 42 programs in 5 P.L. 109-365, Section 409. 6 AARP, Beyond 50.05: A Report to the Nation on Livable Communities: Creating Environments for Successful Aging, AARP Public Policy Institute, May 2005, p. 72 (hereinafter referred to as AARP, Beyond 50.05, 2005). 7 Ibid. endnote 148, pp. 106-107. The American Housing Survey is conducted by U.S. Census Bureau for the U.S. Department of Housing and Urban Development. 8 Ibid. p. 72. 9 The five sites that were the first to receive public funding were: Baltimore, MD; Philadelphia, PA; Pittsburgh, PA; (continued...) ¢ New York state and New York City that received state and city funding, and 41 NORC-SSPs in 25 states that received federal funding through AoA.10 Embedded in the philosophy of the NORC-SSP model of service delivery is community empowerment and engagement. The goal of the NORC-SSP is to create communities where older individuals can maintain their independence and lead a healthy and productive quality of life as they age in place. That is, as residents grow older in the community, and as their needs evolve over time, the types of community-based supports and services change in response to individuals' needs. NORC-SSPs promote independence and healthy aging through engaging older residents before a crisis by responding to residents' needs. Unlike other publicly financed programs, participation in the NORC-SSP is based on resident status, rather than functional or economic criteria.11 NORC-SSPs typically are collaborative partnerships between public and private entities including residents, government, housing managers and owners, local health and social services organizations, and philanthropies. These public and private entities come together to create a coordinated array of services and programs that meet both the needs and preferences of the residents in the NORC. According to the United Jewish Communities, there are four main categories of potential NORC-SSP services: · Case management, case assistance, and social work services; · Health care management and health care assistance, including disease prevention and health promotion; · Education, socialization, and recreational activities; and · Volunteer opportunities for project participants and other interested community members.12 Other services that NORC-SSPs may offer include assessment and referral services, nutrition education or meals programs, and transportation, among other things. In theory, NORC-SSPs allow health and social service providers to take advantage of economies of scale within the community in order to efficiently target home and community-based services toward older individuals in need of assistance and potentially at-risk for institutional placement. Descriptions of two NORC-SSPs are provided below. (...continued) Cleveland, OH; and, St. Louis, MO. 10 Testimony of United Hospital Fund Director, Fredda Vladeck, in U.S. Congress, Senate Committee on Health, Education, Labor, and Pensions Committee, Subcommittee on Retirement, Security and Aging, Naturally Occurring Retirement Communities: A Model for Aging in Place, hearing, 109th Cong., 2nd sess., May 16, 2006, S.Hrg. 109-599 (Washington: GPO, 2007). 11 Fredda Vladeck, A Good Place to Grow Old: New York's Model for NORC Supportive Service Programs, United Hospital Fund, 2004. 12 United Jewish Communities, NORCs: An Aging in Place Initiative, at http://www.norcs.com, visited December 11, 2007. (continued...) recommendations for FY2005, see H.Rept. 108-792, pp. 1198-1201; for FY2004 H.Rept. 108-401, pp. 795-798; for process and to test innovative ideas about services and programs for older persons. For NORC funding demonstration projects in the field of aging. Funds are to be used to expand knowledge about aging and the aging 13 Title IV of the OAA authorizes the Assistant Secretary for Aging to award funds for training, research, and of 41 NORC supportive services projects across 25 states (see Table 1).13 During that period, the provided a combined $21.4 million in grant funding from OAA Title IV appropriations for a total recommended that the AoA fund specific NORC-SSPs in various locations. For those years, AoA individuals residing in NORCs. In FY2002, FY2003, FY2004, and FY2005, Congress recommendations for a number of projects to provide supportive services programs to older In recent years, House and Senate Labor-HHS appropriations legislation has included committee ¢ .)7002 ,OPG :notgnihsaW( 995-901 .grH.S ,6002 ,61 yaM ,.sses dn2 ,.gnoC ht901 ,gniraeh ,ecalP ni gnigA rof ledoM A :seitinummoC tnemeriteR gnirruccO yllarutaN ,gnigA dna ytiruceS ,tnemeriteR no eettimmocbuS ,eettimmoC snoisneP dna ,robaL ,noitacudE ,htlaeH no eettimmoC etaneS ,ssergnoC .S.U ni ,oripahS .K hteB fo ynomitseT :ecruoS .5002YF dna 3002YF ni gnidnuf tnarg VI eltiT AAO deviecer PC .yap ot ytiliba s'laudividni na fo tnemssessa na no desab seidisbus margorp edulcni lliw taht ledom "ecivres-rof-eef" pihsrebmem a tset lliw margorp ehT .egnellahc a si margorp noitatropsnart elbakrow a gnipoleved dna ytilibaniatsus laicnanif gniniatniam taht dnif yeht tub ,seitivitca laicos htiw sroines detalosi ecno gnigagne ni laicifeneb neeb sah margorp eht troper osla ffatS .sdeen dna secnereferp sroines sserdda ot ,ylevitcaer fo daetsni ,ylevitcaorp skrow taht ledom a fo stifeneb eht eton ffatS .sisirc a tuohguorht troppus lanoisseforp gnidivorp dna ,secivres esnopser ycnegreme ruoh-42 dna skcehc erusserp doolb sa hcus secivres htlaeh gnidivorp ,noitalosi laicos gnitanimile edulcni PSS-CRON siht fo slaog ehT .esaesid cinorhc dna ytilibasid yaled ro tneverp ot dengised hcaorppa desab-noitneverp a sezisahpme margorp ehT .sevres ti sroines 008 yletamixorppa eht ot secivres htlaeh dna ,krow laicos ,noitatropsnart ,noitaercer sedivorp PC .aera CD ,notgnihsaW retaerg eht nihtiw sCRON ni gnivil sroines ot smargorp dna secivres sgnirb taht seitreporp muinimodnoc dna tnemtrapa evif fo tnemeganam eht dna ,snoitadnuof ciporhtnalihp ,stnemnrevog etats dna ytnuoc ,seicnega gnoma pihsrentrap etavirp-cilbup a si )PC( srentraP ytinummoC )DM ,ytnuoC yremogtnoM( margorP srentraP ytinummoC .)7002 ,OPG :notgnihsaW( 995-901 .grH.S ,6002 ,61 yaM ,.sses dn2 ,.gnoC ht901 ,gniraeh ,ecalP ni gnigA rof ledoM A :seitinummoC tnemeriteR gnirruccO yllarutaN ,gnigA dna ytiruceS ,tnemeriteR no eettimmocbuS ,eettimmoC snoisneP dna ,robaL ,noitacudE ,htlaeH no eettimmoC etaneS ,ssergnoC .S.U ni ,relleK revraG ecyoJ fo ynomitseT :ecruoS .smargorp rieht htiw no eunitnoc ton did setis wen eht fo owt ,tluser a sA .gnignellahc saw ytilibaniatsus margorp ,elbissop saw ytilibacilper dnuof margorp eht elihW .snoiger oihO ruof ni ledom PSS-CRON sti fo ytilibacilper eht tset ot sdnuf noitartsnomed VI eltiT AAO desu margorp snoitpO ytinummoC eht ,2002 nI .tnarg )DUH( tnempoleveD nabrU dna gnisuoH fo tnemtrapeD .S.U a dna ,seef tnediser ,tnemeganam gnidliub ,snoitubirtnoc elbatirahc morf gnidnuf seviecer snoitpO ytinummoC .secruoser ytinummoc fo noitazilitu dna ssenerawa desaercni htob retsof dna tsurt dliub hcihw ,sroines dna srotanidrooC ecruoseR yb depoleved neeb evah taht spihsnoitaler evitisop eht eton ffatS .noitatropsnart dna ,noitacude ,ssenllew dna htlaeh no sucof seitivitca dna smargorp snoitpO ytinummoC .sredivorp ecivres ytinummoc dna ,srodnev ,sreganam gnisuoh htiw spihsrentrap poleved dna sgnidliub CRON ni krow ohw srotanidrooC ecruoseR yb detsissa era stnediseR .sredivorp ecivres laicos fo esabatad dezinagro na hguorht secivres fo noitceles dna ,seitivitca rof gnirahs-tsoc ,msireetnulov ,slicnuoc yrosivda hguorht seitivitca margorp dael dna poleved sroineS .tnemrewopme roines dna noitazinagro ytinummoc htob sedulcni ledom margorp eht ,secivres dna stroppus ytinummoc detegrat htiw ytinummoc eht ni yltnednepedni gnivil stnediser redlo knil retteb ot depoleveD .raey rep stnediser redlo 007 yletamixorppa sevres dna sdoohrobhgien dnalevelC ruof ni detacol sgnidliub CRON evif ni setarepo ,dnalevelC fo noitaredeF ytinummoC hsiweJ eht yb 5991 ni nageb ,snoitpO ytinummoC )HO ,dnalevelC( margorP snoitpO ytinummoC ¢ ¢ proportion of Title IV funding allocated to NORC-SSPs increased from 9.5% of Title IV funds in FY2002 to 16.2% in FY2005. No congressional requests for NORC-SSP funding were made for FY2006. For FY2007, the House and Senate Appropriations Committees recommended funds for, respectively, 15 and 5 NORC projects; however, no funds were allocated to NORC-SSPs.14 Further congressional interest in NORCs was evident during the reauthorization of the OAA in 2006. In preparation for the OAA reauthorization, NORCs and NORC-SSPs were the subject of several hearings held by the 109th Congress.15 As a result, the OAA Amendments of 2006 (P.L. 109-365) included a provision requiring the Assistant Secretary of Aging to award funds to carry out model aging in place projects, including NORC-SSPs, under the Community Innovations for Aging in Place initiative. The aim of the Community Innovations for Aging in Place initiative is to help sustain the independence of older individuals in communities where they have established personal, family, and professional supportive networks. Entities who receive funds are required to provide comprehensive and coordinated health and social services, including the following: case management, case assistance, and social work services; health-care management and health-care assistance; education, socialization, and recreational activities; volunteer opportunities for project participants; outreach; and coordination of OAA Title III services (e.g., supportive services and centers, family caregiver support, congregate and home-delivered nutrition services, and disease prevention and health promotion services) for eligible older individuals served by the project. Funding to NORC-SSPs under the broader Community Innovations initiative is contingent on future appropriations.16 (...continued) FY2003 H.Rept. 108-10, pp.1113-1116; for FY2002 H.Rept. 107-342, pp.108-110. 14 House Committee on Appropriations, Departments of Labor, Health and Human Services, and Education, and Related Agencies, H.Rept. 109-515, 109th Cong., 2nd sess., p. 161ff; Senate Committee on Appropriations, Departments of Labor, Health and Human Services, and Education and Related Agencies, S.Rept. 109-287, 109th Cong., 2nd sess., p. 212. 15 U.S. Congress, Senate Committee on Health, Education, Labor, and Pensions Committee, Subcommittee on Retirement, Security and Aging, Planning for an Aging Population: The Administration's Recommendations for the Older Americans Act Reauthorization, hearing, 109th Cong., 1st sess., May 17, 2005, S.Hrg. 109-132 (Washington: GPO, 2005); U.S. Congress, Senate Committee on Health, Education, Labor, and Pensions Committee, Subcommittee on Retirement, Security, and Aging, Roundtable Discussion: The Older Americans Act, hearing, 109th Cong., 2nd sess., February 14, 2006, S.Hrg. 109-437 (Washington: GPO, 2006); U.S. Congress, Senate Committee on Health, Education, Labor, and Pensions Committee, Subcommittee on Retirement, Security and Aging, Naturally Occurring Retirement Communities: A Model for Aging in Place, hearing, 109th Cong., 2nd sess., May 16, 2006, S.Hrg. 109-599 (Washington: GPO, 2007). 16 For further information on OAA FY2008 funding proposals see CRS Report RL33880, Older Americans Act: FY2008 Funding and FY2009 Funding Proposals, by Angela Napili. 214,139$ 137,392 532,691 641,542 003,691 AP ,aihpledalihP 373,92$ 373,92 -- -- -- RO ,dnaltroP 559,530,1$ 559,84 -- -- 000,789 HO ,dnalevelC 019,79$ 019,79 -- -- -- HO ,itannicniC 651,288$ 677,442 -- 083,736 -- VN ,sageV saL 370,741$ 559,84 811,89 -- -- YN ,retsehcoR 677,442$ 677,442 -- -- -- YN ,kroY weN 370,741$ 559,84 811,89 -- -- YN ,olaffuB 635,400,1$ 255,984 489,415 -- -- MN ,euqreuqublA 532,691$ -- 532,691 -- -- )JN ,tseWorteM( JN ,ynappihW 532,691$ -- 532,691 -- -- )JN nrehtroN( JN ,egdE reviR 883,221$ 883,221 -- -- -- )ytnuoc recreM( JN ,notecnirP )seitnuoc 746,221$ -- 746,221 -- -- yaM epaC & citnaltA( JN ,etagraM 492,542$ -- 492,542 -- -- )ytnuoc naecO( JN ,doowekaL 128,591$ 128,591 -- -- -- )JN lartneC( JN ,htebazilE 128,591$ 128,591 -- -- -- )ytnuoc ciassaP( JN ,notfilC 246,193$ 246,193 -- -- -- )JN nrehtuoS( JN ,lliH yrrehC 856,384,1$ 892,022 -- -- 063,362,1 OM ,siuoL .tS 704,139$ 019,79 -- 794,338 -- )silopaenniM( NM ,aknotenniM 518,039$ 255,984 -- 362,144 -- )tiorteD( IM ,slliH dleifmoolB )CD 508,551,2$ 401,979 -- 107,671,1 -- ,notgnihsaW retaerG( DM ,ellivkcoR 849,791,2$ 221,796 -- 628,315 000,789 DM ,eromitlaB 428,686$ -- 428,686 -- -- AM ,notsoB 490,928$ -- 490,928 -- -- NI ,silopanaidnI 031,094$ 668,641 811,89 641,542 -- LI ,ogacihC 137,392$ 137,392 -- -- -- AI ,senioM seD 655,962$ 019,79 885,37 850,89 -- AG ,atnaltA 791,492$ 334,37 467,022 -- -- LF ,eetanaM-atosaraS 694,338$ 019,79 492,542 292,094 -- LF ,imaiM 429,491$ -- 429,491 -- -- OC ,revneD 128,591$ 128,591 -- -- -- AC ,otnemarcaS 668,641$ 668,641 -- -- -- AC ,ogeiD naS 017,621,1$ 814,636 -- 292,094 -- AC ,selegnA soL 532,691$ -- 532,691 -- -- ZA ,noscuT latoT 5002YF 4002YF 3002YF 2002YF noitacoL 5002YF-2002YF ,)sCRON( seitinummoC tnemeriteR gnirruccO yllarutaN ot )sPSS( smargorP secivreS evitroppuS rof gnidnuF laredeF . 1 elbaT ¢ ¢ noitacoL 2002YF 3002YF 4002YF 5002YF latoT AP ,hgrubsttiP 004,791 641,542 492,542 019,79 057,587$ IR ,ecnedivorP -- -- 950,94 -- 950,94$ TU ,ytiC ekaL tlaS -- -- -- 137,392 137,392$ AV ,dnomhciR -- -- 532,691 -- 532,691$ AV ,hcaeB ainigriV -- -- 507,171 -- 507,171$ AW ,elttaeS -- -- 771,741 -- 771,741$ IW ,nosidaM -- -- 214,343 -- 214,343$ latoT 060,136,3$ 747,614,5$ 985,563,5$ 732,710,7$ 336,034,12$ nA :sCRON" ,seitinummoC hsiweJ detinU morf deifitnedi snoitacol PSS-CRON no desab sisylana SRC :ecruoS snoitacol esehT .7002 ,11 .ceD detisiv ,470741=DIelcitrA?lmth.egap/moc.scron//:ptth ta "evitaitinI ecalP ni gnigA lanoissergnoC" sa denifed "setadnaM lanoissergnoC" deviecer taht seetnarg AoA fo tsil eht ot derapmoc erew secivreS namuH dna htlaeH fo tnemtrapeD morf "sesoprup cificeps rof stcejorp laiceps fo gnidnuf detcerid ,SHHD ,dna ;AoA ,tcA snaciremA redlO eht fo VI eltiT rednU :6002 raeY lacsiF stnarG evitcA fo muidnepmoC ,)SHHD( .AoA ,tcA snaciremA redlO eht fo VI eltiT rednU :2002 raeY lacsiF stnarG evitcA fo muidnepmoC Over the next few decades, the older population is expected to grow dramatically. Between 2005 and 2010, the population age 65 and older is expected to increase 10%, from 37 million to 40 million, and then by an additional 36%, to 55 million, by 2020. The U.S. Census Bureau projects that in 2030 the U.S. population will have an estimated 72 million older Americans, more than twice as many as the number estimated in 2000.17 This increase is, in part, due to longer life expectancies and the aging of the baby boom generation. Not surprisingly, most older Americans desire to remain in their homes for as long as possible. According to a survey conducted by AARP the vast majority (84%) of individuals age 50 and over want to remain in their current residences. This desire increases substantially by age, with 91% of persons 65 to 74 and 95% of persons 75 and older expressing the desire to remain living in their own homes.18 As the older population continues to increase both in size and as a proportion of the total U.S. population, and as individuals continue to live longer post-retirement, the demographic pressure of an aging population is likely to increase demand for health and social services. Congress will face a decision as to whether to expand the role of the federal government in funding these services to older adults living in home and community-based settings. If Congress chooses to expand the federal government's role, one program model they might consider is NORC-SSPs. This section briefly describes some issues for Congress to consider with respect to expanding federal funding of NORC-SSPs. These issues include program eligibility, sustainable program funding, implementing program standards and outcomes measures, and areas for further research. 17 Federal Interagency Forum on Aging-Related Statistics, Older Americans 2004: Key-Indicators of Well-Being, Washington, DC: U.S. Government Printing Office, 2004. (Hereinafter cited as: Federal Interagency Forum on Aging- Related Statistics, Older Americans 2004). 18 AARP, Beyond 50.05, 2005. ¢ ¢ Some federal and state programs or initiatives (e.g., OAA services, Medicaid, SSI) require individuals to be determined eligible for benefits or services based on certain demographic, income, and/or functional criteria, often measured as one or more limitations with Activities of Daily Living (ADLs)19 Unlike these types of programs, services within NORC-SSPs are available to all older residents living in the community, not just those who are aged, frail, or economically disadvantaged. One issue for Congress is whether or not federal funding to NORC-SSPs should assist more affluent communities or individuals. While some believe that eligibility for federal funds should be targeted to needy individuals, others believe there are public benefits derived from targeting funds more broadly at the local level whereby communities can best address individual need through partnerships with key stakeholders (e.g., residents, housing managers, and health and social service providers). These partnerships in turn can address issues affecting NORC residents at the local and community levels. Many of these initiatives may also benefit the public at-large by fostering economic development, building accessible and affordable housing for the frail elderly and other persons with disabilities, and improving public transportation services. Including active older adults in NORC-SSPs provides opportunities for civic engagement and community leadership as well as increasing awareness of available community services. Moreover, offering services and supports to those who are low-income, but not necessarily eligible for public assistance, may prevent or delay individuals from spending down their own assets to qualify for public programs or benefits. Thus potentially reducing demand for public assistance or forestalling unnecessary institutionalization. Given the diversity of NORCs and NORC-SSPs, Congress may want to consider developing program standards so that all programs meet certain identified goals or specified outcomes measures. Program outcomes may take into account both the short-term and long-term outcomes of NORC-SSPs. For example, supportive services programs may meet resident's immediate needs by addressing social isolation, depression, or assistance with personal care, transportation, or housework. Over the long-term the NORC-SSPs will, ideally, become a trusted resource for residents and families to turn to in a crisis, in addition to building awareness about what community services are available to help residents live independently. Outcomes measurement may need to look beyond tracking program participation to better understand reasons for non- participation. Data on non-participation may be an indicator of a vulnerable older adult population experiencing social isolation. Establishing specific program standards and outcome measures may also assist Congress in ensuring that funding for NORC-SSPs is targeted to specific groups for specific purposes and outcomes can be measured over time. Such standards may also ensure NORC program services are not duplicative. At the federal level, several programs exist to provide social and health- related services to individuals in home and community-based settings. They include separate 19 Activities of Daily Living generally refer to the following activities: eating, bathing, dressing, toileting, dressing, walking across a small room, and transferring in or out of a bed or chair. ¢ funding for supportive services and nutrition programs under Title III of the OAA, the Social Services Block Grant program, and Medicaid home and community-based long-term care services to those who meet certain financial and functional eligibility criteria as defined by each state. Congress may want to consider the extent to which federal financing is made available for NORC-SSPs in relation to other public and private financing. According to research on NORC- SSPs for the HHS Assistant Secretary for Planning and Evaluation (ASPE), "the challenge, as with many supportive services programs, is finding the right private-public-philanthropic resource mix, and the right balance among individual, community, and societal obligations."20 While Congress has shown interest in funding NORC-SSPs, funding has been limited to OAA Title IV grants which fund temporary research and demonstration initiatives. Local dollars were also used to supplement the federal grants. Each site that received a NORC-SSP federal grant provided a match of $1 local dollar for every $3 federal dollars.21 However, since FY2005 AoA has not awarded grants for these programs. One challenge for NORC-SSPs has been sustaining funding over time. Some NORC-SSPs have relied on other public and private funding sources such as state and local governments, residents, housing management, community organizations, and philanthropies. Many of these funding sources may also be temporary. Other NORCs, unable to financially sustain their programs, have ceased to provide services.22 NORC-SSPs are continuing to experiment with generating internal sources of funding through membership fees, resident activity fees, building management fees, and cooperative fees. While internal funding may be a necessary source for program sustainability, NORC-SSPs may want to ensure services remain available to all residents so that fees don't place an undue financial burden on those with limited means. If Congress continues to fund NORC-SSPs, it may also consider funding national research on the topic in order to provide information on best practices for implementing a NORC-SSP or to offer technical assistance to grantees. Research might focus on efforts to apply the NORC-SSP model to hard-to-serve areas such as rural communities and other less-densely populated areas. Further research could explore the geographic characteristics necessary for successful NORC-SSP implementation in terms of community identity and size, population density, and local infrastructure. Research that utilizes data sources such as the U.S. Census to define a NORC's geographic boundary and characteristics of its resident population may assist in establishing a more uniform definition of NORCs along with the ability to target federal funds toward vulnerable populations. 20 Ormond et al., Supportive Service Programs, 2004. 21 Ibid. 22 Testimony of Joyce Garver Keller, in U.S. Congress, Senate Committee on Health, Education, Labor, and Pensions Committee, Subcommittee on Retirement, Security and Aging, Naturally Occurring Retirement Communities: A Model for Aging in Place, hearing, 109th Cong., 2nd sess., May 16, 2006, S.Hrg. 109-599 (Washington: GPO, 2007). kblack@crs.loc.gov, 7-7839 Analyst in Gerontology Kirsten J. Colello ¢ ------------------------------------------------------------------------------ For other versions of this document, see http://wikileaks.org/wiki/CRS-RL34289