Supportive Services Programs to Naturally Occurring Retirement Communities

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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.

Introduc tion ..................................................................................................................................... 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 ¹
homes as they age, often they need additional assistance to maintain their independence. 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 ²
improvement activities.
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

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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 ³
the mid-1980s. 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 ⁴
and older).
Under federal statute, the OAA Amendments of 2006 (P.L. 109-365) included language defining
the term “naturally occurring retirement community” to mean:

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^Se^r^v^ic^e^Pr^ogr^am^s^,²⁰⁰⁴⁾^.

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^{is n}^o^{t an}ⁱⁿ^stit^u^tioⁿ^a^{l car}^{e o}^r^assis^t^ed^livⁱⁿ^g^settiⁿ^g^.
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 ⁶
communities, which could be defined as NORCs. 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 ⁷
community where most neighbors were also age 55 and older.

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 ⁸
associated with advancing age. 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), ⁹
AoA. As of 2005, more than 80 NORC-SSPs received public funding, including 42 programs in

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⁽^c^onti^nue^d.^..)

New York state and New York City that received state and city funding, and 41 NORC-SSPs in ¹⁰

25 states that received federal funding through AoA.

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 ¹¹
criteria.
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 ¹²
members.
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.

^(...c^on^tin^ue^d)
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¹⁰^T^e^sti^m^on^y^of^Unite^{d Hospi}^t^a^l^Fu^{nd Dire}^c^t^or^{, Fre}^d^da^V^l^a^d^e^c^k^{, in}^{U.S. Co}^ng^re^{ss, Se}^na^te^Com^m^itte^e^{on He}^a^l^t^h^,
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^Re^tire^m^eⁿ^{t Communi}^tie^{s: A M}^o^de^{l for A}^gⁱⁿ^{g i}ⁿ^Pl^ac^e^,^h^eariⁿ^g,¹⁰⁹^Cong^{., 2}^s^e^s^s^{., Ma}^y^{16, 20}⁰⁶^,^S.H^r^g^.¹⁰^9-⁵⁹⁹
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^Hospita^{l F}^uⁿ^d^,²⁰⁰⁴^.
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²⁰⁰^7.

Community Options Program (Cleveland, OH)
^{Community Op}^{tions, began in}¹⁹⁹⁵^{by th}^{e Jewish Comm}^{unity Fed}^{eration of Cleveland, operates in}^{five NORC}
^{buildings located in four Cleveland neighborhoods and se}^{rves a}^ppr^{oximately 700 older residents}^pe^{r year. Developed}
^{to better link older residents living indepe}^{ndently in t}^{he commu}^{nity with targeted comm}^{unity s}^u^p^p^{orts and services,}
^{the p}^{rogram model includes both}^{community orga}^{nization and senior empowerme}^{nt. Seniors develop and lead}
^{program activities throug}^{h advisory coun}^{cils, volunteerism, cost-sharing for activities, and selection of services}
^through^{an orga}^{nized database of social service providers. Residents are assisted by}^{Resource Coor}^{dinators who}
^{work in NORC b}^{uildings and develop partne}^rships^{with hou}^{sing m}^{anagers, vendors, and}^community^service
^{providers. Community O}^{ptions p}^{rograms and activities focus on}^h^{ealth and wellness, education, an}^{d transportation.}
^{Staff note the}^{positive relationships that}^have^been^{developed by}^{Resource Coordinators and seni}^{ors, which b}^uild
^{trust a}^{nd foster}^{both increa}^{sed a}^{wareness a}^{nd utilization of community reso}^{urces. Commu}^{nity Opt}^{ions receives}
^{funding f}^{rom cha}^{ritable contrib}^{utions, building managemen}^{t, resident fees, and a U.S. Departme}^{nt of}^{Housing and}
^{Urban Developme}^{nt (HUD) gran}^{t. In 2}⁰⁰^{2, the Commu}^{nity O}^{ptions p}^{rogram us}^{ed OAA Title IV demonstration}
^{funds to test}^the^{replicability of it}^{s NORC-SSP model}^{in four O}^{hio regions. While the program}^foun^{d replicability was}
^{possible, program su}^{stainability was challenging. As a res}^{ult, two of the ne}^{w sites did not continue o}ⁿ^{with th}^eir
^programs.
^Source:^{Testimony of Joyce}^Gar^{ver Keller, in U.S. C}^{ongress, Senate Committee on Health, Educati}^{on, Labor, and}
^{Pensions Committee, Subcommittee on Retirement, Security a}^nd^Aging,^{Naturally Occu}^rri^{ng Retirement Communities: A}
^{Model for Aging in Place}^{, hearing, 1}⁰⁹^th^{Cong., 2}^nd^{sess., May 16,}²⁰⁰^{6, S.Hrg. 109-5}⁹⁹^(Washington:^{GPO, 20}^07).
Community Partners Program (Montgomery County, MD)
^{Community Partne}^{rs (CP) is a pu}^{blic-private part}^ners^{hip among ag}^{encies, county a}^{nd state gover}^nm^ents,
^philanthro^{pic foundations, and th}^{e manageme}^{nt of five a}^partme^nt^{and condominium pro}^{perties that}^{brings s}^ervices
^{and programs}^{to seniors living in}^{NORCs within th}^{e greater}^Wash^{ington, DC area. CP provides recreation,}
^{transportation, social work, and health services}^{to the a}^pproximat^{ely 800}^{seniors it serv}^{es. The p}^{rogram emp}^{hasizes a}
^preve^{ntion-based ap}^{proach desig}^{ned to preve}^{nt or delay disability and ch}^{ronic disease. The goals of this NORC-SSP}
^{include eliminating social is}^olat^io^{n, providing health se}^{rvices su}^ch^{as blood pressur}^{e che}^{cks and}^24-^{hour eme}^rgenc^y
^response^{services, and}^{providing professional su}^{pport t}^hroug^hout^{a crisis. Staff note the}^bene^{fits of a model that}
^{works proactively, instead of rea}^{ctively, to address seniors prefer}^{ences a}^{nd needs. Staff also report}^{the p}^{rogram ha}^s
^been^bene^{ficial in engaging once i}^{solated seniors with social activit}ⁱ^{es, but t}^{hey find t}^{hat maintaining}^financial
^{sustainability and developing a w}^{orkable trans}^{portation program}^{is a challenge. The p}^{rogram will test a membe}^rship
^{“fee-for-service” model that will i}^{nclude progra}^{m su}^{bsidies based}^{on an asses}^{sment of a}ⁿ^{individual’s ability to pay. CP}
^{received OAA Title IV grant f}^und^{ing in FY200}^{3 a}^{nd FY200}^5.
^Source:^{Testimony of Beth K. S}^{hapiro, in U.S. Congress, Senate Committee on Health, Education, Labor, and}
^{Pensions Committee, Subcommittee on Retirement, Security a}^nd^Aging,^{Naturally Occu}^rri^{ng Retirement Communities: A}^th^nd
^{Model for Aging in Place}^{, hearing, 1}⁰⁹^{Cong., 2}^{sess., May 16,}²⁰⁰^{6, S.Hrg. 109-5}⁹⁹^(Washington:^{GPO, 20}^07).

In recent years, House and Senate Labor-HHS appropriations legislation has included committee
recommendations for a number of projects to provide supportive services programs to older
individuals residing in NORCs. In FY2002, FY2003, FY2004, and FY2005, Congress
recommended that the AoA fund specific NORC-SSPs in various locations. For those years, AoA
provided a combined $21.4 million in grant funding from OAA Title IV appropriations for a total ¹³
of 41 NORC supportive services projects across 25 states (see Table 1). During that period, the

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^de^m^ons^tr^a^tion^pr^oje^c^t^sⁱⁿ^t^h^e^fⁱ^e^l^{d of}^a^g^ing^.^Fu^nds^a^r^e^t^o^be^us^e^d^t^o^e^x^pa^{nd k}ⁿ^o^w^l^e^d^g^e^a^{bout a}^g^ing^a^{nd t}^h^e^a^g^ing
^pr^oc^e^s^s^a^{nd t}^o^te^s^tⁱⁿⁿ^o^v^a^tiv^e^ide^a^s^a^{bout s}^e^r^v^ic^e^s^a^nd^pr^og^r^a^m^s^f^o^r^olde^r^pe^r^s^ons^.^F^o^r^N^O^R^C^f^undi^ng
^r^e^c^o^m^m^e^nda^tions^f^o^r^FY²⁰⁰⁵^{, s}^e^e^H^.^R^e^{pt. 1}^08-⁷⁹^2,^pp^{. 1}¹⁹⁸^-¹²⁰^{1; f}^o^r^FY²⁰⁰⁴^H^.^R^e^pt^{. 1}^08-⁴⁰^1,^pp.⁷⁹^5-⁷⁹⁸^{; f}^o^r
⁽^c^onti^nue^d.^..)

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, ¹⁴
respectively, 15 and 5 NORC projects; however, no funds were allocated to NORC-SSPs.
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 ^th¹⁵

several hearings held by the 109 Congress. 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 ¹⁶
future appropriations.

^(...c^on^tin^ue^d)
^FY²⁰^{03 H}^.^R^e^pt.¹⁰^8-¹⁰^,^pp^.1¹¹³^-¹¹^{16; f}^o^r^FY²⁰⁰²^H^.^R^e^pt.¹⁰^7-³^42,^pp^.1^08-¹¹^0.
¹⁴^H^ous^e^C^o^m^m^itte^e^{on A}^ppr^opr^ia^tⁱ^ons^,^D^e^par^tm^eⁿ^ts^{of L}^a^b^o^r^,^H^e^al^{th a}ⁿ^d^H^u^m^aⁿ^Se^r^v^ic^e^s^,^{and Ed}^uc^atio^{n, an}^d
^R^e^l^a^t^e^d^A^g^en^ci^es^{, H}^.^R^e^pt^{. 1}^09-⁵¹^{5, 1}⁰⁹^th^Co^ng^.,²^nd^s^e^s^s^{., p. 1}^61f^f^;^Se^na^te^C^o^m^m^itte^e^{on A}^ppr^o^p^rⁱ^a^t^ions^,^De^partmeⁿ^ts^th^nd
^{of L}^a^b^o^r^,^H^e^alt^h^an^{d H}^u^m^aⁿ^Se^r^v^ic^e^s^,^{and Ed}^uc^ati^{on an}^d^Re^l^a^te^d^Ageⁿ^cⁱ^e^s^{, S}^.^R^e^pt.¹⁰^9-²⁸⁷^,¹⁰⁹^Cong^.,²^sess.^,^p^.
²¹²^.
¹⁵^{U.S. C}^ong^re^{ss, Se}^na^te^Com^m^itte^e^{on He}^a^lth^{, Ed}^uc^a^tio^{n, L}^a^bor,^aⁿ^d^P^e^nsi^ons^C^o^m^m^itte^e^,^Subc^om^m^itte^e^on
^Re^tire^m^eⁿ^{t, Se}^c^u^rity^a^{nd A}^g^ing^,^Planⁿⁱⁿ^g^f^o^r^aⁿ^A^gⁱ^{ng P}^o^p^u^l^a^tio^n:^T^h^e^Admⁱ^nis^t^r^a^ti^on’^s^Re^c^o^m^m^e^ndat^io^ns^for^t^h^e^th^st
^Olde^{r Ame}^r^ic^{ans Ac}^{t Re}^a^u^t^horiza^tion^,^h^eariⁿ^g,¹⁰⁹^Cong^.,¹^s^e^s^s^{., Ma}^y^{17, 2}⁰⁰⁵^,^S.H^r^g^.¹^09-¹³^{2 (}^W^a^s^hing^ton:
^G^P^{O, 20}⁰⁵⁾^{; U.S.}^Co^ng^re^{ss, Se}^na^te^Com^m^itte^e^{on He}^a^lth,^E^duc^a^tio^{n, L}^a^{bor, a}^nd^P^e^nsio^{ns Com}^m^itte^e^,^Subc^om^m^itte^e^th^nd
^{on Re}^tire^m^eⁿ^{t, Se}^c^u^rity^{, a}^{nd A}^gⁱⁿ^g^,^Ro^un^dta^b^le^Dⁱ^s^c^us^sⁱ^oⁿ^:^T^h^e^O^l^de^r^Am^e^r^ic^ans^Ac^t^,^h^earⁱⁿ^g,¹⁰⁹^Cong^.,²^sess.^,
^Fe^br^ua^r^y^{14, 2}⁰⁰⁶^,^S.H^r^g^.¹^09-⁴³^{7 (}^W^a^s^hing^ton:^G^P^O^,²⁰⁰⁶⁾^;^U^.^S.^C^ong^r^e^s^s^,^Se^na^te^C^o^m^m^itte^e^{on H}^e^a^{lth, Ed}^uc^a^tion^,
^L^a^bor^{, a}^nd^P^e^ns^io^ns^C^o^m^m^itte^e^,^Subc^om^m^itte^e^{on R}^e^tir^e^m^eⁿ^{t, Se}^c^u^r^ity^a^{nd A}^g^ing^,^Naturally^Oc^c^u^{rring Re}^tire^m^eⁿ^t^th^nd
^C^o^m^m^unitⁱ^e^s^:^{A M}^ode^l^for^A^gⁱ^ng^{in Pl}^ac^e^,^h^eariⁿ^g,¹⁰⁹^Cong^.,²^s^e^s^s^{., Ma}^y^{16, 20}⁰⁶^{, S.H}^r^g^.¹⁰⁹^-⁵⁹^{9 (}^W^a^s^hing^ton:
^G^P^O^,²⁰⁰⁷⁾^.
¹⁶^For^f^u^r^t^he^r^inf^o^r^m^a^{tion o}ⁿ^O^A^A^FY²⁰^{08 f}^uⁿ^dⁱⁿ^g^pr^o^pos^a^l^s^s^e^e^C^R^S^R^e^por^t^R^L³³⁸⁸⁰^,^O^l^de^r^Am^e^r^ic^ans^Ac^t:
^FY20⁰⁸^Fu^ndⁱⁿ^{g a}ⁿ^d^FY2⁰⁰⁹^F^u^ndi^ng^Pr^op^os^als^,^by^A^nge^la^Na^pili.

Table 1. Federal Funding for Supportive Services Programs (SSPs) to Naturally
Occurring Retirement Communities (NORCs), FY2002-FY2005
^Location^FY20^{02 FY20}^{03 FY20}^{04 FY20}⁰⁵^Total
^{Tucson, AZ}^—^—^196,²³⁵^—^$196,²³⁵
^{Los Angeles, CA}^—^490,²⁹²^—^636,⁴¹⁸^$1,12^6,7¹⁰
^{San Diego, CA}^—^—^—^146,⁸⁶⁶^$146,⁸⁶⁶
^{Sacramento, CA}^—^—^—^195,⁸²¹^$195,⁸²¹
^{Denver, CO}^—^—^194,⁹²⁴^—^$194,⁹²⁴
^{Miami, FL}^—^490,²⁹²^245,²⁹⁴^97,9¹⁰^$833,⁴⁹⁶
^{Sarasota-Manatee, FL}^—^—^220,⁷⁶⁴^73,4³³^$294,¹⁹⁷
^Atlanta,^GA^—^98,0^{58 73,5}^{88 97,9}¹⁰^$269,⁵⁵⁶
^{Des Moines, IA}^—^—^—^293,⁷³¹^$293,⁷³¹
^{Chicago, IL}^—^245,¹⁴⁶^98,1¹⁸^146,⁸⁶⁶^$490,¹³⁰
^{Indianapolis, IN}^—^—^829,⁰⁹⁴^—^$829,⁰⁹⁴
^{Boston, MA}^—^—^686,⁸²⁴^—^$686,⁸²⁴
^{Baltimore, MD}^987,⁰⁰⁰^513,⁸²⁶^—^697,¹²²^$2,19^7,9⁴⁸
^Rockvil^{le, MD (Greater Washingt}^on,^{— 1,17}^6,70¹^—^979,¹⁰⁴^$2,15^5,8⁰⁵
^DC)
^Bloomfie^{ld Hil}^{ls, MI (Detroit)}^—^441,²⁶³^—^489,⁵⁵²^$930,⁸¹⁵
^{Minnetonka, M}^N^(Min^neapolis)^—^833,⁴⁹⁷^—^97,9¹⁰^$931,⁴⁰⁷
^{St. Louis, MO}^1,26^3,36⁰^—^—^220,²⁹⁸^$1,48^3,6⁵⁸
^Cherry^{Hill, NJ (Southern N}^J)^—^—^—^391,⁶⁴²^$391,⁶⁴²
^{Clifton, NJ (Passaic county)}^—^—^—^195,⁸²¹^$195,⁸²¹
^{Elizabeth, NJ (Cent}^{ral NJ)}^—^—^—^195,⁸²¹^$195,⁸²¹
^{Lakewood, NJ (Ocean cou}^nty)^—^—^245,²⁹⁴^—^$245,²⁹⁴
^{Margate, NJ (Atlantic & Ca}^{pe Ma}^y^{— —}^122,⁶⁴⁷^—^$122,⁶⁴⁷
^counties)
^{Princeton, NJ (Me}^{rcer co}^unty)^—^—^—^122,³⁸⁸^$122,³⁸⁸
^{River Edge, NJ (North}^ern^NJ)^—^—^196,²³⁵^—^$196,²³⁵
^Whippan^{y, NJ (Met}^{roWest, NJ)}^—^—^196,²³⁵^—^$196,²³⁵
^Albuq^uerq^{ue, N}^M^—^—^514,⁹⁸⁴^489,⁵⁵²^$1,00^4,5³⁶
^{Buffalo, NY}^—^—^98,1¹⁸^48,9⁵⁵^$147,⁰⁷³
^{New York, NY}^—^—^—^244,⁷⁷⁶^$244,⁷⁷⁶
^{Rochester, NY}^—^—^98,1¹⁸^48,9⁵⁵^$147,⁰⁷³
^{Las Vegas, NV}^—^637,³⁸⁰^—^244,⁷⁷⁶^$882,¹⁵⁶
^Cincinnati,^OH^{— — —}^97,9¹⁰^$97,9¹⁰
^{Cleveland, OH}^987,⁰⁰⁰^—^—^48,9⁵⁵^$1,03^5,9⁵⁵
^Portland,^OR^{— — —}^29,3⁷³^$29,3⁷³
^{Philadelphia,}^PA^196,³⁰^{0 245,}¹⁴^{6 196,}²³^{5 293,}⁷³¹^$931,⁴¹²

^Location^FY20^{02 FY20}^{03 FY20}^{04 FY20}⁰⁵^Total
^Pittsburgh,^PA^197,⁴⁰^{0 245,}¹⁴^{6 245,}²⁹⁴^97,9¹⁰^$785,⁷⁵⁰
^Providence,^RI^—^{— 49,0}^{59 —}^$49,0⁵⁹
^{Salt Lake City, UT}^—^—^—^293,⁷³¹^$293,⁷³¹
^{Richmond, VA}^—^—^196,²³⁵^—^$196,²³⁵
^{Virginia Beach, VA}^—^—^171,⁷⁰⁵^—^$171,⁷⁰⁵
^{Seattle, WA}^—^—^147,¹⁷⁷^—^$147,¹⁷⁷
^{Madison, WI}^—^—^343,⁴¹²^—^$343,⁴¹²
^Total^$3,63^1,0^{60 $5,41}^6,7^{47 $5,36}^5,5^{89 $7,01}^7,2³⁷^$21,4^30,⁶³³
^Source:^{CRS analysis based on}^{NORC-SSP l}^{ocations identified fr}^{om United Jewish Communities,}^{“NORCs: An}
^{Aging in Place Initiative” at http://}^norcs.com/^{page.html?ArticleID=1}⁴⁷⁰^{74, visited Dec. 11,}²⁰^{07. The}^{se locations}
^{were compared to t}^{he list of AoA grantees t}^{hat re}^{ceived “Congr}^{essional Mandates” defined as “C}^ongressional
^{directed funding of s}^{pecial projects for spe}^{cific pur}^{poses” f}^{rom Departme}^{nt of Health a}^{nd H}^{uman S}^ervices
^(DHHS),^{Compendium of Active Grants Fiscal Year 2006: Under Title IV of the Older Americans Act}^{, AoA;}^{and, DHHS,}
^{Compendium of Active Grants Fiscal Year 2002: Under Title IV of the Older Americans Act}^{, AoA.}

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 ¹⁷
twice as many as the number estimated in 2000. 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 ¹⁸

in their own homes.
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^Fe^de^ra^{l Inte}^ra^g^e^nc^y^Forum^{on Ag}^ing^-^Re^la^te^{d Sta}^tistic^s,^O^l^de^r^Am^e^r^ic^ans²⁰^04:^K^e^y^-^I^ndic^a^tor^s^of^W^e^ll-^Be^ing^,
^W^a^s^h^ing^t^{on, D}^C^{: U}^.^{S. G}^o^v^e^rⁿ^m^e^nt^P^rⁱⁿ^ti^ng^O^f^fⁱ^c^e^,²⁰⁰⁴^{. (}^H^e^r^eⁱ^na^f^t^e^r^c^ite^{d a}^s^{: Fe}^de^r^a^{l I}ⁿ^te^r^a^g^e^ncy^For^u^m^{on A}^g^ing^-
^Re^la^te^{d Sta}^tistic^s,^Ol^d^e^{r A}^m^eri^c^an^{s 20}⁰⁴^).
¹⁸^A^A^RP^,^Be^y^oⁿ^d^50.⁰⁵^{, 20}⁰⁵^.

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 ¹⁹
Daily Living (ADLs) 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^A^c^tiv^itie^{s o}^f^Da^il^y^Lⁱ^vⁱ^ng^g^e^ne^ra^lly^re^f^e^{r to the}^f^o^llowⁱ^ng^a^c^tiv^itie^{s: e}^a^ting^,^ba^thiⁿ^g^,^dre^ssing^,^toile^ti^ng^{, dre}^ssing^,
^w^a^l^k^ing^a^c^r^os^s^a^sm^a^{ll r}^oom^{, a}^{nd tr}^aⁿ^s^f^e^r^rⁱ^ng^{in or}^out^of^a^be^d^or^c^h^aⁱ^r^.

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 ²⁰
resource mix, and the right balance among individual, community, and societal obligations.”
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 ²¹
provided a match of $1 local dollar for every $3 federal dollars. 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 ²²
ceased to provide services. 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^O^r^m^{ond e}^t^a^l^.,^Su^pp^or^tiv^e^Se^r^v^ic^e^Pr^ogr^am^s^{, 20}⁰⁴^.
²¹^Ibid^.
²²^T^e^s^tⁱ^m^on^y^of^J^o^y^c^e^G^a^r^v^e^r^Ke^lle^r^,^{in U}^.^{S. C}^ong^r^e^s^s^,^Se^na^te^C^o^m^m^itte^e^{on H}^e^a^{lth, Ed}^uc^a^tio^{n, L}^a^bor^{, a}ⁿ^d^P^e^nsⁱ^ons
^Com^m^itte^e^,^Subc^om^m^itte^e^{on Re}^tire^m^eⁿ^{t, Se}^c^u^rity^a^{nd A}^g^ing^,^Naturally^Oc^c^u^rrin^g^Re^tire^m^eⁿ^{t C}^o^mmunitie^{s: A}^M^ode^l^th^nd
^{for Ag}ⁱⁿ^{g in}^Pl^ac^e^,^h^eariⁿ^g,¹⁰⁹^Cong^.,²^s^e^s^s^{., May}^16,²⁰^06,^S.^H^r^g^.^109-⁵⁹^{9 (}^W^a^s^hing^to^{n: G}^P^O^,²⁰⁰⁷⁾^.

^Kir^s^ten^J^.^Co^lello
^Aⁿ^al^y^s^tⁱⁿ^G^e^ron^t^ol^ogy
^k^b^l^ack@^c^rs^.l^oc.g^o^v^{, 7-}⁷⁸³⁹