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Learning from Vertical NORCs:Challenges and Recommendations forHorizontal NORCsLaura Bronstein a & Bonnie Kenaley ba Department of Social Work, Binghamton University, Binghamton,New York, USAb School of Social Work, Boise State University, Boise, Idaho, USAVersion of record first published: 03 Dec 2010.

To cite this article: Laura Bronstein & Bonnie Kenaley (2010): Learning from Vertical NORCs:Challenges and Recommendations for Horizontal NORCs, Journal of Housing For the Elderly, 24:3-4,237-248

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Journal of Housing For the Elderly, 24:237–248, 2010Copyright © Taylor & Francis Group, LLCISSN: 0276-3893 print / 1540-353X onlineDOI: 10.1080/02763893.2010.522452

Learning from Vertical NORCs: Challengesand Recommendations for Horizontal NORCs

LAURA BRONSTEINDepartment of Social Work, Binghamton University, Binghamton, New York, USA

BONNIE KENALEYSchool of Social Work, Boise State University, Boise, Idaho, USA

Maximizing quality of life for older adults poses challenges for for-mal service providers. One strategy to identify and address factorsinfluencing physical and mental health and to promote auton-omy of community-dwelling older people is through a naturallyoccurring retirement community (NORC), a community develop-ment model of formal and informal home and community-basedsupport. This descriptive article provides a review of the literaturerelevant to the NORC concept and a comparison of the dimen-sions of structure, design and location, management, cost andaffordability, and socialization between vertical NORCs (high-riseapartments) in major metropolitan cities and horizontal NORCsin small cities and suburban and rural communities. Implicationsand suggestions for horizontal NORCs are discussed.

KEYWORDS NORC, naturally occurring retirement community,aging in place, urban aging, suburban aging, rural aging

INTRODUCTION

The changing demographics around the world have received a great deal ofattention in recent years. In 2017, the number of people older than 65 years isexpected to exceed those under age 5 for the first time in global history, andthe difference between these two age groups is only expected to expand overtime (United Nations Department of Economic and Social Affairs PopulationDivision, 2005). In the United States and other developed countries, these

Address correspondence to Laura Bronstein, Chair and Associate Professor, Departmentof Social Work, College of Community and Public Affairs, Binghamton University, Box 6000,Binghamton, NY 13902, USA. E-mail: lbronst@binghamton.edu.

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demographic shifts are accelerated by advances in medical treatments andhealthier aging lifestyles. Juxtaposed against these shifts are challenges of theeconomic downturn yielding financial constraints. Together, these variableshave motivated governments, community agencies, families, and consumersto search for viable solutions to meet the needs of healthy and frail non-institutionalized older adults, creating pressure on community-based servicesto maintain and increase accessible, comprehensive, affordable, and highquality services in challenging times.

Already rates of institutionalization of older adults are decreasing whileformal home- and community-based care are expanding (Anderson &Hussey, 2000). For example, in the United States, home care has becomea critical source of treatment for homebound older adults (65+). This pop-ulation represents 72% of all service recipients (National Center for HealthStatistics, 2005). For example, in New York estimates of a 40% increase inthe number of older adults will intensify demand for community supportservices, particularly for poor, frail, and isolated individuals (Deitz & Garcia,2007).

Despite the need, and what would appear to be cost savings over insti-tutional care, community-based care of homebound and frail older adults arechallenging to provide (Bruce, Van-Citters, & Bartels, 2005). Older adults arelikely to have coexisting acute and chronic medical conditions and functionaldisabilities, and some have mental health problems (Gellis, 2006). Those whohave adequate physical and mental ability are often hampered by commu-nity factors, such as lack of transportation or sidewalks, and other factors thatpromote social isolation. These risk factors can lead to increased morbidity,health care use, and, ultimately, institutionalization. To address both qualityof life and cost concerns, geriatric health promotion and illness preventionhas become a high priority (Institute of Medicine, 2001). One mode of max-imizing health, mental health, and independence in both frail and healthyolder adults is through community development and home-based supportusing a naturally occurring retirement community (NORC) model.

This descriptive article begins with a review of the literature relevantto the NORC concept, a term first coined by Hunt and Guner-Hunt (1986)to mean “housing developments that are not planned or designed for olderpeople, but which over time come to house largely older people” (p. 4). Asa relatively new phenomenon, there are few empirical studies of NORCs.Those that have been written are narrow in scope, consisting of case stud-ies (Bronstein, Gellis, & Kenaley, 2009; Grant-Savela, 2009, 2010), attentionto issues of attraction to and selection of NORCs as a place to live (Grant-Savela, 2009, 2010; Hunt, Arch, & Ross, 1990), or are based on short-termdata (Bronstein et al., 2009). Although providing access to health care is a pri-mary need and an important component of all NORCs, it is the psychosocialneeds including mental health and social support and the physical environ-mental needs in and around ones home and community, where NORCs pay

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Challenges and Recommendations for Horizontal NORCs 239

additional attention. Hunt (1991) described an important component ofNORCs as providing places “where neighboring can occur naturally” (p. 137).

The bulk of the literature on NORCs has focused on vertical (high-rise)NORCs in major metropolitan areas. However, it is crucial to examine theneeds of older adults in small cities, suburbs, and rural communities, wherethe majority of older adults live in their own single-family homes. Thesecommunities are referred to as horizontal NORCs because they are spreadover an expanse of land. In addition to reviewing the developmental historyof NORCs and their characteristics, this article delineates five componentsthat characterize and differentiate horizontal and vertical NORCs, includingstructure, design and location, management, cost and affordability, and so-cialization. The article concludes with a focus on implementation challengesand potential solutions for successfully developing horizontal NORCs to bet-ter serve older adults who are aging in place in small cities, suburbs andrural communities.

DEVELOPMENT AND CHARACTERISTICS OF NORCs

NORCs have developed in the United States and other countries (includingsimilar programs in Israel and Singapore) in response to social isolation, un-availability of caretakers, and the desire of many older adults to age in placewhenever possible (Auslander, Soffer, & Auslander, 2003; Billig, 2004). Inthe 1960s, the U.S. federal government (through programs such as Medicare,Medicaid, and the Older Americans Act) was the primary level of governmentattending to the social and health needs of older adults. However, by themid 1980s, responsibility for long-term care shifted to the individual states.More recently, shrinking public funds are leaving a greater proportion ofthe burden of caring for older adults to the community and to family care-givers, many of whom are ill-equipped for this role (Bolda, Lowe, Maddox,& Patnaik, 2005).

In the United States, some of the earliest NORCs developed in NewYork City (http://www.udeworld.com/norc.html). In 1994, the New YorkLegislature declared in Section 410 of the Laws of New York the intentionto support NORCs as a mechanism to assure a good quality of life, accessto community-based services, and prevention of unnecessary hospitalizationor institutionalization for older adults living in their own communities. By1999, New York had funded 14 NORC programs, all in high-rise apartmentbuildings in the state, with the majority in New York City (Pine & Pine,2002). These apartments became known as vertical NORC programs, andwere designed to support a service system to aid the older adults whoresided in them. In 2006, in response to statewide town hall meetings onthe service needs of older adults, the New York State Office for the Agingprovided funding for its first horizontal NORC (New York State, 2005). Today,

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much of the focus is still centered on vertical NORCs; however, horizontalNORCs in small cities and suburban and rural areas are garnering increasedattention in the literature (Bronstein et al., 2009; Grant-Savela, 2009, 2010).

Although health and psychosocial needs of older adults are of primaryconcern, equal attention needs to be paid to environmental issues, bothinside and around the home, as well as in the larger community. A well-maintained home and an accessible caring community are critical factorsthat contribute to individual well-being and to the ability to remain at home.Some researchers have noted that a healthy NORC places a good deal of em-phasis on the environmental components that foster social interaction suchas sidewalks, limited automobile traffic, and enhanced recreation facilities(Masotti, Johnson-Masotti, Fick, & Macleod, 2006). Hunt (2001) suggestedthat the goal of environmental design in communities should be to fosterinformal support to older residents from friends and family. These are par-ticularly critical issues for horizontal NORCs where older adults cannot getas many on-site services compared to vertical NORC residents. Thus, olderadults in horizontal NORCs are more dependent on environmentally friendlycommunity structures and supports where they can venture out safely andwhere providers can access them with needed services.

In addition to caregiving needs and environmental supports, those olderadults whose physical and mental states are healthy enough to allow themto live independently are at a high risk for social isolation and loneliness.Social relationships are often identified among the basic needs of olderadults. Negative consequences from social isolation include depression, sui-cide, poor nutrition, and a decrease in immunological function (Gellis, 2006;Rubenstein, Lubben, & Mintzer, 1994). Because the majority of older adultslive alone in the suburbs or in rural areas (Deitz & Garcia, 2007; Folts, Muir,& Nash, 2005), there is a need to address social isolation in these communi-ties. On the other hand, along with the need for social support, older adultsalso desire privacy and independence, which includes the ability to live intheir own homes (Folts et al., 2005).

Researchers who address social isolation in adults often emphasize theimportance of informal care networks (Hunt, 2001). However, building com-munity networks is more challenging in small cities and suburban NORCsand even more difficult in rural areas than in vertical high-rise apartmentbuilding NORCs where accessibility to services and to neighbors is less ofan issue. This is compounded by the fact that housing for older adults is lessadequate in suburbs than in cities and least sufficient in rural areas (Foltset al., 2005). Moreover, about half of elderly households in rural areas are ator near the poverty line (Folts et al., 2005). Hunt (2001) described the suburbsas “the antitheses of NORCs” (p. 230), and rural communities are probablyeven more so, perhaps with the exception of upper middle class retirementcommunities located “out in the country.” Policy advocates have suggestedthat frail, disadvantaged older adults are likely to increase in numbers in the

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Challenges and Recommendations for Horizontal NORCs 241

suburbs as the population continues to age (Frey, 1999). In addition, pro-jected baby boomer aging is expected to cause suburbs such as New York,Philadelphia, Chicago, and Los Angeles to become considerably “older” thanthe cities themselves in the next 30 years (Frey, 2007). Therefore, althoughexamples of successful NORCs have developed in apartment buildings inlarge urban areas, there is an increasing need for horizontal NORC programsthat support older adults in their own homes outside of major metropoli-tan cities because that is where the majority of older adults reside and willcontinue to reside (Folts et al., 2005).

DISTINGUISHING DIMENSIONS OF VERTICAL NORCs

Despite the similar age demographics, developing and sustaining successfulvertical NORCs in major metropolitan areas is a very different enterprise thanit is in small cities, suburbs, and rural areas where older adults are spread outin private homes. In reviewing the literature and through the authors’ ownexperiences with NORCs, five main and interrelated factors emerge to helpguide the understanding of these distinctions including structure, design andlocation, management, cost and affordability, and socialization. See Table 1for a comparison of dimensions between vertical and horizontal NORCs. Be-cause most of the literature has focused primarily on vertical NORCs, theseelements are discussed in the following section. The implications sectionincludes a comparison of the differing aspects of these five dimensions andsuggestions for developing and sustaining healthy horizontal NORC commu-nities.

Structure

Vertical NORC programs as originally funded were housed in high-rise apart-ment buildings (Pine & Pine, 2002). Today, even within the vertical NORCsthere is variance in structure and the number of apartment units, rangingfrom less than a dozen units to well over 500 units (Hunt et al., 1990;Vladeck, 2004). In addition to high-rise apartments, contemporary verticalNORCs may encompass condominiums and multiple apartment complexesthat spread over several acres (Vladeck, 2004). Despite the fact that the newervertical NORCs may vary in structure, they have clearly defined geographicboundaries and possess the common factor of being perceived as a “singlerecognizable group.” This shared identity and relatively small geography isin sharp contrast to the horizontal NORCs that can be spread out over miles.The shared identity lends itself naturally to a sense of community, somethingthat often has to be proactively created in horizontal NORCs. In addition,the structures of vertical NORCs suggest a more homogeneous group of

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TABLE 1 Comparison between Vertical and Horizontal NORCs

Dimensions Vertical Horizontal

Structure High rise buildingsApartment, condominium,multiple complexesDefined geographic area“Single recognizable group”NORC resident advisorysupport

Low rise buildingsSingle family homesExpansive geographic areaLacks identification asrecognizable groupDispersed, if any NORCresident advisory support

Design & Location Self-containedOn-site servicesCompact layoutClose proximity to socialnetwork, vendors,transportationInstitutional safetyfeatures/solutions

Not self-containedNo on-site servicesExpansive layoutVariable proximity to socialnetworks, vendors,transportationLacks institutional safetyfeatures/solutions

Management On-site management by singleorganizationOn-site managementoversees maintenance,activities, amenities,security/emergency services

No on-site managementCommunity collaborativemay oversee maintenance,activities, amenities,security/emergency services

Cost & Affordability Not subsidizedWaiting listFixed or unstable rents

Not subsidizedOften fixed mortgages

Socialization Socialization/support/surrogatefamily opportunities

Diminished opportunity for so-cialization/support/surrogatefamily opportunities

residents, which in turn simplifies the variety of programming and serviceneeds to import or link with the buildings’ older residents.

Design and Location

Vertical NORCs are often self-contained in that they provide a space andvenue for an array of resident-focused activities. The provision of on-siteservices, such as social events, senior clubs, laundry, mail service, salons,or case management, and medical/home care services offsets transportationcosts and eliminates challenges and fears of navigating systems external tothe building, some of which may be unsafe due to difficult terrains, inclementweather, or crime (Hunt, Merrill, & Gilker, 1994). The compact layout of thevertical NORCs also benefits health care providers in that multiple clients maybe served within a short amount of time compared to serving those who livein single family dwellings (MacLaren et al., 2007). The close proximity ofneighbors may also enhance the formation of social networks, as well asthe monitoring of the neighbors’ status and, ultimately, easy access to theresident in case of an emergency (Hunt et al., 1994).

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Challenges and Recommendations for Horizontal NORCs 243

In addition, vertical NORC structures may implement safety features andsolutions to minimize or alleviate physical barriers (structural or landscape)(Ormond, Black, Tilly, & Thomas, 2004). High-rise apartment complexesand other types of vertical NORCs are often constructed proximate to pub-lic transportation or within walking distance to neighboring grocery stores,pharmacies, churches and synagogues, medical facilities, parks, restaurants,and recreational settings (Ormond et al., 2004). This allows vertical NORCresidents more immediate access to needed services. Vertical NORCs mayalso offer a living environment that is quiet, homey, and small enough tomanage. Outdoor accessibility via balcony, door, or picture window is anadded attraction in some vertical NORCs, providing contact with the out-doors without the burden of taxing upkeep, such as mowing lawns and yardwork (Hunt et al., 1994).

Management

Vertical NORCs housed in high-rise buildings, multiple apartment com-plexes, or condominiums often have the benefit of on-site manage-ment or an association advisory board. On-site management or advisoryboards may assume the role of overseeing the maintenance and up-keep of the structure, providing space for activities, managing ameni-ties and activities, providing security and emergency measures, and iden-tifying residents in need of services (MacLaren, Landsberg, & Schwartz,2007). In addition, management of vertical NORCs may support the de-velopment and preservation of NORC resident advisory councils with anindirect benefit of empowering the residents to advocate for a betterequality of life (Ormond, Black, Tilly, & Thomas, 2004). Housing man-agement may be influential by “resolving problems that it has difficultyhandling, such as disruptive behavior, dangerous conditions, or finan-cial arrears that may undermine the operation of the NORC (MacLarenet al., 2007, p. 142). Financial participation by housing companies is crucial,not only because funds are needed to offset the NORC’s operating costs, butalso due to the management’s or owner’s investment as a critical elementin the program’s success (Altman, 2006). In addition, housing companiesand owners may provide cash matching or in-kind contributions of spaceor receive annual government funded support for the programs (Vladeck,2004).

Cost and Affordability

Vertical NORCs housed in subsidized apartments are limited in number andoften maintain waiting lists (Vladeck, 2004). For individuals with fixed in-comes or incomes at or near poverty level, an increase in rent or a de-crease in food stamps may make living in a vertical NORC unaffordable. In

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2002 and 2003, 27% of households headed by someone 50 years or olderexperienced a “housing cost burden” (AARP, 2010). Today, the percentage ofthose with this burden may be substantially greater, considering the currenteconomic downturn. Subsequently, residents on fixed or limited incomes liv-ing in vertical NORCs may conserve funds by reducing expenditures relatedto social activities, resulting in a break of social ties, loss of informal supports,increased isolative behaviors, and the risk of experiencing impaired mentalhealth. Furthermore, fees related to group activities sponsored by manage-ment or the NORC may amplify the financial burden. However, housingmanagers have found older residents to be stable tenants who demonstratedependability with rent payments, and who maintain their apartments ingood shape, resulting in cost-effectiveness and indirect benefits to the ten-ants (Hunt et al., 1990). Finally, the proximity of management to NORCresidents allows them to be “looked in on” so difficulties can be noted whenthey arise.

SOCIALIZATION

“Older adults know more of their neighbors when the area where they liveis a naturally occurring retirement community” and “56% of those 50 andolder who live in such communities know 10 or more of their neighbors,compared to 44% of those who live in other areas” (AARP, 2010, p. 4).The density of apartment and condominium units characteristic of verticalNORCs supports the interaction among residents, albeit a basic awarenessof an individual’s coming and going from their home. The close proxim-ity also encourages partnering between residents, decreasing isolation andincreasing opportunities to engage in social and routine activities. For ex-ample, the ease in developing and sustaining friendships within the verticalNORC environment may support individuals to engage in new activities, es-pecially activities outside of the NORC structure. These friendships may alsoencourage those who would have otherwise been reluctant to explore ontheir own, as well as provide a sense of security. For residents who have norelatives or families who live close by, the vertical NORC has the capacityfor building surrogate families.

IMPLICATIONS AND SUGGESTIONS FOR HORIZONTAL NORCs

As noted above, a primary advantage of the high-rise vertical NORC is thatit offers a single recognizable identity. This is seen as an advantage in that itoffers a kind of community for older adults, many of whom see their other“communities” dwindling as they age, retire, or are unable to work and losefriends and family to death. Therefore, it is incumbent on horizontal NORCs

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to define their communities and establish a group identity. In some ways,this is done merely by labeling a community a NORC. Building on this labeland publicizing the community and services it provides adds to this senseof identity as people both in and outside of the horizontal NORC note theadvantages it offers. In addition, having a Resident Council comprised ofNORC residents from throughout the expanse of the horizontal NORC offersleaders in strategic locations that can maximize that identity for all.

The second primary attribute of the vertical NORCs noted above is theirdesign and location in one or more high-rise apartment buildings. The pri-mary advantage of this is access. Providers of health care, social services,and concrete services such as home maintenance have easy access to sev-eral people and thus can provide services in a timely and cost-effective way.In fact, in many vertical NORCs these services are on-site and available im-mediately (especially home maintenance). Because individual homeownersare purchasing concrete services where renters in vertical NORCs get theseas part of their rental agreements, there is a need to provide homeowners inhorizontal NORCs with recommendations of concrete service providers thatare reputable and interested in serving older adults. One way to establishthis is by asking concrete service providers to offer discounts to older adultsin exchange for being recommended as reputable by NORC personnel. Ofcourse providers’ services need to be constantly monitored through feed-back from residents to make sure the list has integrity. In addition, becauseof the transportation needs in horizontal NORCs, grant or state funding thatsupports these programs needs to be directed into transportation costs of so-cial service providers and NORC staff—a cost that is not an issue in verticalNORCs.

Third, there are advantages and disadvantages to on-site managementsuch as that provided in a vertical NORC. As related from a provider in ahorizontal NORC, “Everything is centrally located in apartment complexeswhich are very, very different. Your management is different, you’re reach-ing out to people, even your financial pieces . . . we have nobody in thecommunity that has an investment in the same way an apartment ownerwould” (Bronstein & Gellis, 2007). However, despite the conveniences of-fered by on-site management, the horizontal NORC requires that servicesbe delivered by a community collaborative because there is no other wayto meet the diverse needs of the older adults in the horizontal NORCs. Al-though developing and maintaining a community collaborative is extremelychallenging, it also optimizes attention to diversity and the ability to bestmatch individual needs with appropriate community services (Bronstein etal., 2009). Therefore, the required need for community collaboration may infact be of benefit to horizontal NORCs even if they are more cumbersometo develop and maintain.

Fourth, issues of cost and affordability may be one of the few distin-guishing factors that are actually easier to address in horizontal as opposed

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to vertical NORCs. That is because horizontal NORCs have more long-timehomeowners among them, many of whom have paid off their mortgages. Ofcourse increasing taxes, home maintenance issues, and extra transportationcosts can often add up to the cost of rent, but more often costs are less of afactor in older adults being able to meet monthly housing bills in horizontalNORCs than in vertical NORCs.

Last, the potential of social isolation, often seen as the greatest risk toolder adults, is another factor that is more challenging in horizontal NORCs.The risk of isolation increases as you move from small cities to suburbs torural areas where neighbors are increasingly spread out. It is a higher risk innorthern communities where older adults tend to stay inside more often ininclement weather. However, because of the critical nature of socialization,staff in horizontal NORCs need to direct primary attention toward efforts atincreasing contact among residents. This can occur by sponsoring events ofinterest to older adults, such as trips to local theatre, movies, card games,concerts, and museums. Such events can be advertised at places where olderadults tend to gather, such as houses of worship. However, outreach is criticalto engage older adults that are most isolated, and this takes manpower, oftenrequiring horizontal NORC staff and volunteers to go door-to-door to meetresidents, build relationships, and secure trust. Local service providers atmedical offices, pharmacies, and post offices can be brought on board tobe sure their older adult consumers are aware of the NORC, its staff, andservices. In this way, people with whom residents already have a trustingrelationship can serve as important liaisons, helping to bridge trust to NORCstaff, volunteers, and services.

CONCLUSION

Considering the dearth of empirical studies about NORCs, future inquiryconcerning the impact of horizontal and vertical NORCs on elder quality oflife would be helpful to better inform community developers and providersof elder care. Early research should be qualitative and include the voicesof residents and providers. Ultimately, quantitative studies can provide in-sights regarding quality of life for older adults in NORCs as compared withquality of life for older residents who do not reside in NORCs. Such studiesshould examine vertical and horizontal NORCs separately and as comparedwith similar neighborhoods (urban, suburban, and rural), due to the differ-ences such communities offer with regard to structure, design and location,management, cost and affordability, and socialization.

There are challenges to supporting NORCs in all types of communitiesaround the United States and the world. Perhaps they have developed morequickly in large cities because of the ease of access when older adults residein closer proximity to one another. However, given the quality of life issues

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and financial costs to institutionalization, it behooves us to invest resourcesin NORCs in communities of all shapes and sizes to enable older adults to agein place and to do so in communities characterized by safety, affordability,dignity, and friendship.

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