If asked, most elderly adults reveal a desire to continue living in the familiar surroundings of their own homes and neighborhoods as they age. But the existing focus on institutionally-based geriatric care means that many wind up living nursing homes instead. This change of environments not only deprives Buffalo’s aging residents of their self-sufficiency and quality of life; it actually enables the mental and physical declines that produce frailty.
As part of our Promises to Keep initiative, the Community Health Foundation of Western and Central New York (CHFWCNY) launched the Frail Elderly Neighborhood Project in 2005. Through this project, CHFWCNY and committed stakeholders from three Buffalo neighborhoods — Masten/Hamlin Park, Kaisertown, and the Lower West Side — seek to provide frail elders with person-centered, community-based alternatives to nursing home care. We believe such alternatives enable seniors to age with dignity by living at home for as long as possible.
In 2005, as part of our commitment to helping frail elders get the care they need, CHFWCNY convened a group of long-term care leaders to discuss possible strategies and areas of focus for this population. At that meeting, participating stakeholders identified the importance of working at the neighborhood level to enable elderly individuals to stay in their homes for as long as possible.
The group determined that modeling established grassroots projects offers the best way to improve the lives of frail elders and gain support within Buffalo communities. Because seniors’ needs vary from one neighborhood to the next, each neighborhood must build upon its strengths to develop a localized approach.
At that time, CHFWCNY offered to convene and facilitate the process of bringing together people and resources to facilitate the creation of more elder-friendly neighborhoods. We decided to focus the project on the City of Buffalo where there are a large number of frail elders still living in neighborhoods, many of whom do not have the same resources to remain in their neighborhoods that their suburban counterparts do.
CHFWCNY developed two goals and several corresponding desired outcomes for the Frail Elderly Neighborhood Project:
- Identify the needs of frail elders and their families to support their continued residence in their own neighborhoods.
- Enable communities to provide services that support and facilitate aging at home.
- Communities understand each neighborhood’s strengths and their residents’ perspectives.
- Stakeholders prioritize and implement strategies to build on assets and eliminate barriers to a community-based system of care.
- Communities make and see specific improvements in the quality of life and care of their elderly residents.
- CHF and stakeholders achieve measurable results that can inform public policy.
Based on these goals and desired outcomes, we developed a three-part plan to make Buffalo neighborhoods more elder-friendly:
- Phase I: Select neighborhoods for inclusion in the project.
- Phase II: Set priorities for the project.
- Phase III: Implement neighborhood-specific, community-based programs and services to make neighborhoods more elder-friendly.
Phase I: Neighborhood Selection
In late 2005, CHFWCNY began meeting with community stakeholders and key health and human services providers to determine which Buffalo neighborhoods would benefit most from a neighborhood approach to elder care and fit with our desire to assist the most vulnerable elders. We also solicited a quantitative analysis of census data and municipal planning information to highlight the challenges faced by older Buffalo residents who want to age at home. Using the report’s findings and the stakeholders’ input, we selected three neighborhoods based on need, readiness for change, and their large elderly populations:
- Masten/Hamlin Park
- Lower West Side
By concentrating on three communities with significant cultural and demographic differences, we expect to gain a broader, multi-dimensional understanding of the challenges faced by Buffalo’s frail elders that desire to age in place and how to overcome them.
Phase II: Priority Setting
Because the success of community-based systems of care depends on community input and perspectives, we looked to the participating neighborhoods’ stakeholders — including frail elders and other residents, business owners, service providers, community leaders, funders, and frail elders’ caregivers — to help set the project’s priorities.
To engage frail elders in identifying the main concerns, CHFWCNY used a consumer-friendly process called concept mapping. The concept mapping process helps groups organize and understand their shared ideas by identifying a problem — in this case, a lack of community-based care options that help frail elders stay in their homes as they age — and asking community members to brainstorm ideas and solutions. We opted for concept mapping because it makes both the collection and presentation of information accessible to all types of stakeholders.
During the first phase of the concept mapping process, 47 people from the three neighborhoods participated in focus groups and individual interviews to generate nearly 250 responses to the focus prompt, “One specific thing that would make it more likely for a person to remain in this neighborhood as they grow old is . . .” Responses ranged from more neighborhood watch groups to less littering, constructive activities for youth to affordable and reliable home repair services to better street lighting.
Using the Concept Mapping process, the 250 responses to the focus prompt were synthesized, sorted and rated to identify:
- How important the idea or issue generated by the response is for increasing the likelihood that people will remain in their neighborhood as they age
- How successfully each idea or issue generated by the response is currently being addressed in their neighborhood
Analysis of the results revealed safety and livable housing are the most important issues that would make it likely a person can remain in their neighborhood as they grow old. However, these issues were also the least likely to be effectively addressed in each of the three neighborhoods. Participants also indicated that an enjoyable environment, social connections for elders, a strong community were important factors in making their neighborhoods livable as they grow older.
Phase III: Next Steps
In September 2007 the phase II concept mapping results were shared with each of the three participating neighborhoods, as well as local government officials and legislators who influence the systems that impact the issues raised by the process. Sharing the results inspired community discussions and solutions about how to address the identified issues emphasizing housing and safety.
To begin addressing these challenges, PUSH Buffalo, a grassroots organization in the Lower West Side neighborhood, was engaged to research best practices in other communities successfully addressing these same issues. The report is helping to inform strategies that can be implemented to begin addressing safety and housing challenges in all three neighborhoods.
As CHFWCNY continues to meet with leaders in all three neighborhoods, we look toward long-term opportunities for meeting the challenges identified through the concept mapping process. Given the grassroots nature of community organizing and engagement, we expect the Frail Elderly Neighborhood Project to evolve over many years. However, the responsiveness and interest level of stakeholders in all three communities indicates that we are moving in the right direction.
As each neighborhood develops additional projects related to the Frail Elderly Neighborhood Project, we will add information about them to the CHFWCNY website.