“It Takes a Village”

March 19, 2012

By Matt Perry
California Health Report

The rapidly-spreading Village Movement is helping older adults age gracefully by offering the best of two colliding worlds: “aging in place” to avoid institutional living while creating tight community bonds to foster better health and social connections.

But these villages are not retirement communities with fixed geographic boundaries. They are collections of individuals living in their own homes across traditional neighborhoods, communities, even entire cities or regions, with the members of each community connected by a network that offers them essential services allowing them to remain independent.

In a typical Village Movement “community,” a phone call to a central number connects residents to a vast array of services: transportation, home repair, yoga classes, business recommendations, even life coaches.

“All the amenities of living in a retirement community without having to leave your own home,” explains Lisa Hendrickson, president and CEO of Avenidas, which operates Avenidas Village for ten communities surrounding its Palo Alto headquarters.

An aging nation is jumping on the Village bandwagon. The Arlington, Virginia-based Village to Village Network, which helps establish and manage villages, reports that there are now 70 villages nationwide, with 115 more in development. Though most are located along the northeast Atlantic coast, California is swiftly gaining momentum, with 13 existing villages – six in the Bay Area – and a whopping 25 more in the planning stages.

In rural Plumas County north of Lake Tahoe, Nance Reed had knee replacement surgery two years ago and received an endless stream of help from Community Connections while she recuperated: overnight home supervision, food, library books, and car rides to physical therapy.

Reed was even transported 90 minutes each way to the hospital for surgery while other village members cared for her cats.

“Our program’s wonderful,” says Reed gratefully of the all-volunteer organization. “People took care of me.”

“They’re almost always grass roots organizations because members of the community want them for themselves and their friends,” says Hendrickson, who is on the advisory council of the Village to Village Network. She says villages succeed when they stay “small and very familiar.”

While Villages have their own distinct personalities, they share several common principles: they are self-governing, offer services for older adults, foster social connections, have local business ties, adopt a holistic approach, and often assist with healthcare needs.

In some villages, there’s even 24-hour phone assistance for safety and medical needs.

Since 90% of village members are 65 and over, the greatest needs are for transportation and home maintenance.

In 2002, Beacon Hill Village in Boston pioneered the village concept with the help of wealthy, educated neighbors who could afford the pricey membership fee. In many communities today, these can range up to $1,000 or more annually.

In California, these fees an vary dramatically. Avenidas Village charges $825 per person, or $1,050 per couple. By contrast, annual membership in Plumas County is $25, with a lifetime renewal of just $25.

Annual fees entitle members to a range of free services. Others may be fee-based. In San Francisco Village, for example, additional costs apply for meal preparation, computer repair, financial planning, and various other services.

This year the Archstone Foundation, located in Long Beach, offered grants to nine California villages to help spread the village philosophy by improving marketing efforts to keep memberships affordable in underserved communities.

“We’re trying to look at areas where there isn’t much money,” says Joseph Prevratil, Archstone’s president and CEO. “The big key is sustainability.”

San Diego’s Tierrasanta neighborhood is an isolated, hilly area bordered by freeways, a military base, and park. With few local businesses or bus routes, it’s largely a bedroom community inhospitable to aging adults.

“Within 15 miles radius you can find all the services you need, but you can’t get to them,” says Pam Chapman, executive director of Tierrasanta Village. “It’s very common for you not to know anyone who lives in your neighborhood.”

Opened in 2008 with just 27 members, Tierrasanta Village provides traditional transportation and home repairs, but also offers a vast array of social programs that include exercise classes, sing-alongs, bridge, educational lunches, lectures, movies, potlucks, writing retreats, and even a personal life coach.

Chapman hopes to expand Village membership beyond the current tally of 173 by marketing to the neighborhood’s 6,000 adults aged 50 and over – the minimum age needed for membership.

Disappointed by a local community center that didn’t cater to seniors, Maureen Geyer researched Tierrasanta Village at length before signing up with her mother.

When the mother-daughter roommates went to their first village monthly meeting, Geyer knew she’d found the right place.

“Seeing her face light up was well worth everything,” says Geyer, who also worries about her own aging process.

Geyer is thrilled to have others to talk to about aging while gaining an additional support system for her mom.

“It feels like someone took a burden off my shoulder,” she says, with relief. “I feel like they’ve got my back.”

“Psychologically, there’s a tremendous amount of improvement in people being safer, well-cared for, connected,” says Chapman. “They are amazingly less isolated.”

Tierrasanta is a “hub” model that works in smaller, self-contained neighborhoods – one of three traditional village models.

The “hub and spoke” model features a central administrative office orbited by satellite neighborhoods – some several miles away.

The third model – and one with the least expensive membership fee – is the “time bank” model. Members volunteer services and receive equal volunteer time in return.

One time bank example is Plumas County. With its rural setting, mountainous terrain, and tiny population of mostly low-income citizens, these factors produced a village far different from its well-heeled Beacon Hill origins.

“It didn’t have anything to do with money,” says Leslie Wall, program coordinator for Community Connections, which administers the village.

For Wall, the village concept turned the traditional social services model upside down to “tap into people’s strengths instead of their needs.”

Membership dues are virtually non-existent. The only staff needed to administer the program is paid by Wall’s employer – the non-profit Plumas Rural Services – which operates several other programs.

Of the village’s four core values, Wall says the first is the most important: “The real wealth of a community is its people.”

While most village models cater to older adults, tiny Plumas County emphasizes a generational mix. Of its 266 members, 25% are 18 and under. The oldest member is 91, and the youngest only six. Older adults often receive technology assistance from their younger counterparts.

And in this mountain community, the greatest needs are far different than their urban or suburban neighbors; cutting wood, stacking it, and shoveling snow are in high demand.

The time bank model “has much more potential in under-resourced communities where people have time available but not the financial resources,” says Andrew Scharlach, director of the Center for the Advanced Study of Aging Services.

In the Bay Area, San Francisco Village shares offices with the Institute on Aging in the city’s Inner Richmond district, but its 145 members span the entire city – a “hub and spoke.”

New executive director Kate Hoepke hopes to expand membership to 400 in the next three years, targeting the city’s progressive neighborhoods.

Scharlach says the expansion of village memberships depends on overcoming two major barriers: proving the value of village services, and overcoming the stigma of aging.

Many older adults have belonged to churches or clubs that provided social connection, and want to know what else the village can provide. Scharlach says seniors also don’t like to be affiliated with “all those old people.”

“It’s not so much a question of affordability,” says Scharlach, a Kleiner Professor of Aging at the University of California Berkeley. “It’s a question of perceived value.”

Villages are therefore responding to growing member requests for healthcare assistance.

San Francisco Village will launch its “Transition to Home” initiative this spring to help returning hospital patients get settled after hospital stays. Services include buying food, helping with home care referrals, filling prescriptions, and transporting patients to their first follow-up visits.

Scharlach says virtually no data exists yet to indicate that villages improve health, but he cited Avenidas as an example of one that is creating progressive healthcare partnerships.

While Avenidas already offers robust services to transition hospital patients back home, the village also trains members as “Med-Pals” who accompany patients to appointments, take notes, and ask questions.

“It’s the kind of thing your daughter might do if she were in town,” says Hendrickson.

Partners inside Stanford Hospital will check on village members and provide health advocacy, then assist with discharge planning.

Avenidas is also using its Archstone grant to develop a partnership with the Palo Alto Medical Foundation – a large area group practice – to improve care for its members. Villagers are specially tagged so that group doctors and nurses know they have additional support outside their immediate family.

Is the village concept a return to the good old days when neighbors cared for neighbors?

“That’s the idea,” says Scharlach. “It provides a protection against social isolation… There’s certainly tremendous health benefits in that.”

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