Stories

Lincoln Square Neighborhood Center NORC Program

Community

Understanding the Community

Revitalizing an Institution

Founded just a few years after World War II ended, the Lincoln Square Neighborhood Center has its roots in the settlement house movement, and its programs have historically been designed to respect and capitalize on the community’s culture, tradition, and history. That translates into a commitment to “leverage the social capital of our residents,” explains Stephanie Pinder, the center’s executive director.

Despite its storied past, Lincoln Square had fallen away from the people who lived there and onto hard times in the waning decades of the 20th century. The physical space was in desperate condition, with holes in the ceiling and filth on the floors. Staff skills were thin and the board of directors had ceased to function effectively.

Although they were aging and in need, residents had little reason to turn to the neighborhood center for help. A single room comprised the senior program, offering lunch three times a week, and some arts and crafts, but not much more.

In 1999, new leadership came in and the painstaking process of renewal began. Stephanie Pinder brought a background in community organizing to her position as executive director. At her side was homegrown talent Joanne Ricco, who was struggling to keep the existing senior services program alive.

When city NORC program funding became available, Ms. Ricco saw it as a tool for strengthening the community and rebuilding its relationship to the neighborhood center. She set out to make that happen.

Talking to the Seniors

Ms. Ricco had grown up in Amsterdam Houses, and married one of its native sons. She knew its people – often several generations of the same family – and she knew their personal history. That had two enormous benefits as Lincoln Square Neighborhood Center pursued city funds. It meant she understood what a program could do for her community, and it meant she had the trust of its residents. Older adults would open their doors when Ms. Ricco knocked, and then they would talk candidly – about empty pantries, faraway family members, their own late-night drinking, and so much more.

As Lincoln Square developed its proposal for city funding, Ms. Ricco guided the process of finding out what the older population needed. Input from older adults came in many forums – Town Hall meetings in building lobbies, discussions at the small senior program site, and one-on-one conversations in person or on the phone.

Lincoln Square staff asked broad questions designed to elicit specific answers: What are you missing? What do you need to make life better? The answers informed the first proposal submitted – and funded – by the City of New York. Continued...

Partnerships

Partnering with the Community

Bringing in a Health Partner

To meet New York City’s requirement to include a health partner in its NORC program application, Lincoln Square Neighborhood Center approached two providers – one a hospital, the other a visiting nurse agency. Their question: What will you bring to the program?

After hearing presentations from both candidates, neighborhood center staff selected Roosevelt Hospital, the closest to Lincoln Square and the 911 responder for the community. Roosevelt saw its interests as establishing a stronger presence among its neighbors, serving them better, and generating more business for its home care agency. “The link was hard-wired,” said Anne Moses, then director of the hospital’s community health project. “I place a nurse in the center who brings referrals to the home care agency.”

But soon after the program began, Roosevelt decided to sell its home care agency. By then, Ms. Moses had become a committed champion, and she went in search of a new home within the hospital.

Her pitch was that becoming engaged with the NORC program was an appropriate way to extend the hospital’s core mission of improving the health of the community. The Department of Government and Community Affairs “got it” and agreed to take on the program. Moses also advocated its value as a way to:

• Create greater awareness of the hospital’s rich array of programs and services.
• Provide another point of entry into those programs.
• Identify recruits for clinical trials.
• Develop a client base for residency training programs.
• Cultivate a sense of loyalty to the hospital.
• Reduce hospital length of stay.

“In any partnership, there has to be value for both partners,” says Ms. Moses. “The NORC program has to figure out what the hospital will value.”

Reaching Out, Then Saying Thanks

Shortly after receiving city funds for the NORC program, Lincoln Square Neighborhood Center staff wrote to influential local political and business leaders urging them to attend the first planning meeting. Each letter named all the others who were invited, and said, in essence, “We have a unique opportunity to strengthen the lives of the people in this community, and we think each of you can bring something that will help to do that.”

Almost all of the invitees showed up, and many of them eventually signed on as members of the NORC Advisory Council, which continues to provide community input into the program. Participants include older residents, neighborhood center staff, members of the local business improvement district, public officials, and representatives of educational and not-for-profit agencies in the neighborhoods. About 40 people attend a typical quarterly meeting; minutes are distributed afterwards. “Everyone has a voice,” says Stephanie Pinder, executive director of the Lincoln Square Neighborhood Center. “People say what they need to say, and if they identify an issue, it becomes an item we deal with.”

Advisory Council members engage with the neighborhood center in different ways, and at different levels of intensity. Core partners, including representatives from Roosevelt Hospital and the New York City Housing Authority, are at the table for every meeting. So, too, are legislators looking to connect with their constituents and local Community Board members, who are unpaid city advisors involved in many quality-of-life issues. And some partners, such as representatives from the American Bible Society, attend regularly because they are interested in growing their involvement.

Other agency representatives are brought in only when issues relevant to their immediate mission are on the agenda. For example, after two seniors were killed crossing the street, the Advisory Council invited the non-profit organization Transportation Alternatives to explain the process for getting the city to change the timing of its traffic lights and reduce other crossing hazards.

What most of these partners have in common, says Ms. Pinder, is that their relationships with Lincoln Square Neighborhood Center began small. “You start with one thing and you build on that,” she says. “It can take years of cultivation.”

One way to cultivate loyalty is simply to say “thanks.” Ms. Pinder does that with handwritten notes, newsletter blurbs, profiles in the program’s annual report, and an awards luncheon. “Every opportunity you can take to thank someone, you just have to take,” she says. “Everything is meaningful. And then you grow it into something larger. ” Continued...

Implementation

Designing and Implementing Your Program

Strengthening Health Care Services

The Lincoln Square Neighborhood Center’s first NORC program proposal to the city was designed with a strong social work focus, and an emphasis on improving access to entitlement programs. But soon after getting off the ground in 2000, staff discovered another, more basic, need.

You don’t know what you don’t know

Despite Lincoln Square’s strong connections to the community, the most fragile elders had been overlooked in the initial planning for a NORC program. The gap for them -- indeed, the chasm – was access to health care, but mobility restrictions had cut them off from the forums created to articulate the needs of older adults.

That realization dawned as residents began venturing into the lobby for free health screenings, only to be urged to get to the hospital immediately. Staff discovered that less than one-third of seniors in the Lincoln Square community had a regular source of health care – most were using clinics or hospital emergency rooms episodically. Many had expired medications or were taking drugs with potentially dangerous interactions. In the program’s early days, the part-time nurse – on board just four hours a day, three days a week ­­­– intervened in 40 potentially life-threatening health care crises.

Shaping a response

Health services were immediately moved to the top of the priority list, giving Lincoln Square an urgent reason to strengthen its fledgling partnership with Roosevelt Hospital. Staff from the two institutions held a series of planning meetings to hammer out a response to the newly discovered health care crisis.

In 2001, the United Hospital Fund provided $50,000 towards the cost of a full-time nurse, supplementing the resources Roosevelt had committed. By tracking that nurse’s activities, Lincoln Square staff was able to show that seniors accessed on-site health care services 1,200 times in the first eight months of funding. Staff also documented 197 health promotion activities, including exercise classes, health education workshops, health screenings, support groups, and health fairs.

“Having someone on site five days a week creates a very different model,” says Anne Moses, the NORC program’s champion at Roosevelt. “That person becomes part of the care team. That’s very different from someone who just drops in.”

The health care component of the program has only grown in subsequent years:

Connections to primary care: An early emphasis on connecting people to primary care physicians at Roosevelt Hospital meant that by 2007, 95% of senior participants in the NORC program had a primary care provider. In 2000, only 20% had one.

Tackling hypertension: The extent of uncontrolled hypertension in the community led Roosevelt to create Healthy Living for a Healthy Heart, a nine-week intervention that provided assessment, education, and activities for Lincoln Square seniors. The hospital put together a team that included a physician, a nutritionist, an exercise physiologist, a health educator, and a nurse to develop a multidisciplinary approach that resulted in dramatic – and documented – improvements in blood pressure.

Emergency Department report: Lincoln Square and Roosevelt created a simple strategy for informing the neighborhood center’s on-site nurse of any NORC program resident who was admitted the previous day to Roosevelt’s Emergency Department. The nurse then provides follow-up, visiting seniors in the hospital or calling them when they return home, to assess their health care needs and determine what other support may be appropriate.

This initiative was funded through the United Hospital Fund’s NORC-Health Care Linkage Project, established in collaboration with the New York Community Trust. The process proved easy to implement, and has been working well. So well, in fact, that Beth Israel Medical Center, a sister hospital within the same large health system, now uses the same approach.

Safer medications: MyMeds, a medication safety project, was also developed under the Linkage Project. The idea is to create a profile of all the medications used by older adults, to house this at local pharmacies and to make it available to Emergency Department physicians on request.

An evaluation showed that most Roosevelt doctors have not asked for the profiles, which have to be faxed to them. Staff believes immediate electronic access would be more useful, and may eventually reconfigure MyMeds to accommodate that. Meanwhile, the project has had other benefits:

• Each senior has consolidated prescriptions in a single pharmacy, which improves the continuity of care and gives pharmacy partners opportunities to intervene to prevent drug interactions.
• The NORC nurse now has accurate and up-to-date medication profiles available for each client.
• Beth Israel Medical Center found MyMeds idea promising enough to develop a pilot test of its own.

All of this took time and resources – but first, it took information. Neighborhood center staffers stuck their toes in the water with early plans for a NORC program, based on what they thought they knew about the needs of the residents. They gained experience, they learned more, they collected data, and they discovered gaps.

Then, they used all of that to inform their practice, revise their early approach and develop new strategies, some of which are now being replicated by others.

Using Data to Guide Program Development

The AdvantAge Initiative

In 2003, the Lincoln Square Neighborhood Center joined nine other sites across the country as participants in the foundation-funded AdvantAge Initiative. The initiative describes its mission as helping to build “elder-friendly communities that are prepared to meet the needs and nurture the aspirations of older adults.” At the heart of the project was a comprehensive telephone survey of older adults in each of the selected communities that focused on:

• Basic needs for housing and security.
• Maintenance of physical and mental health.
• Independence for frail, disabled, and homebound elderly.
• Opportunities for social and civic engagement.

Lincoln Square staff laid the groundwork for participation in that survey by alerting them to the interviewer’s call; explaining the value of collecting information; and offering coupons to local stores for their participation. Without that preparation, suspicion would most likely have trumped cooperation. “You can’t overestimate the need to have someone connected with the community make the introductions,” said Stephanie Pinder, the neighborhood center’s executive director.

The Findings

The AdvantAge Initiative’s 2003 “data snapshot” of the Lincoln Square neighborhood on Manhattan’s Upper West Side revealed three compelling facts:

• Fourteen percent of the senior respondents skipped meals or went to bed hungry because they did not have enough money for food.
• More than one-quarter of respondents rated the safety of their neighborhood as either “fair” or “poor.”
• Fifty-six percent reported feeling depressed or anxious and many who needed mental health services said they were not available.

The data underscored the observation that Lincoln Square staff later made in a report to funders: “The more you do, the more you uncover and need to do.”

Social workers were not completely surprised by the findings. They had seen how older adults descended on the congregate lunch, especially on Mondays because no food was served over the weekend. They had heard reports of drug dealing in the buildings and knew that some of their clients were hostages in their own homes. And they were aware that many of the people they served struggled with depression and anxiety.

But having data to support anecdotal observation changed the discussion. “The data confirmed our own experiences and allowed us to move the agenda forward,” said Ms. Pinder. Program staff brought the findings to the NORC Advisory Council, whose members were shocked by some of the hard numbers. They insisted on moving as quickly as possible on a three-part plan of attack: to confront hunger; address safety and security; and improve mental health.

The Advisory Council became the sounding board and guiding hand, with quarterly meetings where Lincoln Square staff reported on recent activities, fielded questions, and considered new ideas. Through their own web of connections, Council members also helped to bring in new partners and to mobilize new resources to meet the needs. Continued...

Implementation continued

First Things First: Taking on Hunger

Addressing hunger was the first respond to the findings of the AdvantAge Initiative. In tackling that challenge, an existing partner became more involved, a new partner came to the table, and projects and interventions were put in place that appear to have greatly reduced hunger as an issue in the community.

The American Bible Society, headquartered just a few blocks away, was already a member of the NORC Advisory Council, and its Christmas luncheon and Easter and Thanksgiving baskets were popular with older adults. Lincoln Square’s focus on hunger resonated for the Bible Society, drawing them in as a more active player. Immediately, it launched its first food drive, which is now a recurring activity, with proceeds going directly to senior residents or to the center’s congregate lunch project.

“The Bible Society found a niche that was relevant to them and their mission,” says Stephanie Pinder, the neighborhood center's executive director. [The hunger projects have also proved to be an entry point for further engagement with this partner. The Bible Society is now developing a home visiting project and has introduced NORC program staff to colleagues at the nearby American Museum of Natural History so they can talk about ways to bring older adults into the museum.]

In seeking other resources to deal with hunger, Lincoln Square worked to increase Meals on Wheels services, and was introduced to the Community Food Bank of NYC. Its connections with this new partner, coupled with foundation funding from the Tuttle Fund and the Guttman Foundation, has allowed staff to purchase bulk food at a reduced price, create a food pantry that distributes fresh produce and canned goods, and expand the availability of congregate meals from three to five days a week.

“Our sense is that we have made an impact. We hear seniors saying ‘thank you, you have made a difference, this has been important to me,’ ” says Pinder. “But we can’t yet say firmly that hunger has been reduced by a certain percentage.” A grant from the Samuels Foundation will allow the AdvantAge Initiative to resurvey Lincoln Square in 2008 and hopefully, will produce just that data.

Tapping Resident Knowledge: Safety and Security

Seniors in the Lincoln Square community knew something more about crime than the local police. But the cops were willing to listen.

The AdvantAge Initiative survey showed that more than one-quarter of older residents felt unsafe in their own backyard. Neighborhood center staff invited the New York City Police Department to attend the Advisory Council meeting at which they presented that data. The officer who came tried to be reassuring, explaining that local statistics actually showed a low incidence of crime.

NORC program staff had to probe to understand why official crime logs seemed to contradict the perception of danger. The residents at the meeting helped make meaning from it all. There was drug-dealing in the community, they said, but they were afraid to report it. The police responded that crimes that don’t get reported don’t get addressed.

But the fear among residents was not misplaced: After one had anonymously reported a drug dealer in her building, the police had picked him up, knocked on her door with the man in tow, and asked, “is this the guy?” Clearly, new policies and procedures were needed.

The Advisory Council established a Safety and Security Task Force to begin a dialogue, identify possible solutions, and monitor results. Someone on the council mentioned the Westside Crime Prevention Program and a representative was invited down to talk about actionable and safe strategies for reporting crimes. As a result:

• Six police officers were assigned specifically to the public housing complex where the NORC program is located.
• A staff member from Westside Crime Prevention acts as a go-between, protecting the anonymity of senior residents by taking their crime reports and turning them over to the police.
• Older adults are being trained to provide the detail that is necessary in a crime report for the cops to take effective action.
• Advisory Council members, including elected officials, have pressured the city’s Housing Authority to remove trash, and to fix the broken intercoms that can open the door to intruders.
• The Safety and Security Task Force continues to meet, maintaining a forum for dialogue among the police, the Housing Authority and the community.
• The protocol in place for reporting crimes in Lincoln Square has been replicated by other public housing developments in New York.

All of these measures keep attention on basic safety, which is a prerequisite for most other forms of community engagement. Still, Stephanie Pinder acknowledges that “safety and security will always be issues. There is never just one solution.”

A Continuum of Mental Health Services

With its finding that 56% of Lincoln Square Neighborhood Center survey respondents felt depressed or anxious – and weren’t getting the mental health services they needed – the AdvantAge Initiative highlighted the prevalence of depression and anxiety in the community.

Data also showed that:

• Two-thirds of residents who showed signs of depression and anxiety on a broad screening test met the diagnostic criteria for moderate or severe depression when a more in-depth assessment was conducted. Three people needed to be hospitalized immediately.
• Almost everyone offered some form of mental health services was willing to use them.

The neighborhood center has responded to those findings by embedding mental health practice into the fabric of its NORC program, doing as much as possible on its home territory, and creating a continuum of other service options.

As an early step, staff created a Partnership Council, bringing together many of the agencies involved in the complex work of geriatric mental health on Manhattan’s Upper West Side. The collaborative network includes providers at the Hudson Guild, United Neighborhood Houses, the Alzheimer’s Association, the Institute of Urban Family Health, and elsewhere.

Drawing on the full range of expertise available in the community:

• NORC program staff has been trained to talk about depression with their clients.
• Every senior who interacts with the NORC program is screened for depression.
• Fitness classes, yoga, support groups, and access to a licensed clinical social worker are available.
• A geriatric psychiatric fellow comes in once a week to address severe needs. That’s a win:win: The fellows get access to a diverse community of seniors, enhancing the opportunity for learning, and the seniors get the support they need.

As is so often the case, funding sources have evolved. The Daniels Fund helped launch many of the mental health services with a $100,000 grant. When that ended, Lincoln Square met the shortfall for a year with its own general operating revenue and then the Samuels Foundation stepped in with a $212,000, three-year grant.

Now, a long-range plan for sustainability is being put into place. Lincoln Square expects to be designated a New York State Department of Health “Article 28” site, allowing it to provide insurance-reimbursable mental health services. Continued...

Sustainability

Sustaining a NORC Program

No Standing Still

The Lincoln Square Neighborhood Center NORC program is in good financial shape. It has buy-in from the senior residents, strong connections to Roosevelt Hospital, its core health partner, and broad participation by elected officials and community partners. The NORC program also has diversified funding and a growing budget, with core services covered for the next six years, and a strategy for stabilizing its mental health services.

None of that means it can stay still. Populations change, needs evolve, and funders, partners, and employees turn over. At Lincoln Square, staff comes together periodically at planning meetings to tackle broad questions such as:

• What has been successful over the past few years?
• What do we want to continue, or expand, and deepen?
• What else do we want to take on in the years ahead?
• What services are missing? What should we add to the mix?

Social workers who know the senior residents well give voice to their concerns at the planning meetings. Results are then presented at the Advisory Council’s June wrap-up meeting, which is always attended by at least ten seniors. At that annual event, everyone has a chance to talk about where the NORC program is headed and to make some decisions about agenda items for the upcoming year.

Countless other less-structured opportunities also allow seniors to be heard as plans evolve. “Seniors will come into my office and tell me what is right and what is wrong,” said executive director Stephanie Pinder, explaining the open-door policy of the entire staff. “We get their input all the time both in formal and informal settings.”

That helps ensure not only that the program is sustained, but that it is sustained in the interest of those for whom it exists.