The New Aging Enterprise - aarp

needed. Like Erickson, they effectively “unbundled” services and payment to create a package
much cheaper than assisted living or conventional home care. The paid employees of Beacon
Hill Village not only provide information and referral; they also provide friendly visiting and
social support. This grassroots innovation has now been replicated in other places around the
USA: the Richmond District of San Francisco; Yonkers, NY; and Falmouth, Massachusetts.
The grassroots innovation represented by Beacon Hill Village was not the first effort of
its kind. Naturally occurring retirement communities (NORCs) were first recognized in the
1970s, appearing in urban high-rise apartment buildings such as Manhattan’s West Side. 15 Like
Beacon Hill, these NORCs included people who were aging in place and seeking government
assistance to enable them to remain in their homes. Since 1994, New York State has provided
financing for social services, including nurses and case managers, in places with high
concentrations of older people, including some suburban neighborhoods, dubbed horizontal
NORCs. Initially, 10 housing complexes were funded, and that number grew to 14 by 1999.
Policy-makers have also shown interest in NORCs as a site to encourage healthy aging. For
example, municipal governments are positioned to use NORCs as a platform for health
promotion and exercise through zoning or development of walking paths, for example, which
Erickson has done in its retirement communities. 16 The dimensions of health promotion and
social networking underscore the point that NORCs, like Beacon Hill Village, are not merely
“bricks-and-mortar” housing arrangements or “boutique” experiments in community living.
In some respects, the emergence of NORCs was in response to declining federal funding
for senior housing in the last decades of the 20 th century. 17 In addition, many older people
needing support were unable to afford higher-priced assisted living in the private marketplace,
and they certainly preferred to avoid nursing home placement, even though it might be funded by
Medicaid. Above all, most older people preferred to live independently in their own homes.
NORCs, along with grass-roots initiatives like Beacon Hill Village, therefore respond to a
distinctive market segment: middle-class people who are not sick enough for Medicare, who
have too much income for Medicaid services, and who are not rich enough for private individual
care. But this segment is far from a niche, since it includes all but the very rich and the very
poor.
Does the Beacon Hill Village model represent a wave of the future? Most efforts to
replicate Beacon Hill have appeared in neighborhoods fairly strong in “social capital,” with
residents who are well-connected and capable of leadership because of their careers in
professional work. The first NORCs, too, appeared in housing complexes with a tradition of
organization inspired by labor unions or voluntary associations. Beacon Hill Village leaders
subsequently wrote an operating manual based on their experience and worked with MIT to
encourage replication at other sites around the country. In New York, state government provided
support for replication and technical assistance. In other locations, social service organizations
have played a key role in organizing projects and recruiting volunteers. In short, innovations like
Beacon Hill Village and NORCs do not “just happen” without substantial prior investment in
either social capital and government support to sustain the systems that permit people to live
independently.
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