In 2007, the State of Indiana launched a statewide NORC program demonstration initiative to bring the NORC program model to both urban and rural communities in Indiana. The origin of the initiative, called Communities for Life (CFL), can be traced to 2006, when the governor appointed a new director of the State Division of Aging, Steve Smith, who was determined to upend the conventional funding pyramid for elder care, shifting monies from institutional-based to community-based programs for seniors.
Mr. Smith spent a year traveling the state, talking to community leaders and seniors searching for new ways to deliver services to Indiana’s older adults. During this time, he became intrigued with NORC programs in New York and Indianapolis (the latter established with a federal earmark). These programs had been successful in engaging a broad group of stakeholders and getting local residents involved in creating their own support services — matching the director’s vision for community–based care. However, it remained to be seen whether the model could be adapted to address different types of communities and implemented across Indiana. To answer these questions, the Division of Aging created a NORC program demonstration initiative to establish five NORC programs.
In June 2007, Indiana’s Division of Aging contracted with the University of Indianapolis Center for Aging & Community (UIndy CAC, or simply CAC), a group viewed as neutral and unbiased, to oversee the creation and management of the demonstration initiative, which included managing a Request for Application (RFA) process and providing technical assistance. The competitive RFA process resulted in the awarding of planning grants to five project sites.
Concurrently, Indiana was undertaking the statewide implementation of the AdvantAge Initiative, a national survey tool, to identify challenges faced by seniors who choose to age in place in their communities. The AdvantAge Initiative was being conducted through Indiana’s 16 Area Agencies, using federal grant funding and supplemental funding from the Daniels Fund. CAC partnered with AdvantAge Initiative personnel to arrange for oversampling in the five grant-awarded Neighborhood NORC (NNORC) communities. This effort proved to be extremely useful in drilling down to in-depth data, critical for being responsive to the communities the grantees were going to serve.
The five communities used their yearlong planning grants to develop project plans to address an identified “banner issue” within the community. The banner issues were identified through the work of the individual NNORC resident-led steering committees as issues critical to successful aging in place.
The five NNORC communities, including their lead agencies and banner issues, are:
Golden Ages NNORC, Indianapolis
• Lead agency: Martin University
• Banner issue: Home modifications and in-home safety
Huntington NNORC, Huntington
• Lead agency: Huntington County Council on Aging
• Banner issue: Information access for personal safety
Gary Midtown NNORC, Gary
• Lead agency: Gary Community Health Foundation, Inc.
• Banner issue: Neighborhood and personal safety
Shepherd Communities NNORC, Linton
• Lead agency: Generations, the Area Agency on Aging at Vincennes University
• Banner issue: Senior mobility through transportation, home modifications, and physical wellness
La Salle Park NNORC, South Bend
• Lead agency: REAL Services, Inc.
• Banner issue: Information and referral for seniors
To learn more about Indiana’s NORC program demonstration initiative, NORC Blueprint interviewed Jennifer Bachman, M.Ed., Senior Projects Director at the University of Indianapolis Center for Aging & Community, who manages the Communities for Life program. The deliberate and focused strategy pursued by the State of Indiana in adapting the NORC program model to its diverse environments may be particularly informative and valuable to other states as they begin to think about reframing and reshaping the way they deliver aging services.
NORC Blueprint: The State of Indiana implemented a demonstration program that included a controlled process with a great deal of technical assistance and additional resources. Other states have pursued different ways of implementing NORC programs. Why did Indiana choose to go with this type of demonstration program?
Jennifer Bachman: The Division of Aging wanted to develop services based on the philosophy of NORC programs. But it didn’t know whether the urban NORC programs in New York and the Elder-Friendly Communities model in Indianapolis would work for the range of neighborhoods found in Indiana. So, the project was designed as a pilot and planning grant to answer this question, beginning with a small, but varied group of communities from across the state.
Also, the NORC program model was going to be a big change for our communities, which were used to having services delivered to them, and we realized they couldn’t provide services from day one. Based on our experience, I would recommend at least six months of planning and support to help a community understand what it means to do something from the ground up. Building from the ground up presents a steep learning curve for everyone.
Could you describe the RFA (request for applications) process? Why did you use such a structured approach, and what did you hope to learn from it?
We borrowed from New York State’s RFA, but we crafted it to meet our needs. For example, since this was a planning grant, our RFA focused more on ascertaining what the applicants hoped to accomplish, organizational capacity, management structure, and so on, rather than on how they would implement services. Also, the budgeting part was less prescriptive than New York’s, again because our program was focused, at least initially, on planning versus actual implementation.
Using a structured approach allowed us to gather as much information as possible about each of the communities, so we could be fair and neutral when reviewing and selecting the five communities.
Were you looking for specific types of communities?
Yes, we wanted a mix of NNORCs that reflected Indiana’s economic, geographic, and racial diversity. But we didn’t set out to specifically choose, say, two urban and three rural communities, or communities from five different regions of the state. We were looking for the best overall proposals. It turned out that the five highest-scoring applications were extremely diverse. We don’t know if that was due to our RFA process or if it happened by chance.
What criteria did you use to select the communities?
We asked for various demographics about the number of older adults, the type of housing, etc., making sure they qualified as NORCs. All applicants had to be not-for-profit organizations that specialized in housing, health, neighborhood development, or human services that served — or would serve — the local community. Another criterion was that multiple service providers could participate, but one organization had to serve as the lead applicant and actively manage the planning process. Applicants with strong community partnerships were given more consideration. We also looked at their leadership, and at what the lead agency had already been doing in the community, trying to ascertain their passion and commitment as well as their capacity to run a NORC program and facilitate its growth.
How did you assess the strength of communities’ partnerships and leadership qualities?
We assessed their strengths through the information they submitted in their applications. We also requested letters of support from local aging services, residents, neighborhood associations, community and civic groups, not-for-profit organizations, area agencies on aging, businesses, and others. The relative importance of all these factors — leadership, partnerships, the commitment of residents — became a topic of discussion in the review process. These were fruitful discussions.
How was your review process structured?
We developed a scorecard to evaluate each of the applications. The applications were scored by a review committee, including two NORC program experts from New York and two from Elder-Friendly Communities in Indianapolis. In addition, there was an expert in organizational and community development from another university. Each member scored the applications independently. We then brought the group together for discussions and to make the final selections. No one from the State Division of Aging or CAC was involved in the scoring or the final selections. We wanted a completely independent and unbiased review process.
How was the demonstration program funded?
The first year of the program was funded by a grant of roughly $885,000 from the State Division of Aging. This came from monies that were already in the Division’s budget, but were reallocated by the director. Out of that total, $375,000 went directly to the five communities for community building, planning, and program design. The remainder went to technical assistance, provided by CAC, Elder-Friendly Communities, and the AdvantAge Initiative Survey, plus an independent evaluator. So each NORC program was initially awarded $75,000 for program design and implementation, plus the cost of technical assistance from CAC.
After the first year, the State Division of Aging provided six months of bridge funding totaling $500,000. Of this, $75,000 went to each of the communities, allowing them to begin program implementation, execute their banner issue, strengthen community partnerships, and seek additional funding and support. The rest went to technical assistance.
Beyond that, we’ve asked the state for an additional $750,000 to sustain the programs for the next two years.
Was there a match requirement for each community?
Matching funds were not required for the first year, although applicants who applied with in-kind or matching funds were looked upon favorably. Also, applicants were required to demonstrate the ability to raise matching funds by the end of the grant period.
Have the communities raised funds on their own?
Yes, all of the NNORC programs have been able to raise funding or arrange in-kind services. For example, one program got a Community Development Block Grant from the U.S. Department of Housing and Urban Development. Another community partnered with its county health department, which had received funding for senior services. Another program arranged for social work students from the local university to create surveys, canvas the community, analyze the data, and produce a report.
When the planning grant started, we were uncertain if we were going to receive additional funds for program implementation. Still, by the end of the planning grant phase, every single one of the communities came back to us and said, “We will continue our work regardless of whether we get more funding from the state.” That was a joy to hear. Also, we’re finding that once a community has been galvanized, people come knocking on their door, asking, “How can we partner with you to meet your community’s needs.”
I feel strongly that a NNORC community should not get a large pot of money to start. It’s better if you provide some seed money and say, “Start the process, and let’s see what happens.” They were all amazed at how much they were able to do with $75,000. The enthusiasm and creativity and the partners with the in-kind services emerged because they had to. Continued...
NORC Blueprint: Indiana has made an effort to work with the Area Agencies on Aging (AAA) on this demonstration, working differently with different initiative sites. More specifically, what roles have the AAAs played?
Jennifer Bachman: In three of the NORCs, the local AAA is serving as the lead agency. We were also involved with the AAAs through the AdvantAge Initiative. We partnered with Dr. Phil Stafford from the Center on Aging & Community at Indiana University, who was conducting the statewide AdvantAge Initiative, to have the survey include our five NNORC communities. With this survey data, we were able to drill down into each community. That has proved to be incredibly enlightening. The data revealed that what is happening in an eight-county AAA may be very different from what is happening in an individual community. For example, the survey showed that 78 percent of people 65 and older in Area 8 have had a flu shot in the past 12 months. However, in the Martindale/Brightwood NNORC, which falls within Area 8, the vaccination rate was just 56 percent. So, if the local AAA were to provide blanket programs and services for their area, they would not necessarily be meeting the needs of specific neighborhoods. This brings home even more the lesson that we need to listen to and involve people at the community level. One size does not fit all. We knew that, but having the objective data was worthwhile.
I’ve heard repeatedly that technical assistance has been critically important in Indiana’s statewide approach. What can you tell us about it?
One of the most important components of technical assistance was having a clear, structured process — and the same process for each NNORC program. Without that roadmap, it would have been very difficult for the programs to succeed. We developed training sessions on leadership development, asset mapping, and data collection, among other topics. We constantly referred to best practices and other proven methods in the field — for example, the United Hospital Fund’s NORC Blueprint and the work of Partners for Livable Communities.
We also developed new tools, such as an interim scorecard that we, or the community itself, used to evaluate whether the NNORCs were ready to implement programs and services. Interestingly, the need for technical assistance has been more intensive since they’ve begun implementation of programs and services. It’s one thing to plan for something and conceptualize it; it’s another thing to actually implement it. Many people are not familiar with project management or with things like negotiating with vendors to get the best prices or adjusting plans to deal with unexpected, real-world problems. Much of this depends on the leader you hire and on the experience they have as managers.
What was your approach to the technical assistance for the programs?
First came building the infrastructure for the NNORC programs. We worked with each program to identify the leaders in the community and pull together the key stakeholders, including agencies inside and outside the community, such as hospitals and universities. We also put a strong emphasis on bringing the residents together to form the steering committees, making sure their role was very clear.
Second was asset mapping, teaching and providing tools to work with the community to determine its assets — everything from residents living in the community to community service organizations to corner grocery stores.
Was the technical assistance individualized, in groups, online?
It was mostly individualized. We held quarterly meetings for the five project directors and their coordinators that included training on leadership, asset mapping, data collection, evaluation, and how to determine banner issues. These meetings also offered opportunities for the project leaders to network and share their successes and challenges. We did put some information on the CAC website, but most materials — for example, work plans and reporting templates — were sent directly to the communities. Site visits were made to all five communities to provide hands-on technical assistance and to meet with the community partners.
What are the next steps to making the NORC programs permanent?
We are still waiting to hear about our request for funding to sustain the NNORC programs for another two years. We do know that the state is extremely positive about the initiative, but they need to more fully evaluate the results of this pilot project. Before the State Division of Aging considers making NNORC funding permanent, they will want to know more information about outcomes — whether the programs are succeeding in addressing their banner issues and accomplishing other specific targeted goals they set out to meet.
Do you have plans for expansion?
As part of our funding request, we asked the state for funds to create five more NNORC programs. We’re also talking with the city of Indianapolis, which is very interested in the NORC concept. We’ve also had meetings with neighborhood centers and groups in the city who are interested in our work and see a potential link with the Housing and Urban Development Neighborhood Stabilization Program dollars.
Not knowing the state’s commitment, I don’t know how big the NNORC program concept can get in Indiana. The good news, for us and for Indiana, is that because of the AdvantAge Initiative, we have a great platform of information and data about our elderly and issues related to aging to build upon.
Looking back, what have been the greatest challenges for the initial five sites?
Each site faced different challenges. Participants at one site had been meeting as a community for years prior to the Communities for Life program. They were like the stallion out of the gate. The challenge was for them to slow down and not come up with the answers too quickly, to allow the community to come to its own decisions.
Another community struggled with political corruption. Their greatest challenge was choosing who would serve on the advisory committee, because if you brought the wrong person to the table — somebody who had been associated with corruption — then you wouldn’t get the buy-in from the community. That is an issue I would never have imagined.
And then there were the floods. In June of 2008, while we were planning the NORC programs, there was flooding that incapacitated entire regions. The planning process was interrupted in a few of the NNORC communities to deal with the immediate crisis, provide emergency assistance, and clean up. Millions of state dollars had to be redirected because of the flooding, which will undoubtedly impact funding this year. We don’t know the full impact of this natural disaster.
These are what I call local environmental contexts — things like weather, leadership changes, health issues — which any organizational model will have to contend with. You cannot anticipate these things. So, you can’t prescribe a process that does not allow the flexibility of movement and change within the community. You do need structure and accountability, but at the same time, you have to allow for fluidity.
In general, each community struggled to understand exactly what a NNORC program entailed and how much work it is and will continue to be. It’s a hard concept to grasp.
What would you do differently if you could do this process all over again?
We would change how we notified people about the RFA. We sent out information about the RFA through CAC’s e-notification system to about 1,500 aging network professionals. In retrospect, it would have been better if we had spent more time spreading the word, perhaps through local newspapers, giving the communities more time to complete their RFAs. As it was, the communities had to submit their RFAs within 30 days. Another thing we would do differently is, after narrowing down the list of candidates, we would conduct site visits, going out to meet with communities and the lead agencies before making the final selections.
Another lesson learned is the importance of evaluation — that is, determining whether a NNORC program is succeeding. The community needs to be closely involved in its own evaluation. It has to be a dialogue, a constant back and forth.
One last thing is that we’re constantly wrestling with that issue of fluidity, with responding to the community where it is. Nothing is static. The challenge for us is how to grow this model and build the community-based service programs and at the same time remain respectful of each community and its own processes, characteristics, and challenges.