Plugging the Gap for Community-Dwelling Older Adults: How the Villages Initiative Picks Up Where Policy Falls Short

Increasingly, public policy attention is focusing on meeting the health needs of older adults aging in place. However, this population has a number of other needs that must be met by nongovernmental efforts. One such effort is the rapidly growing Villages initiative, which has emerged as an innovative, nationwide, grassroots movement that enables older adults to age in place and remain socially engaged and connected with their local community. The Villages charge membership fees in exchange for providing or facilitating access to resources and support that meet the needs of community residents as they age, in areas where current aging policy falls short. A recent article in the Public Policy and Aging Report addresses the policy gaps and unmet needs addressed by the Villages initiative that led to their emergence as a nationwide movement and then describes the current state of the Village movement nationwide.

Although greater public policy attention is being paid to providing care in a person’s home, there are a number of current policy gaps that the Villages are able to address for their members. First, although policy programs such as the Older Americans Act (OAA) and Medicare and Medicaid address older adults’ health needs, they do not adequately address needs related to social support and engagement, and do not take a holistic perspective toward older adult wellness. Additionally, these programs are generally aimed at addressing the health and personal care needs of older adults who are the most vulnerable physically and financially. Some policy approaches to meeting older adult needs are only available to low-income older adults (such as Medicaid), while others (such as OAA) often have long waiting lists for services. This has created a gap that Villages can fill by providing sources of assistance and social support to middle class older adults who currently receive little government support for aging in place, as well as potentially serving as an alternate source of support for lower-income adults.

The Villages initiative also attempts to address difficulties created by limited mobility and transportation options available for older adults, and the negative impact this can have on social connections and integration with the community. Opportunities exist for organizations such as Villages to assist older adults in participating more fully in their community. This could be in terms of being more able to take part in cultural events as a result of transportation assistance. Additionally, the Villages offer older adults an outlet for being more civically engaged through participation in Village activities as volunteers or board members. As an alternative to top-down approaches, Villages can provide a grassroots venue for older adults’ voices and preferences to be at the forefront. The authors write that “Villages thus may be meeting a fundamental human need for purpose and direction in one’s life and the opportunity to be a contributing member to society.”

So how has this played out across the Villages network? The article provides the following sketch of the current state of the Villages initiative from surveys conducted with Villages nationwide:

Over 70 percent of Villages have indicated that enhancing access to services is their primary goal; in addition, they highly value strengthening social relationships and reducing social isolation among older adults. Another important component of the Villages is the substantial role played by older adult volunteers in the founding, operation, and development of a Village. A 2014 survey found that Villages average less than two paid staff members, and rely greatly on member and nonmember volunteers. Services commonly provided by the Villages include transportation (99 percent of all Villages surveyed), telephone support for members (99 percent), home maintenance (97 percent), social or cultural activities (93 percent), volunteering opportunities (86 percent), and technology support (90 percent). Additionally, Villages often vet local businesses and service providers for their members. However, for all of these commonalities across Villages, there remains considerable variation. For example, some have no staff at all and are completely run by volunteers, and the variety of services offered differs from Village to Village. There are also a number of services that are offered by a lower percentage of Villages, such as group exercise (72 percent), health education and health advocacy (54 percent and 58 percent), and legal and financial services (55 percent and 58 percent). Among the least-widely offered services reported in the article are a 24/7 help line (29 percent), congregate meals (33 percent), and mental health counseling (36 percent).

Organizationally, dues can range from nothing to up to $1,285 per household, and around two-thirds of Villages offer discounts for financially needy older adults. Villages’ membership dues make up around 48 percent of Village funds on average, with private donations making up a significant portion of many budgets. In light of this, the financial sustainability of the Villages model will remain a concern to the movement as it grows and matures.

At present, Villages serve a healthier, younger, more financially secure population of older adults, and are located in middle to high income areas, with only about 12 percent of members reported to be financially insecure, less than 25 percent needing assistance with chores, and less than 15 percent requiring personal care. These details raise questions about what community capacity (human capital and available resources for solving problems) is needed to support a Village’s operation, as well as how Villages will cope as their members come to require more significant assistance with age.

However, while questions and concerns persist, both the state of Villages and their ability to address policy gaps remain very encouraging. As the authors summarize, “It seems that the Villages will not unilaterally eliminate the challenges in supporting older adults in their own homes or communities as their needs change. However, Villages seem to be filling a critical gap for older adults experiencing a variety of age-related changes…Villages play a role in leveraging community-based resources and networks of support that provide an essential human connection for members as they age.”

Source:

Davitt JK, Lehning AJ, Scharlach A, et al. Sociopolitical and cultural contexts of community-based models in aging: The Village initiative. Public Policy Aging Report. pru055 (((2015). DOI:10.1093/ppar/pru055

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