NORC’s are “Naturally Occurring Retirement Communities”. The term was originally coined in 1984 by Professor Michael Hunt of the School of Architecture and Urban Planning at the University of Wisconsin. He had noticed that a large apartment building in downtown Madison housed mainly older people who had migrated there for convenience – they could walk to stores, parks, theaters and doctors’ offices. He called this “naturally occurring retirement community” an example of “in-migration”.

Other types of NORC’s occur where there are already stable longtime communities of residents who are apt to stay in their locations and age in place together – this is called “aging in”.  I think what we are seeing in Marin is an example of “aging in”. Residents tend to love living here – the climate is fantastic, the mountain and views are hard to beat anywhere, the air is clean, the services are high quality, the arts are in evidence. Why go anywhere else if we can afford to stay here?

The third type of NORC’s have been defined as being examples of “out migration”. These cases happen often in rural communities where younger working people move, leaving the older folks behind. From what I’ve observed over the years, we have a bit of “out migration’ happening in Marin as well. Many aging parents tell me that their adult children cannot afford to live here in Marin or can’t find jobs here, so they have moved north, to the East Bay or out of state. Thus many older people here have no local family to care for them as they age.

NORC’s really got going originally in New York. The pioneer activist in the movement is Fredda Vladeck, a geriatric social worker who worked with the state and city of New York to garner matching funds from private agencies. The first NORC was born in a housing development called Penn South, in 1986. Penn South housed 5000 older people (of its 6200 residents) – most of whom were lifelong union organizers who had never married or, if they had married, never had children. So, they did not have the traditional circles of support.

At Penn South, the residents also did not trust social workers. They feared that the social workers would try to get them to move into nursing homes. After years of working to build trust, the community was thriving – full of renewed arts programs, activities, intergenerational bonding and mutual care. Members were all contributing their volunteer services. Further, the state and city funding paid for a variety of health services to be offered on-site. Visits to ER’s dropped dramatically as overall physical and emotional health and wellness increased. Isolation and depression decreased.

This “vertical NORC” model (in a high-rise) spread throughout New York and morphed to includeNORC WOW’s (NORC Without Walls). These NORC’s exist in demographic-based communities where members live in their own homes. Hundreds of NORC’s exist across the US now – there are many different iterations depending on the culture of each community and the members.

For example, here’s information on one thriving NORC Without Walls in St Louis:

Productively Aging: St. Louis’s Naturally Occurring Retirement Community

For more information about the history of NORC’s read this fascinating interview inDesigner/Builder magazine with Fredda Vladeck:

 NORC Blueprint: A Guide to Community Action .

Here’s a quote from Fredda:

“What we’ve accomplished is about changing the discussion from long-term care to long-term living. It’s moving the mindset and recognizing that older adults, as old and as frail and as fragile as they are, have roles to fill in their community. It’s up to us to find those appropriate roles and recognize that it’s not just about putting in a service: it’s about addressing the quality of life of older adults.

 

There’s a major push right now among public policy folks in the aging and long term care world to do what’s called community-based care. I’m not sure exactly what that means. I think the larger question here is we need to be thinking about the role of older adults in communities and how they can continue to be valued contributors. At Penn South we told people in wheelchairs, who ordinarily would have been stuck in their apartments, that there was stuff they could do here to help this community and this program. We told them, bring your home care worker too. That’s fine. You have a role in this community and in this society, and our job is to help you realize your potential.”

 

 

In Marin, we have naturally occurring retirement communities happening whether they are officially affiliated with the NORC movement or not. Alternative housing arrangements for seniors are cropping up all over, including here. They may include housing complexes with NORC’s, NORC’s Without Walls in neighborhoods, Villages (another neighbor helping neighbor model), or even CCRC’s Without Walls (Continuing Care Retirement Communities Without Walls). It is good to see a variety of choices. (See this recent article about CCRC’s Without Wall in the NY Times: A Choice of Community Care, in Your Own Home.)

With all of the creative energy in Marin and in the Bay area, I’m sure there will be many more community models emerging as we boomers continue to age. If you know of more examples in our area, please feel free to email me or post a comment. Thanks!

– Nancy Rhine, MS, LMFT is a licensed marriage and family therapist who specializes in working with midlife and older individuals, couples and families. She is Mill Valley’s former Commissioner on the Marin County Commission on Aging and a passionate advocate for older members of our communities. You can reach her at nancyrhine@aol.com. 

Therapy and Integrative Care Contributes to Reducing Depression in Older People

I recently blogged about the potential benefits of geriatric counseling for older individuals and their families.

Then my husband sent me a link to this July 25 article from the wonderful New York Times blog“The New Old Age” called “More Older People Treated for Depression.” Click on the link to read the entire piece. Some relevant quotes are listed below.

• “For years, mental health specialists lamented that depression was seriously under-diagnosed and under-treated in the elderly. Laypeople saw it not as a disease but as an inevitable part of aging. Doctors missed it because depression didn’t always look the way it did in younger patients– less sadness and weepiness, more physical symptoms and disengagement. Older people themselves often rejected help because mental illness carried a stigma.”

• “Not anymore. Over the past decade, ‘we’ve seen a really big increase in the recognition of depression and the initiation of treatment,’ said Dr. Unützer, a geriatric psychiatrist now at the University of Washington. ‘The bad news is that a lot of these folks aren’t a lot better.'”

• “One apparent explanation: the setting. A great majority of older people seek treatment through their primary care doctors, few of whom are able to offer much more than a prescription. One approach that has proved successful is to move more comprehensive care for late-life depression into existing offices and clinics.

• “Among 1,800 depressed people over age 60, a group randomly assigned to collaborative care showed far greater improvement. After a year, 45 percent had at least a 50 percent reduction in depressive symptoms, compared with that dismal 19 percent in usual care. They reported less functional impairment, greater quality of life.”

• “There’s an advocacy role for family members to play. Talking to a primary care doctor may be a good way to start treating depression, but in many cases that’s not where to stop.”

• In one personal story cited in the blog article, a depressed elderly woman who has not found effective help begins to receive treatment in a comprehensive care center and from atherapist who visits her twice weekly in her assisted living apartment. “It has turned back the clock 10 years,” states her adult daughter.

Why Is Counseling An Important Health Tool For Older Adults?

As we gather more years in our lives, we naturally encounter more and more experiences. Many of them are lovely, joyful and profound. Many of them also inevitably involve loss. Loss can refer to deaths in our families, amongst our loved ones, our pets and extended community. Loss can also be experienced in relationship to job changes, retirement, living situations, finances, physical capabilities, independence, hopes and dreams.

Learning how to deal with cumulative loss is paramount to good mental health and one’s sense of wellbeing. Coping skills commonly used by people to manage grief and loss include cognitive/behavioral techniques, mindfulness meditation, prayer, support groups, self-help literature, workshops, exercise, music, poetry, writing and individual, marital, and/or family counseling.

Older generation adults may or may not have experience with, or a belief in the valuable benefits of, counseling. Many are strong survivors who believe in the value of discipline, determination and will power to surmount challenges.

Counseling may have never been part of their family culture. There can come a time, however, when “white knuckling it” alone through emotional pain may not be the most effective strategy for health. Oftentimes, older people don’t want to burden their adult children with their worries and concerns. Where can they turn?

Traditionally, older people have sought comfort from their family doctors or spiritual leaders. Doctors nowadays do not have the time they used to have to spend counseling patients. Spiritual leaders’ time is usually limited as they often have large congregations to care for. A wise and experienced geriatric counselor who is genuinely caring, nonjudgmental and a good listener can be a powerful support team member for older people.

Why Is It Important for Older Clients to see a Geriatric Counselor?

All Licensed Marriage & Family Therapists receive a deep training in counseling-psychology, a variety of evidence-based treatment models and solid intervention techniques. Similar to geriatric MD’s, however, geriatric counselors also have extensive additional training and experience in addressing specific issues encountered in aging. With older people, many more pieces of the health “puzzle” come into play.

For instance, physical health status, medications, living conditions, safety, socialization vs. isolation, independence vs. dependence, spirituality, lifelong learned personality patterns, nutrition, shifting roles in families, impacts of ageism in society, a continuing sense of purpose and value, an ability to contribute to their communities – all of these and more contribute to the older individual’s sense of wellbeing.

A close attention to working collaboratively as part of a compassionate and competent support team is also often called for in serving older clients. With each client’s express written permission and where beneficial to each client, geriatric counselors can contribute greatly to the client’s wellbeing through effective communication and teambuilding with physicians, caregivers, facility social workers, nurses, psychiatrists, care managers, spiritual leaders and family members. “It takes a village” is often true in serving the wellbeing of older clients.

Thus, it is important that geriatric counselors are well-versed and up-to-date with the common physical challenges, safety issues, emotional challenges, relationship/role changes, societal influences, support teams and environmental concerns encountered by aging clients. In order to effectively advocate for, educate on behalf of and serve this population as a therapist, simply knowing the basics of counseling psychology is not enough.

In Marin County, geriatric counselors can be found through a local google search, through a search on Marin County’s online site for the Division of Aging and Adult Services, through the Find A Therapist tool on the Marin California Marriage & Family Therapists website, or through a referral from your spiritual advisor or physician.

Neighbor is a Verb

My 91 year old mother uses the word “neighbor” as a verb. As in, “People don’t neighbor here anymore”. She grew up and has lived most of her life in an era when people didn’t lock their doors and neighbors came over unannounced for a friendly cup of coffee or to borrow the proverbial cup of sugar.

She bemoans the fact that in her later years in an upscale retirement neighborhood in Scottsdale and now even in a good-sized retirement home, people tend to keep to themselves, valuing (apparently) their privacy.

My husband and I live in a small apartment complex that we manage. We have screened our renters and have a wonderful, stable group of 8 families. We have patio garden and deck areas filled with growning fruit, flowers, veggies and.. children! It is alive, and there are multi-generations living and enjoying each other here.

I bring this up because last week a new UCSF research study came out that has spread like wild fire around the Net and print media. It was published in the Archives of Internal Medicine. UC Health describes the results in: Loneliness Linked to Serious Health Problems, Death Among Elderly.

NPR’s Michael Krasny interviewed one of the study’s authors, Carla Perissinotto, M.D., M.H.S., assistant professor in the UCSF Division of Geriatrics and Karyn Skultety, director of clinical and community services for the Institute on Aging in an excellent radio piece: Loneliness in Later Years.

UCSF researchers interviewed 1,600 participants and asked them basically three questions:

Do you feel left out?
Do you feel isolated?
Do you have companionship in your life?

These questions address issues of loneliness. Note that loneliness is not the same thing as depression which is more about a lack of enjoyment, energy and motivation.

It’s important to note, and something that surprised the researchers (but not those of us who work with older people), that people can be very lonely even though surrounded by people as in an assisted living facility. It’s about the *quality* of relationships, not the *quantity*.

Back to my mother’s use of the word “neighbor” as a verb. Recently, a print poster has been making the rounds in the media called “How to Build Community”. One of the to-do items listed that especially caught my eye was “Sit on your front stoop”.

How many of us do that in our neighborhoods anymore? Granted not all of us have front stoops! But, even metaphorically, have we gotten so insular and isolated and fearful of our privacy that we no longer know and look out for our neighbors?

“Aging in Place” or “Aging in Community” initiatives that I’ve been writing about are initiatives sweeping the country that are two answers to the isolation and loneliness people are experiencing, especially for those who are becoming predominantly homebound.

“Neighbor” is a verb. How can we begin to use it in our communities to help not only those of us who are growing older and becoming less mobile but also overwhelmed single parents, latch key children, kids with no grandparents nearby, widows, etc.

Perhaps, as the poster creator lists, we can “turn off our TV’s, sit on our front stoops, greet people, organize a block party, know our neighbors, hire young people for odd jobs, have a potluck, and dance in the streets”.