Stories

Crestmoor Downs NORC Program

Community

Understanding the Community

Learning as You Go

Because it was already providing some in-home services to older residents at Crestmoor Downs, staff at Jewish Family Services (JFS) had some basic demographic information about them. They also knew that most seniors felt unconnected to their neighbors, and that some of them could not remain at home without services.

But they had a lot of knowledge gaps. No one knew what type of additional services residents would actually use, or what it would take to bring people together as a community. The real push to learn all that came after Congressional funds were earmarked for a NORC program demonstration project.

The first Senior Connections activity at Crestmoor Downs was an Open House, held to introduce people to a program that was just getting off the ground. Four hundred people showed up, some in wheelchairs, others pushing walkers and oxygen tanks, to eat, be entertained, and have their blood pressure checked by a nurse. “The turnout told us there was a huge interest, and a need in the community,” says Jewish Family Service program supervisor Cathy Grimm. “But we still had to figure out what they truly wanted.”

Collecting data and insights

To build a fuller understanding, Jewish Family Services staff circulated an interest survey at the Open House, and soon afterwards put the survey under the doors of all residents age 60 and older (using a list provided by the management office).

The survey confirmed that the community had broad and varied interests, but it also revealed a few surprises. For one, residents were not particularly eager for medication management, personal care, or financial services. For the most part, they thought they had those bases covered. What they wanted were day trips, outside speakers and performances, and holiday events.

“The more we worked with them, the more we learned they didn’t want services, they wanted to come together as a community,” said Ms. Grimm. “Many of them didn’t know their neighbors and felt isolated. Their main concerns were knowing people and being able to do things.”

Another tool to collect data about the residents, and to give them a voice in ongoing operations, is the Resident Information Form. Distributed at the monthly Wellness Clinic and other program events, the form asks about family connections, social isolation, health status, and the ability to manage basic activities of daily living. As a snapshot of the community, the form also provided the baseline data essential to a year-long program evaluation.

The Residents Council, which has guided the Crestmoor Downs NORC program since its inception, provides still another opportunity for resident input.

What it means to be a NORC

When federal funds first became available for NORC program demonstration projects, the Allied Jewish Federation and Jewish Family Service chose two sites for the Denver launch. Since JFS was already working at Crestmoor Downs and the Allied Apartments, those seemed like appropriate settings for an expanded program.

Back then, staff thought a NORC program could be established anywhere there was a concentration of older people. There was just one problem: Allied Apartments was not a NORC.

Its three high-rise buildings were owned by the Jewish Federation and had been set up specifically to house low- and moderate-income seniors. A package of supportive services, including case management, access to social workers, and a meal program, were already available. There was nothing “naturally occurring” about the complex. Allied Apartments was an age-restricted facility that by definition excluded younger people.

During the 17-month federal demonstration project, JFS introduced many of the same activities at both Crestmoor Downs and the Allied Apartments. But at the urging of a potential funder, JFS staff also reached out to some of the people on the national scene who had been thinking about, and developing, NORC programs for a long time.

Those connections helped to sharpen the agency’s thinking about where it wanted to concentrate its energies. Since Allied already had some on-site social work services in place, JFS separated the two residential settings so that it could concentrate on building a new model. Residents of Allied are now supported through other programs while JFS continues to grow a NORC program in Crestmoor Downs.

The Daniels Fund, a Denver philanthropy that had given Jewish Family Service modest support in the past, recognized early that age-restricted housing was not a NORC. Daniels was interested in advancing the concept of a community-engaged NORC program, not paying for traditional services in traditional senior housing. With its $72,000 grant in 2007, it now provides about half the core support for the Crestmoor Downs program. Continued...

Partnerships

Partnering with the Community

Delicate Dance with a Housing Partner

The Crestmoor Downs housing partner provides significant funding for the NORC program, markets its services as a leasing benefit, and draws on the program as a source of support for senior residents.

Despite all that, not everyone associated with the housing entity has always viewed the program as an unalloyed blessing.

Initially, the leasing office seemed to turn its back on the NORC program. When Crestmoor Downs took on a new staff person to market the apartment complex, she complained to the owner that senior programs were “too visible.” Young people touring the facility did not want to see so many older people gather together, she said.

Seniors were told they could not hold yoga classes in the party room of the complex. They were asked not to post activity announcements in the elevator.

Aware of the need to respect the concerns of the housing partner, NORC program participants complied. “You can’t go in with your own agenda,” said Cathy Grimm of Jewish Family Service. “It is about compromising. If you are bringing in partners, you have to consider what they need in order to buy in.”

At the same time, staff set about winning them over. “We remind them that seniors are typically responsible tenants,” said Alison Joucovsky, program coordinator of the Crestmoor Downs NORC program. “And we encourage them to see this as a great marketing tool for anyone over the age of 60.”

Joucovsky has also cultivated a close relationship with the building managers. “I’m in and out of the buildings all the time and we have built a rapport,” she says. “They feel comfortable calling me. If there is a problem with someone in Apartment 201, they know I will help to take care of it.”

All of that seems to be working. The leasing office eventually began showing potential senior residents the setting of NORC program activities, asked for more of its newsletters to distribute, and now alerts Ms. Jacouvsky when an older adult moves in. “They have finally realized this is a good thing,” said Ms. Jacouvsky. “Part of that is just the process – it takes time and becoming used to seeing us around.”

When Crestmoor Downs was sold in 2007 to an Atlanta-based corporation that manages apartment complexes around the country, NORC program staff wondered whether the program had a future. So far, at least, things look good. The new owners, who have not previously owned real estate that is home to so many senior residents, have recognized the benefits of working with people who know the community, and have given NORC program staff a real office for the first time, complete with telephone lines and wireless access.

“We’re beginning to educate them about our mission,” says Ms. Grimm. “Eventually, we’ll come to them for financial support, but right now our goal is just to prove they want to keep us here.” Continued...

Implementation

Developing and Implementing Programs

You Want it, You Make It Happen

One of the defining characteristics of Senior Connections at Crestmoor Downs is that classes, clubs, trips, and get-togethers don’t get scheduled unless an older resident is willing to take on the responsibility of making them happen. “This is a resident-focused and resident-run program, and that’s what makes it unique,” said Alison Joucovsky, its coordinator.

At any given time, 15 or more different activities are likely to be announced in the newsletter – among them, exercise and fitness classes, lectures, book groups, club meetings, meal get-togethers, and political discussions. With a single full-time staff member, there is no way all of that can happen without community involvement. “I’m a facilitator, the residents really do the work,” said Ms. Joucovsky. “They understand that if this program is going to go, they need to help.”

When someone expresses interest in a dance class or a poker tournament, Ms. Joucovsky is quick to say, “You need to be the captain. We will announce it in the newsletter, but you need to field the phone calls and set up the time to meet.” The result is a culture of involvement, and with it an empowering sense of ownership. “It makes people buy into the program and feel invested,” she emphasizes.

Classes are self-sustaining – each one costs $5, which pays the instructor. Some classes are initiated by residents, others by instructors willing to take a risk. If enough people show up, making it worth the instructors’ time, the class continues; if not, it may fall away.

The package of activities is always changing as staff and residents experiment with new ideas. Recently, a massage therapist, a manicurist, and a hair stylist have been coming on-site, where residents pay for the convenience of their services.

At monthly planning meetings, the Residents Council weighs in on new ideas for activities and trips. “It is definitely our program,” says senior resident Elaine Long, a member of the Council. “We talk about the kind of outings we should have, we talk about getting other people involved. We strive to get as many seniors as possible out of their apartments and into activities that interact with other people.”

Rethinking Transportation

About two-thirds of the senior residents at Crestmoor Downs who completed interest surveys mentioned transportation assistance. It seemed sensible, then, to purchase a 15-passenger van to help residents get to their medical appointments. NORC program staff announced the service, and then sat back waiting for requests.

Not many came in. Staff asked the Residents Council for feedback and discovered that most seniors had alternatives for getting to their doctors and preferred the convenience of going with adult children, with friends, or by cab. “They didn’t want to wait to be picked up and dropped off, or to get to appointments early,” said Cathy Grimm of Jewish Family Services. “They wanted the van for field trips, they liked going together to the museum or the symphony.”

Transportation services were reconfigured on the basis of that discovery and the van is now used solely for group outings. An alternative service – RIDE, or Responsible Individuals Driving Everywhere -- has been created to accommodate individual needs. Residents make their own arrangements with volunteer drivers who live in the complex, after their driving records are subjected to a background check. Passengers reimburse the RIDE drivers for gas, but it is primarily a community service, not a money-making venture.

“It has been a huge success,” said Ms. Grimm. “Residents like the one-on-one with the drivers. It gives them a chance to develop new relationships.”

Keeping in Touch

A buddy system was one of the services seniors at Crestmoor Downs said they didn’t want. Early in the development of the NORC program, staff had suggested an arrangement whereby residents in the same building would call each other daily to make sure everyone was safe. But some residents already had their own safety systems in place, and others felt the arrangement would be intrusive.

And then a woman who was not participating in the program had a stroke in her apartment. Without family or regular social connections, she lay there for three days before someone got concerned and called the management office. Everyone heard that story – and then decided that a buddy check system might be a good idea after all.

“Sometimes you have to wait for the crisis to happen for people to recognize what they need to stay in place,” said Ms. Grimm. “It has to be their agenda, not ours.”

A related service encourages residents to register for a monthly call from a volunteer. Another way to check in with residents and inquire about their health and well-being, those calls also become marketing tools to remind residents about upcoming NORC program activities.

Some older adults still resist these approaches, insisting, “We don’t want this to be an assisted living facility.” There are also vulnerable residents who are reluctant to use certain services lest they become too visible to others. The fear there is that someone will discover they are faring poorly and demand that they move from the independent living environment of Crestmoor Downs.

That’s where the staff intervenes to clarify the nature of a NORC program. “We are continually educating people that the role of this program is to bring in the services and activities they need,” said Ms. Jacouvsky. “It takes a while for the trust to develop so that people understand this is about keeping them at home, not about saying they don’t belong.”

That trust, when it does develop, fosters greater willingness to ask for help. And having that help available, in turn, allows more seniors to live more safely at home. Continued...

Evaluation

Evaluating Projects of a NORC Program

Taking Stock

When the federal Administration on Aging awarded its NORC program demonstration grant to the Allied Jewish Federation of Colorado, the federation hired the Denver-based Center for Policy Research to produce a portrait of Senior Connections and the community in which it sits.

After a year-long study, the center produced a report that included:

• Basic demographic and socioeconomic data about residents.
• Information about their living arrangements and interests.
• Descriptions of available activities and measures of the extent to which they were used.
• Resident assessment of quality.
• A description of the program’s impact on participants.

Subsequent efforts to assess the Crestmoor Downs NORC program are likely to be the domain of program staff, rather than an outside vendor. Cathy Grimm of Jewish Family Service is comfortable moving forward with a more focused approach. “What matters is that we ask the right questions,” she said. “We want to know that what we are doing is helping.”

Accomplishing that, she says, means first and foremost knowing your purpose. “You should be very clear about what your goals are and what you want to accomplish. If you know that, your ability to assess the process will be much easier.”

While its current approach to evaluation is not elaborate, Crestmoor Downs staff recognize a basic responsibility to track program activities and ask clients how they feel about them as part of their reporting requirements to the Denver-based Daniels Fund, which provides core support.

At a minimum, program staff record the number of people being served, and ask residents to complete a brief satisfaction survey. (This kind of information is often collected in a process evaluation; see Designing and Implementing Your Program, Guiding Principle #6.) In general, Crestmoor Downs tries to gather qualitative information about perceptions of safety, knowledge of local resources, and sense of connection to the community.

“People think you have to do all this fancy measurement,” said Ms. Grimm. “But we have found that the simpler a survey is, the more apt people are to fill it out. We know our purpose. What we need to learn from seniors is: Are we fulfilling it?” Continued...

Sustainability

Sustaining a NORC Program

Diversifying Funding Sources

Almost as soon as the federal demonstration project grant began, Senior Connections at Crestmoor Downs was preparing for its end 17 months later. “You get dollars, and as soon as you get them, you have to start thinking about how you will sustain them, said Cathy Grimm of Jewish Family Services. “It is the nature of the beast, you are always hustling.”

The NORC program’s strategy has been to tap multiple funding sources, but to ask for resources only in digestible amounts. Although program staff believed the Daniels Fund was willing to consider a larger request, for example, they were cautious about overreaching. They chose not to seek additional funds until they felt prepared to use them effectively.

In addition to Daniels, which now covers more than half of the NORC program’s 2007 budget, significant funds come from the housing partner and the Rose Medical Center. Senior residents also make meaningful contributions through membership and class fees.

Contributions from residents

In its first year, staff asked the Residents Council whether seniors would be willing to pay a membership fee for the NORC program. Participants basically dismissed the idea, saying, “most people are on fixed incomes, we can’t ask them to pay.”

But a year into its operation, that sentiment had shifted. During that time, staff made a point of talking about costs and budgets so that residents understood what was involved in keeping the NORC program running. They also knew they would eventually be asked to make a contribution. Ms. Grimm explained, “Our message was, ‘we aren’t asking you to pay upfront. We need to prove this is valuable to you. But after we have been here for a while, we are going to come and ask you to contribute.”

When that time came, the Residents Council recommended keeping the fee under $25 – so staff started a voluntary membership drive asking for $24. Residents put in almost $2,000 -- and they didn’t balk when warned that the fee, while still optional, would rise the following year. “The savings from the Wellness Clinic alone make the fee worthwhile,” said one resident. “We would spend a lot more for a doctor’s co-pay.”

Added Ms. Grimm, “it is hard to come in initially and charge, but somehow people need to understand they will have to pay.” In addition to the costs of membership, seniors put almost $4,700 into the budget through fees they pay for activities.

Bringing the housing corporation on board

When the NORC program first came into Crestmoor Downs, program staff approached the management office to pitch the concept. Grimm said, “Our approach was to say, ‘this will not cost you money. But we can help you keep seniors living here, and we can offer you a good marketing tool to attract others.’”

A year later, with federal funds dwindling and a track record established, that pitch changed. “At that point, we were able to say, ‘if you want us to stay, you will have to provide money because the earmarked dollars aren’t going to be there,” said Grimm. By then, NORC program staff could point to their accomplishments – including maintaining good tenants by keeping them safer in their homes.

The owner recognized the benefit. In 2007, the housing partner provided $48,000 in funding (plus an in-kind contribution of space), representing a little over 20% of the project’s budget. With the complex under new ownership, history may be repeating itself as the NORC program staff again sets out to demonstrate its worth, and only then to ask for support.

Moving the agenda

Sustaining a local NORC program means, in part, garnering broad-based support from the people who can help to institutionalize the concept at a higher level. Cathy Grimm participates in city, state, and national activities – meeting with local Area Agency on Aging staff, reaching out to the offices of the mayor, the governor, and other elected officials, and serving as a delegate to the White House Conference on Aging.

“Part of what we want to put out there is the whole idea of the NORC,” she says. “A NORC in Colorado may not look like a NORC in New York, but together we can push a more thoughtful approach to the whole idea of aging and community.”

With a similar goal in mind, Ms. Grimm helped to create the Aging Dialogue, which brings together a group of foundations that fund senior services in the Denver area. The group meets quarterly to talk about what they are funding and how they can use their money most effectively, and to identify trends in aging. Ms. Grimm has provided some education about the NORC program concept to the Aging Dialogue and everyone gets a chance to move outside their silos to consider the bigger challenge of serving older adults.

In 2007, Jewish Family Services began partnering with the University of Denver’s Geography Department to map seven major counties in the Denver region in order to locate seniors by neighborhood. The Daniels Fund is providing resources, with an eye towards identifying future NORC sites, and replicating a proven success.