Productively Aging: St. Louis's Naturally Occurring Retirement Community
By Ashley Opp
Photo at right: Peggy Neufeld's work with the St. Louis NORC encourages older adults to remain connected to their communities.
People often talk, in worried tones, about how the large number of retired baby boomers will change future society, says Peggy Neufeld, PhD, OTR/L, FAOTA, assistant professor in occupational therapy at Washington University School of Medicine in St. Louis, Missouri. The perception, she says, is that as you get older you become sick, and needy. But Neufeld is undercutting this point of view by working on a community model that shows how socially and civically engaged seniors can be active and healthy, and how tremendously they can contribute to their communities.
Naturally Occurring Retirement Communities
Neufeld works with St. Louis’s Naturally Occurring Retirement Community (NORC), which is simply a geographical area not originally designed for seniors but that has a high number of them who live in their own homes (and have for decades). Although percentages vary, usually 50% or more of an area’s population is 60 years of age or older to qualify as a NORC. No two NORCs are the same—one could consist of a city block or a large, rural area. Some are not identified and do not have supportive services.
The U.S. Administration on Aging funded an initial NORC Demonstration Grant to the Jewish Federation of St. Louis, which turned to the Washington University Center for Aging to do a needs assessment for the St. Louis NORC. Neufeld was part of a research team made up of occupational therapists, social workers, psychologists, anthropologists, and medical practitioners. Researchers examined the U.S. census and identified one square mile with 1,350 residents at 65 years of age and older. This number of residents was 30% of the area’s population, which was less than the typical benchmark for identifying a NORC but substantially greater than the national average (12%). Also, 67% of the older adult population was more than 75 years old.
“We interviewed over 500 people on the telephone and completed 2-hour interviews with 300 of them. We also ran focus groups,” says Neufeld. “We wanted to find out, what makes this place hard to live in? What would make it easier?” These questions are relevant for both the current older population and the baby boomers gearing up for retirement. “We’re having such a boom in our aging population, and we want people to stay in their homes for as long as they want to stay there. Research indicates that people prefer to stay in their homes as they age,” Neufeld says.
The research team made a final report to the Jewish Federation of St. Louis; identified barriers such as lack of sidewalks, transportation, and a place for older adults to socialize; and recommended that supportive services be developed in the NORC. Less tangibly, researchers detected a disconnect in the neighborhood among the older adults. “They really didn’t know others in the area or what services were available. They also had limited opportunities to get involved in the community,” Neufeld says.
To connect older adults, the Jewish Federation wanted a liaison with the research team from the Center of Aging, which became Neufeld’s new role. “I was excited about the project as an occupational therapist because we’re so interested in getting people engaged in life. And that’s exactly what this was about. I also felt that the evaluation process itself needed to help connect residents.”
Building Community
As part of her new role, Neufeld created programming that started with a 6-week wellness course. “Instead of focusing on disease, it focused on what is in their community, how to be connected to it, and how to make their own plans for productive aging,” Neufeld says.
In addition, Neufeld announced “Wednesday Workshops” in a newly created newsletter, with monthly get-togethers on things like advocacy to address community needs, storytelling, health and education topics, hands-on activities such as knitting, and working with computers, which were very popular with the older adults. “At 75 or 85 years of age, they’re still excited about learning,” Neufeld says. The Jewish Community Center, which is one of the NORC partners that is a nondenominational site available to all, provided a room where programming could take place.
Neufeld also promoted community bonding. “Transportation is the number-one issue with older adults. Even within 1 mile, many people cannot walk to the NORC room because of weather,” Neufeld says. She helped create subcommunities called resident councils, in which older adults gathered each month in housing complexes’ common areas. Currently, there are seven resident councils, and they provide a place for older adults to exchange information on such things as trustworthy handymen for house repair or housecleaning services and simply to meet new friends.
Evaluating the Program
The NORC then turned to Neufeld for a process evaluation. “I needed to capture what really happened that first year when this got off the ground, so I carried out a variety of evaluations, which included phone interviews, group discussions, surveys, and collecting qualitative and quantitative data from residents and team members,” Neufeld says.
The initial needs assessment identified transportation as a need for seniors, but one particularly surprising finding of the process evaluation was that older adults did not take advantage of a neighborhood bus that the NORC set up for grocery shopping. Most had found ways to get their groceries through family and friends. Evaluations revealed that what residents really wanted was transportation to cultural events where they could learn and socialize. “They didn’t feel comfortable asking others for transportation to those kinds of programs,” Neufeld explains, “yet we know from research that socially engaging activities relate to overall health and ability to age in place.”
The NORC stopped offering the bus to grocery stores (although a NORC outreach staff can connect individual residents to transportation resources if needed), and now fills a coach bus with seniors going to art museums and festivals for day trips. “People are always stunned when we say we’ve given up the grocery bus, but this is what is important to these residents and it’s what they want,” Neufeld says.
Sustaining Civic Engagement
Neufeld now focuses on sustainability so the NORC can provide resident-valued services with lower staff costs. “To sustain the program, we need a business model that captures the skills and talent of older adults in the specific arenas of business, marketing, and administration and management of nonprofits,” Neufeld says. She is forming an advisory committee with such skills, facilitating the creation of a leadership council to develop and implement new polices that will provide ongoing supportive services for the NORC.
To accomplish building this model, Neufeld wrote a grant proposal for the Jewish Federation to receive $40,000 from the National Center of Aging as part of its Respectability Initiative. The initiative seeks to build models of significant service for older adults, which stems from a national concern that baby boomers will disengage from civic life when they retire.
“Civic engagement means doing things in your community to support its ongoing growth and strength. With older adults, civic engagement could be many things—volunteerism, caring for an older sibling or parent, and lifelong learning to promote activism,” says Neufeld. “Occupational therapy practitioners need to be aware of increasing civic engagement in all ages, especially in light of our increasing aging population.”
“With the baby boomers aging, we’ll have people who are already trained and could fulfill all sorts of new roles in the community,” Neufeld says. “I’d say we have a resource boom coming!”
Ashley Opp is Senior Staff Writer at AOTA.