Many forecasts in the 1980s predicted nursing home use would increase sharply alongside the aging baby boomer population. Yet nursing home occupancy has experienced a decline of almost 3 percent over the past decade. In part, this reflects a preference for staying in one’s home (“aging at home”) or in other independent living alternatives, as well as the high prices that discourage many from living in a comprehensive senior facility and keeps them at home. Yet “independent living” alternatives usually have been limited to senior-living communities, assisted-living communities, and continuing care retirement communities—all of which still require seniors to move out of their homes. So what options exist for older Americans who want some of the amenities of a senior community yet are healthy enough (and prefer) to stay at home in a mixed-age neighborhood?
One interesting model is Villages, an example of the approach sometimes referred to as “senior villages.” Villages is part of a general movement to empower seniors to live at home and avoid hospital admissions and nursing home stays. Interest is growing in finding ways for seniors to live in their setting of choice and to build teams to make that possible.
Villages was started in Beacon Hill, Boston, in 2001 by Susan McWhinney-Morse and eleven of her Boston neighbors. Determined to avoid transitioning to an assisted-living or continuing care community, the group of elderly neighbors decided to find ways to help each other age safely at home. The member-driven nonprofit organization is operated primarily by the neighborhood’s seniors, with assistance from a small group of staff and volunteers. As word of the model spread after its formation, and the idea continues to attract broad attention over time, with inquiries coming in from cities across the U.S. and abroad, asking how to create similar community networks.
In a partnership with the nonprofit Capital Impact Partners, the Beacon Hill Village sponsors the “Village to Village Network” an online resource which lists information for developing and running a Village, Village calendar events, and national Village conference information. It boasts a directory of all open Villages and those under development. The creation of the Beacon Hill Village has inspired approximately 170 other Villages, with an additional 160 more currently under development. While the majority of Villages operate in urban (34 percent) and suburban areas (38 percent), there is also a strong rural constituency (approximately 22 percent). Six percent are “unclassified” by the Network. An annual fee typically provides members with transportation, routine social events, discounted medical and wellness services, provider referrals, and volunteers to help satisfy a broad range of member requests (from moving furniture to grocery shopping and help setting up computers). Membership dues average $600 annually, but can range from $250 to as much as $1000 for couples and packages that include additional services. In some Villages, residents can also opt for “associate member” membership, which grants them access to social networking events but not many support services.
The Villages movement is particularly active in the nation’s capital, with ten Villages in operation in Washington D.C.: in the neighborhoods of Foggy Bottom West End, Northwest DC, Georgetown, Glover Park, the Palisades, Cleveland and Woodley Park, Capitol Hill, Dupont Circle, the far Southeast, and Mount Pleasant. Others are in development in East Rock Creek and the Southwest Waterfront. Overall, the Washington metropolitan area has the highest concentration of Villages in the U.S., with almost 50 either open or in-development.
With seniors age 65 and above now accounting for 11 percent of the D.C. population, the Villages concept could become a valuable part of the city’s strategy to address the costs of aging and the living preferences of seniors. The Villages not only help residents cope with the process of aging, but also empower them to retain their vitality, social networks, and intellectual interests. In contrast to nursing homes, life in the Villages encourages patient advocacy and active engagement in their own medical journey, instead of a more passive role. The Northwest Neighbors Village, for example, offers members a “medical note taker” to accompany them to doctor’s appointments, increasing patient health literacy and ensuring the Village member has a thorough record of what was discussed during the visit. The Villages will connect members with nearby medical providers as needed. They also have worked with local hospitals and primary care physicians to help integrate services more effectively with seniors in their communities, encouraging prevention and helping to reduce medical, nutritional and lifestyle patterns that lead to costly hospital admissions.
So far the D.C. Villages have been established in more affluent corners of the city. In such communities social and professional networks are generally stronger and information and services more plentiful, which makes it easier to establish and operate the Village model. It is worth noting that no Villages exist in Wards 7 and 8, the poorest areas of D.C., which begs the question: does the inherent price and information networks associated with joining and maintaining the services of the Villages limit its replication in lower-income neighborhoods? Or can we adapt the key elements of success into a variant of the model that can take root in lower-income communities? We will explore these questions in our next blog.
The Initiative is a partnership between the Center for Health Policy at Brookings and the USC Schaeffer Center for Health Policy & Economics, and aims to inform the national health care debate with rigorous, evidence-based analysis leading to practical recommendations using the collaborative strengths of USC and Brookings.