Aids to Aging in Place: Assisted Living, Nursing-Home Care, and NORCs

Frank Lang, Director of Housing, St. Nicks Alliance, discusses assisted living.

Berit Hoff

Event: Aging in Place in the City: Environments for Affordable Care and Support
Location: Center for Architecture, 4.18.12
Speakers: Joseph Healy, Jr., Ph.D.; C.O.O., Comprehensive Care Management, Centerlight Health Care, Centerlight Health System; Stacey Johnston, M.P.A., Director of Key Initiatives, Centerlight Health Care; Frank Lang, Director of Housing, St. Nicks Alliance; Georgeen Theodore, Partner, Interboro Partners
Moderator: Christine Hunter, AIA, Principal, Magnusson Architecture and Planning
Organizer: AIANY Design for Aging Committee

On average, New Yorkers are living longer, resulting in a larger number of senior citizens in our population, a trend that will continue to increase significantly in this century. Much thought is being given to developing improved ways to accommodate the specific needs of these seniors so that they may maintain a substantial amount of independence and level of enjoyment as they age. Since geographic range for the performance of daily activities tends to decrease with age, cities seem to be better able to provide needed services in close proximity to seniors’ homes than less densely populated areas. Yet providing services in the most convenient and efficient manner requires considerable planning. Three approaches were discussed in this session.

Frank Lang of St. Nicks Alliance, a not-for-profit organization and settlement house that has served neighborhoods in Brooklyn for many years, spoke about its efforts to create “enriched housing” within one of its affordable senior buildings that contains 150 units, originally constructed as independent housing. This new program provides additional assistance to 25% of the residents, and includes within the building community recreational activity/program areas and dining facilities (complete meals are served), with registered nurses and equipment always available to manage medication and medical care. Assisted-living facilities that provide long-term care for their residents must be specifically licensed, in addition to conforming to federal HUD regulations, Medicaid rules to determine eligibility of residents, and other local laws. This complex matrix of regulations has been a challenge to St. Nicks in its efforts to meet the needs of residents with varying levels of frailty, all of whom cannot qualify for assistance under existing rules.

Joseph Healy and Stacey Johnston spoke about the comprehensive services that Centerlight Health Care offers for seniors in their own homes as well as in their PACE (Program of All-Inclusive Care for the Elderly) Centers, 13 of them in the New York City area. In these centers Centerlight operates a multidisciplinary healthcare delivery system to maintain a desirable quality of life for seniors that enables them to live as independently as possible. It is fully government-funded through Medicare and Medicaid. The centers are located in needy areas, operate from five to seven days per week, and serve approximately 1,100 visitors per day. They provide complete nursing care, including therapeutic rehabilitation on an as-needed daily basis, and present an atmosphere and range of daily activities/programs to encourage seniors to attend. Transportation to the centers is provided. Full meals are served, with foods culturally appropriate to the areas in which the centers are located.

Georgeen Theodore is a founding partner of Interboro Partners, an architecture and planning research office. Much of her research has focused on NORCs (Naturally Occurring Retirement Communities), which are residential buildings or complexes where people have lived for a substantial period of time, so eventually an increasing number of the residents are seniors. The realization that these buildings should offer special services for their aging residents originated in the 1980s here in New York City, and has since spread throughout the country and elsewhere. Specific legislation has been developed for NORCs, aimed at providing support services that enable senior residents to remain in their homes and live independently. In NYC, where there are now numerous NORCs, most of them are in tower-in-a-park, limited-equity co-ops—a type of complex frequently built in the 1950s-1970s where residents have remained because of the financial structure of the developments. Many of these have adapted very well to organizing their senior communities and acquiring funds to provide spaces and needed services ranging from recreation to health care. Questions were raised, though, about whether this is really the best physical form for a NORC. The major criteria for NORCs seem to be a minimum level of density, a community of seniors, and the convenience of services. Thus, future NORCs may emerge in the types of housing that have been built more recently, such as low-rise-high-density complexes or different high-rise models.

An audience member asked the panelists what they see as the next developments in providing for the needs of an ever-growing population of seniors. The speakers indicated that these would have to grow out of the preferences of the next generation of soon-to-be seniors, but they felt that there would be a strong concentration on the use of advancing technology, which is likely to offer caregivers the capability of monitoring remotely seniors in their own homes to be sure they are safe and healthy, and to enhance family connections for homebound seniors. Ideally, the processes of caregiving will become more efficient and effective, and less costly.