When It Feels Right at Home

By FORD FESSENDEN AND VIVIAN S. TOY

Published: July 16, 2006

RHODA GOLD was in her mid-30's in 1950 when she moved from Queens with her husband and three young children to a new ranch-style house in a development called Lake Hiawatha in Parsippany, N.J. She had first heard about the Morris County community from her sister, who had bought a home in the area a few years earlier.

Soon, hundreds of other young families moved in, transforming a summer retreat with bungalows along a wide spot of the Rockaway River into a suburban neighborhood.

Lake Hiawatha has been Mrs. Gold's home for the last 46 years, and she has no intention of leaving now.

''I want to live here until I die,'' she said.

But age is a thief, and its larceny can surprise you. Mrs. Gold, 80, has been living alone since her husband, Irving, died more than a decade ago. She still drives, runs her own errands, prepares her own meals and tends to most of the chores around the house. But there are those home maintenance jobs that she cannot do herself, like changing the 8-foot fluorescent lights in the ceiling fixtures or repairing a broken faucet. Those are the tasks that make her question whether she can stay.

''It's all these little odd things that I'm not strong enough to do,'' she said, adding that her children have moved away and she doesn't want to bother them. ''I don't want to leave my home, but I'm having trouble finding competent help.''

Mrs. Gold has been lucky to find herself in the middle of a social experiment. Lake Hiawatha has been designated a naturally occurring retirement community, or NORC, by the United Jewish Communities of Metro West New Jersey, a social service agency. Using a combination of private donations and federal money, social workers are trying to keep Mrs. Gold and hundreds of other older residents in their homes by delivering the services they need to stay.

For Mrs. Gold, it was a handyman. The social workers helped her find one who had been trained and bonded by the Jewish Vocational Service. She pays the agency whenever she needs the handyman's help. ''As long as I can get things fixed up when they need fixing, I won't move,'' she said.

The experimental project in New Jersey is part of a growing trend across the region as the nation's suburban developments face a demographic wave as momentous as the postwar migration that built them. Many of the suburban communities and neighborhoods, originally designed for young families, are growing old, fast.

Since 1970, the proportion of the population that is retirement age or older has grown 45 percent in the suburbs of New York, and the rate will accelerate steeply as baby boomers begin to reach 60. In the city, by contrast, the number of old people has declined slightly since 1970.

Yet, high-density housing and public transportation make cities, in some ways, an easier place to grow old. Suburban homes with stairs to climb and driveways to shovel can be difficult places for people with diminishing physical abilities. But even with high property taxes in many communities, it can still be less costly to remain at home than to foot the bill at an assisted living center or a nursing home.

''Much of America is going to grow old in the suburbs,'' said Karen Alexander, the program director for the Lake Hiawatha NORC, which is called Parsippany LIVE, for Lifelong Involvement for Vital Elders. ''If we can figure out how to support older people in the suburbs, we can really change the face of aging in this country.''

The goal is irresistibly sensible: Get people out of institutions, which are expensive, and help them function in their own homes. That can mean anything from changing light bulbs to managing medications, mowing yards to monitoring chronic diseases.

''The idea of bringing more services into a place where people are aging makes a lot of sense, but getting the services there has proven very hard,'' said Susan C. Reinhard, co-director of the Center for State Health Policy at Rutgers University. ''We have what is known as an institutional bias -- as soon as you need help, you go to an institution.''

FRAN Osinski of Washington, N.J., in Warren County, has been well schooled in the all-or-nothing calculus of aging care since his 74-year-old stepfather started to suffer health problems last year. Even though he had bought and rebuilt a home to accommodate his stepfather, Marcellus Kuhn, Mr. Osinski had to send him to a $300-a-day nursing home to recover from surgery in January. Medicare officials told him that the nursing home expense was covered, but that Mr. Osinski would have to pay the cost of the equipment he needed to help give his father intravenous antibiotics at home, and he could not afford it.

But now Mr. Kuhn is home and managing just fine, thanks to a pilot program in Warren County that diverts institutional dollars to home care. The money has been used to build a ramp to the house and for things as mundane as a handheld showerhead with a spigot that allows his stepfather to bathe unassisted.

''I'll bet everything they've given me wasn't equal to the cost of a week in the nursing home,'' Mr. Osinski said.

Naturally occurring retirement communities first developed in New York City in the 1980's, when aging experts identified growing populations of older residents in large apartment buildings and developed programs to help them stay in their homes. In these classic NORC's, nurses and health care programs go to the buildings and schedule recreation to keep residents active and create a sense of community.

Thirty-four classic NORC's get state money in New York. There are nine neighborhood-style NORC's in New York, including two on Long Island -- one in Plainview, the other in New Hyde Park. The state turned down an application to declare parts of Yonkers a naturally occurring retirement community. New Jersey has eight suburban NORC's, financed with private donations and federal dollars. There are no NORC's in Connecticut.

Bringing the model to the suburbs has posed new challenges. Growing old in a single-family home can be much more isolating than in an apartment building. It can also be much more difficult, particularly when a resident becomes too frail to maintain a home or drive a car to run errands.

But demographic trends lend urgency to the effort. In 1970, most old people in the metropolitan area were in the city, but that has been reversed. A third of the census tracts in the New York suburbs have over-65 concentrations of at least 15 percent. In the city, just a quarter of the tracts have that concentration.

Some towns are getting old faster than others. Thirty-five years ago, you would have been hard pressed to find a grandparent in Plainview -- only one in 30 people was over 65. Now, it is one in six. Old Bethpage, Commack, East Meadow and Levittown have seen their over-65 populations triple since 1970, as have New Jersey towns like Paramus, South Plainfield, Manville, Bellmawr and Strathmore. In Westchester, Ardsley and Briarcliff Manor have the fastest-growing proportion of older residents. In Connecticut, Storrs, Windsor Locks and North Haven are among the fastest aging.

Of course, not all older residents will age in their homes. Some will retire to the Sun Belt, although that pipeline is not what it used to be, demographers say. Developers are also building more and more assisted-living residences in the suburbs, offering escalating levels of care as residents age. In New Jersey, the number of assisted-living residences licensed by the state has quintupled since 1997, to 217. In New Jersey, there are also numerous large developments for people over 55.

Also, some older people have moved to the city and found circumstances that accommodated them better. Milton Shapiro, an 85-year-old former teacher who raised children in Teaneck, N.J., moved to Manhattan when he retired in 1996 and lives by himself in an apartment house on the Upper West Side.

''I love it,'' he said. ''I have opera tickets and theater tickets, and I walk everywhere. It's like a family in this building.''

But those options are costly, and not available to all.

''Most people want to remain in their own homes, but to make that possible, we need enough of these NORC's and other housing alternatives across the suburbs to take care of them,'' said Renee Pekmezaris, vice president of community health for the North Shore-L.I.J. Health System, which is working with the NORC's on Long Island.

The experts call it aging in place, meaning you stay in your neighborhood and out of the nursing home when you get old. It is a bureaucrat's term, but to William Butler, it is a powerful idea.

For Mr. Butler, 89, the place in question is an apartment in his granddaughter's house in Lake Hiawatha. ''I used to live in senior housing, and it was fine, but it's not like home -- this is like home,'' Mr. Butler said. Trim, but with bad knees and a bad heart, he added, ''I couldn't have it any better than this.''

The roles of NORC programs are evolving, and each one has developed differently. In Lake Hiawatha, the program has concentrated on part-time jobs and home maintenance help for older residents. The NORC in River Edge, which includes Paramus, New Milford and Bergenfield, has hired a nurse, who meets people at senior centers and offers home audits of their medical care.

But whatever else they do, most suburban naturally occurring retirement communities worry about the distances between things. ''The hardest nut to solve is transportation,'' said Fredda Vladeck, who started the original NORC in New York City and is now the director of the Aging in Place Initiative at the United Hospital Fund. ''One of the things we're seeing is that when you start to define it better, the community can begin to come up with solutions, including volunteer driving. The younger elderly can help with that.''

EVEN in places with the fastest growth in older residents, like Paramus and Plainview, the over-65 population amounts to less than 20 percent. Much of Lake Hiawatha is still engaged in doing what suburbs have always done -- raising children -- and the potential for having large populations of hidden older residents is great.

''When the social connection between one another begins to diminish, that begins a very vicious cycle,'' Ms. Vladeck said. Depression, isolation and disability quickly brew into medical problems and hasten entry into nursing homes.

In River Edge, Alan Sweifach, the director for strategic planning for the UJA Federation of Northern New Jersey, which operates the NORC there, hopes to turn garbage collectors, mail carriers and shopkeepers into an early warning system for the problems of hidden older people.

''We also talk to pastors and rabbis, asking if there is there someone who used to come around and they don't see anymore,'' he said.

As each community develops its own idea of how a NORC should be supported, the next step is not clear.

Ms. Vladeck is working on a blueprint for NORC's that may help solidify them as alternatives to institutional care. Last month, the Senate Health, Education Labor and Pensions Committee included money for NORC's in the reauthorization of the Older Americans Act, which would help make their existence a little more stable.

Mr. Sweifach said that all naturally occurring retirement communities had the same goal.

''It's to keep people aging in place and remaining active for as long as they can, and to minimize social isolation,'' he said. ''You can't do it all, but we can sure make a dent for some people.''