Aging in Place and Urban Social Work: A Case Study of a NORC

By: Man Wai Alice Lun, PhD

Currently, there are about 47 million people aged 60 and over in the U.S., which comprises 16.6 percent of the total population. It is believed this number will increase drastically as baby boomers age. As is the case nationally, in New York City there were about 1.3 million (16.1%) aged 60 and over of the city’s total population in 2005. Indeed, the older population of New York City has been increasing at a steady rate of 2.6%, from 1,252,206 in 2000 to 1,284,946 in 2005, according to the New York City Department for the Aging.

Looking at the racial distribution of the older population in New York City, statistics show that older whites as a group have slightly decreased at the rate of 20% between the 1990 and 2000 census data sets, whereas all other racial groups as a whole have increased 31.8% (NYCDFTA, 2003). A racial transition is happening in New York City, with all older racial minority groups growing in all five boroughs, concurrent with a decreasing older white population. New York City is like other urban areas nationwide in facing a rapidly growing aging population.

The majority of older people are dwelling in communities and neighborhoods (cited by Hooyman and Kiyak, 2008, p. 444). Providing home- and community-based health and social services to large groups, also known as “cluster care,” is believed to be a more cost-effective way, as compared with medical nursing homes, in long term care policy. It is necessary to explore whether the present urban area social service systems are able to provide health and social services to meet the needs of an older old population and whether these services are culturally competent.

Aging in Place and Naturally Occurring Retirement Community (NORC)

Although Americans move about and resettle more than people from any other country, the trend for current elders and baby boomers is to reside in their original communities as they age. In fact, the trend of “aging in place” has raised more and more discussions about criteria for healthy aging. One trend of aging in place is called “Naturally Occurring Retirement Community (NORC),” defined in New York as communities in which at least 45% of heads of households, and other residents, in apartments and population-dense neighborhoods have grown older. Nationwide, NORCs are considered to exist when a disproportionate number of older people live in a building or neighborhood (Lanspery, 1995). NORCs vary by location, physical dimensions, population size, demographic characteristics, reasons for existence, and ownership characteristics. According to Lanspery (1995), NORCs are the most dominant, and yet overlooked, form of senior housing. Generally, the official term “NORC” is used when 50% of the residents in a given geographic area are age 60 or over. In addition to vital case management and health services, a variety of social, recreational, and healthy support services are provided within a NORC, and mobility is usually not an issue for seniors to access on-site services. NORC-based senior programs are believed to help reduce isolation and postpone elders’ institutionalization (Lanspery, 1995), increasing a senior’s overall functioning in his or her community.

The provision of social- and health-related services through a NORC with the collaboration of the senior residents and various social, health, and housing providers not only provides an ideal setting for human services and social work practice, but more importantly, also meets the needs of the diverse aging population in urban areas.

Needs of Home and Community-Based Services and Older Minorities

Whether or not older adults are living in NORCs, there is no doubt that many older adults are living in the community. According to DFTA, the majority of older adults age 65 or over resided in a community, and only about 4% were institutionalized in 2000. In addition, the Federal Interagency Forum on Aging-Related Statistics showed that about 30% of older people lived in areas considered “central cities” (cited by McInnis-Dittrich, 2005, page 5).

Urban social work needs to be fluid and timely in its response to the needs of older people. Community-dwelling older adults might not be frail or have physical limitations. Indeed, their health status can be varied. In 2005, about 36% of older adults in New York City had mobility and self-care limitations (NYCDFTA, 2008). They might need certain home- and community-based services, such as supportive social services and nutrition services, to help them continue to live independently, semi-independently, or interdependently and reduce institutionalization.

Another critical urban concern has the tendency to be ignored: poverty among older adults. There is no denying that Social Security and other benefits have reduced the rate of poverty since the enacting of critical welfare policies developed in our country since the Great Depression. In the U.S., there was a 10% poverty rate in the group 65 and older in 2005 (DFTA, 2008). But in New York City, about 20% of older adults were living in poverty. In the Bronx, about 33% of the older population are living at 150% of the poverty level, and 43% are at 200%. And the rate has unfortunately increased 14% between 2000 and 2005. And with our current fiscal recession, this number will increase. To add to the financial woes of an aging society, older minority people aging in their communities will have additional difficulties. Poverty is a critical issue, and we need to make certain that our elder citizens do not face financial problems. As such, it is our duty as citizens to ensure our representative government continues and improves benefits, entitlements, and other financial assistance to build a safety net for this at-risk population. If our government can use our taxpayer resources to build an economic safety net for some big businesses, we have to make sure our government uses our resources to provide a safety net for “the least.”

Implications

How do present and future human services and social workers identify and meet these needs in both direct practice and policy? The implications address the specific challenges for urban social work: rising needs for specialized professional training—the curricula of gerontologist and geriatric social work must be re-tooled across the social work spectrum. Are programs addressing enough of the uniqueness of older persons of color? National data do not give us a lot of information about older persons of color, from demographic distribution to their specific needs. This makes it difficult for the curricula to provide up-to-date, proper and précis knowledge about the aging population. For instance, the research on racial minority senior citizens having greater rates of depression needs to enrich curricula, alter practice, and improve policy addressing mental health issues.

To equip students with important knowledge of aging, the gerontology programs should also make more interdisciplinary efforts. To increase the readiness of all professions and provide multidisciplinary perspectives, educators and students need practical sessions or training to understand physical, psychological, and social changes as we all age. Some departmental collaborative efforts can fulfill this purpose.

Another implication is to ensure that social work plays the role of advocate in seeking additional funding for new programs and restoring funding for previous successful programs for the older populations. Most of the U.S. national social and welfare policies were established within the past 75 years to improve older people’s lives. Social Security was first started in 1935, when seeing the grave effects of a macro economic downturn on the lives of the aged. But it was not until the 1960s that federal spending for programs for older adults expanded rapidly.

In addition to economic climate, our societal values will affect social policy development. Hooyman and Kiyak (2008) state that there is no doubt that our current social policy is shortsighted and fails to deal with social trends and long term planning (p. 678). We all need to take a part of the role of social work as advocate to negotiate long-term benefits for older adults. Particularly, older ethnic minority citizens are less likely to seek formal services because of their language barrier and lack of knowledge. Developing programs that match older minorities’ culture and language can increase and improve the quality of their lives.

Last but not least, providing culturally competent practice is not only a culture and language adjustment, but also a must-have attitude. This is and will always be a challenge to urban social work in our time. As we know, the increasing percentage of older minority people as part of the total population will be high, and the services should increase to match their numbers and needs. As service providers, human services and social workers should move forward in understanding and providing culturally competent practice. A profession that has a foundational principle of working with vulnerable populations like minorities of color should do research to identify the uniqueness of the ethnic groups that they are working with and develop cultural sensitivity toward these groups.

Although language and cultural barriers can prevent older immigrants from seeking health care and other formal services from mainstream society, they also provide the opportunity for more skilled elders to volunteer in helping their diverse neighbors hurdle such barriers.

References

NYCDFTA. (2003). The older population in New York City: Changes in race, Hispanic origin, and age, 1990 to 2000 an analysis of census data. (pdf file)(Spring 2003). New York: New York City Department for the Aging.

NYCDFTA. (2008). Quick facts. New York City Department for the Aging.

Lanspery, S. (1995). AAAs and NORCs. Retrieved October 9, 2003, from http://www.homemods.org/library/pages/aaa.htm.

Hooyman, N.R., & Kiyak, H. A(2008). Social gerontology: A multidisciplinary perspective (Eighth ed.). Boston: Allyn and Bacon.

McInnis-Dittrich, K. (2005). Social work with elders: A biopsychosocial approach to assessment and intervention (Second ed.). Boston: Allyn and Bacon.

Novak, M. (2006). Issues in aging. Boston: Allyn and Bacon.

Man Wai Alice Lun, Ph.D., is Assistant Professor of Human Services at Borough of Mahattan Community College of CUNY in New York City. Her research interests include educational gerontology, long-term care services, and spirituality issues. She has contributed a chapter entitled, “A Day in the Life of a Naturally Occurring Retirement Community” in the book DAYS IN THE LIVES OF GERONTOLOGICAL SOCIAL WORKERS.