MediCaring.org

By Candace Baldwin

 For 60 years, Dorothy Weinstein ran a boarding house for medical students in Boston. But by the time she reached 100, Dorothy decided she needed help making beds and cooking for the students. Her son, who worried for her health and safety, thought that it might be time for her to move to a retirement community. But for Dorothy, there would never be a time to move.

Certain she could find a better solution, Dorothy contacted Beacon Hill’s Village, a community-based membership organization that empowers older adults to remain active and engaged in their communities as they age. She told the Village staff about the trouble she was having navigating the stairs at home—going up and down them backwards, sliding on her bottom.

The Beacon Hill Village offered her some options: It coordinated neighborhood volunteers to provide Dorothy with companionship, light cleaning for the boarders, rides, home care services, and delivered meals and groceries—including pizza on some Fridays. On days Dorothy felt well, she joined lunch groups and lectures organized by the Village. This support meant that Dorothy aged in her own home, still actively engaged in the world around her.

“At age 102, my mom died in her own bed, in her own home, with her family at her side,” said Dorothy’s son. “If it weren’t for the Village, this might never have happened.”

Our country is full of people like Dorothy, who hope to age—and eventually die—in their own homes. In fact, according to a variety of market research data, older adults today overwhelmingly prefer to age in place and increasingly seek options that facilitate this.[i]

Consequently, many older adults purposefully seek supportive communities reminiscent of a time when neighbors were a more significant part of each other’s lives and provided a helping hand, with no expectation of reciprocation.

Older adults – especially baby boomers who have experienced their own parents’ aging – are searching for meaningful lifestyles as they retire and alternatives to nursing homes, assisted living, or continuing care retirement communities, which are increasingly perceived as lacking a sense of “community.” Studies indicate that aging in a community-based setting improves the quality of one’s life and one’s health.[ii]  In response, new models are beginning to emerge to support aging in the community that provide “one stop shopping” through a single point of entry.  Today, the experience of aging is actually a constellation – one that is multi-dimensional and interrelated and recognizes that a  “one size” approach to service delivery does not fit all.

The Village Model

The heart of the Village model is its focus on the individual as the core of the community. In this model, older adults are active members in the service delivery process, and provide essential assistance in the planning and implementation of a wide range of programming offered through the Village. Villages offer members a network of resources, services, programs, and activities that revolve around daily living needs; social, cultural, and educational programs; ongoing health and wellness activities; and member-to-member volunteer support.

Built on cooperative principles, Villages facilitate access to community support services and connection to on-going civic engagement. Most Villages are created and run by its members.  Since the first Village, Beacon Hill Village in Boston, opened in 2002, 110 Villages have opened across the country, providing full-service programs to over 20,000 older adults. Membership levels range from 100-800 people, with an average membership of 150. Currently, at least 120 communities are in the development phase, which could result in an implementation of at least 75 new Villages within the next two years.[iii]

Villages share the following characteristics:

• They are self-governing, self-supporting, grassroots membership-based organizations.
• They consolidate and coordinate services to members.
• They create innovative strategic partnerships that leverage, rather than duplicate, existing community resources.
• They are holistic, person-centered, and consumer-driven.
• They promote volunteerism, civic engagement, and intergenerational connections.

Furthermore, Villages focus on expanding choice and access to their members; they create social networks within the community, and provide assistance to secure long-term services and supports.  Villages have also begun to be part of transition teams for members coming home from the acute- or post- acute care settings.

Research shows that the most damaging threat to well-being in later life is not fear of absolute destitution or poor health, but loss of life purpose and boredom.[iv]  Villages address directly what recent research has documented as the health-related problems caused by social isolation, including depression, increased risk of morbidity, mortality, cardiovascular disease, dementia, and Alzheimer’s disease.[v] Real-life social networks decrease isolation, as well as the likelihood of institutionalization and mortality, and increase longevity. Villages’ emphasis on volunteering not only provides manpower for Village programs, but, more important, provides an organized way to engage members in their community and improve their morale by “making a difference.” 

How Villages Work

Members contact their Village and ask for anything that they want or need that will help them to remain connected to their community. Villages are mindful not to replicate or replace services and supports that already exist in the community; thus each Village crafts its member services and programs based upon the community’s unique needs. While every Village organization is a bit different, every Village provides three core services:

1.concierge or referral to providers or volunteers for anything the member might want or need;

2.health and wellness programs and services to allow members to stay in their homes for as long as possible (i.e. exercise programs, home health care, meals and groceries delivered); and

3.social and community building programs, including seminars, wellness and prevention activities developed and administered by the members themselves.

Member requests can vary from day to day; Village staff ensure these are met either through a referral to a preferred provider or with a volunteer.  Transportation is the most frequently coordinated service for Village members, constituting an average of 60% of service requests. Transportation is provided by vetted and trained volunteers – both member and non-member – and Villages use private vehicles to offer rides to the grocery store, faith-based activities or simply a ride to visit with a friend across town.

Elliot, aged 75, is a prime example of how Village services can fill the gap between health care delivery and managing daily life in the community. When Elliot was diagnosed with cancer, he contacted his Village in Newton, Mass., hoping for a ride five days a week to radiation therapy. Newton at Home Village found volunteers for every ride. While Elliot was very grateful for the transportation help, he realized, much to his surprise, that he was most grateful for the new friendships he made with the drivers.

Friendships and social connections are at the core of all interactions at Villages. If someone needs computer help, a ride to meet their granddaughter to ski or an advocate at a hospital discharge, Villages work hard to fulfill these requests. This “whole person” approach highlights the Villages’ commitment to helping make meaningful connections to the people, organization, and activities that are important in a person’s life.  Although all Villages differ in what services and member benefits they offer, the diversity of programs and services are member-driven and reflective of the community.

Research indicates that 51% of the members volunteer with their Village – making the “neighbor helping neighbor” concept a foundation of the model.[vi] Volunteers not only provide services to the members but also are “in service” to Village operations: serving as founders of newly developing Villages, providing governance oversight on the Village board and committees, conducting classes or organizing social activities, assisting in local marketing and member recruitment, or simply supplementing paid staff in the Village office to respond to member requests. Many Villages use volunteers as an essential part of the fabric of the organization, as well as to help offset the expense of paid staff, thereby assisting in financial sustainability.

Based on research by the University of California Berkeley and Rutgers University, the average annual fee to be a member of a Village is $429 to  $573 per household. A majority (67%) of Villages offer discounted memberships to individuals who have incomes that are in the low and moderate range.[vii] Villages typically operate as non-profit, stand-alone organizations and derive their revenue from a variety of sources. With an average annual budget around $80,000, these organizations rely upon membership fees as a large portion of their revenue. The balance of the organization’s funds comes from a combination of individual donations, private foundation grants, and corporate sponsorships.[viii]

 As with most non-profit organizations, sustainability is of critical importance to Villages. Consequently, the Village to Village (VtV) Network was launched in 2010 as the movement’s national hub. Established as a peer-to-peer network of Villages, the VtV Network brings Villages and like-minded organizations together to create a national learning community to support replication in communities across the country. Since its launch in 2010, the VtV Network has 220 member organizations located in 38 states and three countries. The VtV Network is the “go-to” hub for the Village movement, whose mission is to enable communities to establish and effectively manage aging-in-community organizations initiated and inspired by their members. The goals of the VtV Network are to:

• Promote the Village model as a community approach to aging that can be replicated;
• Assist new, emerging, and established membership-driven Villages to create sustainable organizations;
• Gather feedback on how the benefits and programs can be revised to meet the needs of individual Villages; and,
• Research and evaluate the impact of Villages on a number of social and health factors.

While the Village movement is young, the model continues to resonate with people throughout the country and internationally. It has been described as a “true innovation” at a time when the safety net is being dismantled and baby boomers are beginning to experience the gap between what they (and often their parents) will need over the next twenty to thirty years, and what they can afford.

Candace Baldwin is the Director of Strategy for Aging in Community at NCB Capital Impact and its Village to Village Network initiative, and works closely with Village leaders. The website is www.vtvnetwork.org