"Aging in Place" Communities Offer Seniors Independence and Support

Quick summary

According to AARP, nine out of ten Americans hope to live out their days in their own homes. But as they age, many are faced with a dilemma: They want to remain independent but need at least some of the support that a retirement community offers. Across the country, innovative new programs are springing up to bridge this gap by offering the support that would normally come with assisted living or even a nursing home while allowing seniors to remain in their community.

What kinds of programs are available?

These programs run the gamut from informal neighborhood associations to more organized programs coordinated by community agencies to federally funded demonstration projects.

While the options may seem complex, the underlying principle is simplicity itself: Caring for elders, like caring for children, makes a lot more sense when we do it as a community. If your parents are committed to "aging in place" (a term for those who consciously choose to grow old at home rather than moving to a retirement community), it's worth exploring such programs and finding out whether they exist in your parents' area, or what it would take to start one.

• PACE (Programs of All-Inclusive Care for the Elderly). Pioneered in San Francisco in the 1970s, the PACE model has now spread to about 50 sites nationwide. Run by community-based organizations and funded mainly by Medicare and Medicaid, PACE is open to those over the age of 55 who would otherwise be eligible for nursing home care but are able to live safely in the community with support.

By providing "wraparound" services including social support and medical care -- usually in a neighborhood day center -- as well as in-home meals and other care as needed, PACE programs aim to keep ailing seniors out of nursing homes and in their own homes. Participants have access to coordinated medical care as well as physical, occupational, and recreational therapy; nutritional counseling; social services; specialists such as dentists, optometrists, and audiologists; and home healthcare as needed.

Early research indicates that participating in PACE can slow the decline often seen in nursing home residents. If your parents are not eligible for Medicaid, which is an income-based benefit, they may have to cover some of the cost of the program themselves, but it's generally less expensive than nursing home care.

You can find a list of PACE providers all over the country at the National PACE Association's website or by calling (703) 535-1565.

• NORC (Naturally Occurring Retirement Communities). In a NORC, a neighborhood or apartment building evolves over time to have a large concentration of seniors, who then organize -- generally with the help of a community agency -- to share services and support. By involving elders in coordinating their own care, a NORC aims to provide not only the kind of services they might find in an assisted-living or other retirement setting but also a sense of community.

Funded by the U.S. Administration on Aging, NORCs vary in how they're structured and what they offer, but in most cases a lead agency coordinates services to a particular neighborhood. These services start with healthcare and basic social services and can include everything from financial planning and legal advice to meal delivery and home renovations tailored to aging in place (such as grab bars, access ramps, and additional lighting). Most NORCs also offer members access to social, recreational, and volunteer opportunities in the community, as well as transportation and home healthcare as needed.

The lead agency coordinates with community programs ranging from hospitals and Area Agencies on Aging to local catering and home repair businesses. By allowing seniors to access all of these services with a single phone call, a NORC can simplify things for older adults who need extra support but don't want to move.

You can locate and learn more about NORC demonstration sites across the country via the NORC National Initiative website.

• Elder villages. Another increasingly popular option springing up across the country, these are somewhat more loosely organized than the PACE or NORC models, but they also offer seniors communal support and services as they age. Members pay an annual fee (generally a few hundred dollars) to join, which gives them access to an on-call list of providers who offer everything from home repair and meal delivery services to transportation and in-home care, often at a discounted rate. Some villages also offer free services to members, such as daily check-in calls (especially valuable to seniors who live alone) and disaster preparedness inspections. Villages also hold recreational and social events.

One of the best-known villages is Boston's Beacon Hill Village, which publishes a newsletter and has produced a manual and DVD in an effort to help other communities replicate its model. Beacon Hill even has a concierge service, which will, for example, mail packages, take members' cars in for repairs, water plants, and pick up mail during a vacation.