584667 research-article2015
JAGXXX10.1177/0733464815584667Journal of Applied GerontologyLehning et al.
Article
Variations on the Village Model: An Emerging Typology of a ConsumerDriven CommunityBased Initiative for Older Adults
Journal of Applied Gerontology 1–14 © The Author(s) 2015 Reprints and permissions: sagepub.com/journalsPermissions.nav DOI: 10.1177/0733464815584667 jag.sagepub.com
Amanda J. Lehning1, Andrew E. Scharlach2, and Joan K. Davitt1
Abstract Villages, which are community-based initiatives designed to help older adults age in place through a combination of services, participant engagement, and peer support, have expanded rapidly since their initial development in the early 2000s. Using a sample of Villages in the United States, we examined variations from characteristics of the Village model as portrayed by media and organizational leaders. Results indicate there is no uniform Village model that can be implemented and evaluated by policy makers, funders, service providers, and researchers. Based on the extent of member involvement, methods of service provision, and funding sources, we developed a conceptually and empirically informed typology of Villages that reflects the model’s focus on consumer involvement. Descriptive analyses indicate potential differences in member, community, and organizational characteristics. This emerging typology has implications for understanding Manuscript received: July 3, 2014; final revision received: January 26, 2015; accepted: March 12, 2015. 1University 2University
of Maryland, Baltimore, USA of California at Berkeley, USA
Corresponding Author: Amanda J. Lehning, School of Social Work, University of Maryland, 525 West Redwood Street, Baltimore, MD 21201, USA. Email: [email protected]
Downloaded from jag.sagepub.com at University of Sussex Library on June 5, 2016
2
Journal of Applied Gerontology
the implementation and sustainability of Villages, including whether specific Village types are best suited to certain community contexts. Keywords home- and community-based services, aging in place, Villages Villages are community-based initiatives that aim to help older adults age in place by combining services, participant engagement, and peer support (Scharlach, Graham, & Lehning, 2011). Since the Village model was first launched by Beacon Hill Village (BHV) in 2002, it has achieved widespread adoption across the United States. Articles in the popular press (e.g., The New York Times, The Washington Post), national news features (e.g., PBS News Hour, NBC Nightly News), and descriptions on organizational websites suggest Villages share core characteristics. However, because Villages are described as adapting to the needs and conditions of the neighborhoods they serve (Poor, Baldwin, & Willett, 2012), questions remain regarding whether there is a uniform Village model that can be implemented, supported, and evaluated by policy makers and other stakeholders. Furthermore, the model’s emphasis on member involvement distinguishes its approach from many other aging services. Research indicates that Village leaders are concerned about their ability to support members with varying resources and needs, and perceive challenges to their organizations’ long-term sustainability (Guengerich, 2009; Poor et al., 2012). It remains unclear whether this consumer-driven community-based model for older adults can be sustainable and contribute to positive member outcomes in different environmental contexts. To inform future research and theory development for Villages, the present study examines (a) whether individual Villages implement core characteristics of the Village model and (b) whether a typology based on consumer-driven dimensions has implications for the model’s suitability and effectiveness across different communities and populations.
Background and Literature Review The Village model was first developed in the Beacon Hill neighborhood of Boston by older residents who wanted to remain in their homes for as long as possible (BHV, 2014). BHV aims to address the multiple needs of older adults, encourage mutual assistance, and honor individual choice. BHV offers access to vetted discounted providers, volunteer-provided services and support, and social and cultural activities (Greenfield, Scharlach, Lehning, &
Downloaded from jag.sagepub.com at University of Sussex Library on June 5, 2016
3
Lehning et al.
Davitt, 2012). Members provide financial resources through their dues and donations, and human resources through their leadership on the board. The Village model has expanded rapidly, with more than 125 Villages open in the U.S. in 2014 (Village to Village Network [VtV], personal communication, 2014). In 2010, the VtV was formed to offer technical assistance, facilitate resource sharing, and organize national and regional meetings. According to a recent report by Grantmakers in Aging (2013), VtV “is the largest and fastest growing of all the age-friendly development networks” (p. 16). Based on our review of the BHV and VtV websites, and publications authored by leaders in these two organizations (McWhinney-Morse, 2009; Poor et al., 2012), Villages are portrayed as sharing seven core characteristics (see Table 1). First, Villages are grassroots organizations, developed “by those who are going to use them” (Poor et al., 2012, p. 112). Second, Villages are membership-driven in terms of the governance and design of services and support (BHV, 2014). Third, Villages are self-governing, independent nonprofit organizations. Fourth, Villages are self-supporting through funding from a combination of membership dues and contributions (McWhinneyMorse, 2009). Fifth, Villages coordinate access to external services through vetted discounted providers (VtV, 2014). Sixth, Villages provide services directly through staff or volunteers (Poor et al., 2012). Finally, Villages focus on the “whole person” (BHV, 2014), offering access to many services typically available through aging services (e.g., in-home assistance) as well as social activities and engagement. These same characteristics have been identified in a variety of scholarly articles (e.g., Bookman, 2008; Gupta, 2012; McDonough & Davitt, 2011; Scharlach, Graham, & Lehning, 2012) and newspaper stories (Bahrampour, 2014; Colliver, 2013; Fitzgerald, 2012; Gross, 2006; Pomerance Berl, 2013; Shaw, 2014). However, it is likely that not all Villages will share all seven of these characteristics, since prior research has found differences among individual Villages (Scharlach et al., 2011) and the model is described as adaptable to the local environment (Poor et al., 2012). The first aim of our study is therefore to document variations from the Village model. While many programs for older adults offer referrals to external providers, deliver direct services, and include social activities, a theme in the Villages literature is the model’s focus on consumer participation through the direct involvement of members (McDonough & Davitt, 2011; Poor et al., 2012). Empowerment and choice have become common themes in long-term services and supports for older adults (P. Doty et al., 2012), reflecting American values of independence and individual choice, as well as empirical and theoretical work on the importance of control (and perceived control) for quality of life in later life (e.g., Heckhausen, 1997). Unlike other consumer-directed
Downloaded from jag.sagepub.com at University of Sussex Library on June 5, 2016
4
Journal of Applied Gerontology
Table 1. Core Characteristics of the Village Model (N = 69). Core characteristic Grassroots Membership driven
Self-governing Self-supporting
Vetted discounted providers Provides services Social activities and engagement
Measure
Frequency (%)
Older adults from the community “very” or “extremely” involved in creating the program Any older adult members on governing boards Members involved “at all” in administrative tasks, providing support and services, and advocacy Freestanding organization not operating as a division or program within another organization At least 50% of total budget covered by membership dues, fees for individual services, and/or individual donations At least one preferred provider offers discounts to members Any of a list of 25 services provided by Village staff and/or volunteers Any social, cultural, or recreational gatherings provided by Village staff and/or volunteers
61 (88.4) 53 (76.8) 62 (89.8) 54 (78.3) 52 (75.4)
52 (75.4) 69 (100) 59 (85.5)
Note. Valid responses for each characteristic range from 63 to 69 Villages due to missing data. Percentages are calculated based on a total of 69 Villages.
services, however, Villages focus on member involvement, whether in creating or governing the initiative, delivering assistance, or offering financial support. This consumer-driven approach raises questions about the effectiveness and sustainability of Villages across different community contexts. For example, member involvement in the development, administration, and support activities of the Village may enhance organizational capacity (Chaskin, 2001) and confer benefits on Village members who volunteer (Hinterlong, MorrowHowell, & Rozario, 2007). It may, however, be detrimental to the Village’s survival if members lack time, expertise, or resources (Greenfield, Scharlach, Lehning, Davitt, & Graham, 2013). Villages depending more on volunteers to deliver services and supports may be better equipped to support those with primarily social needs, whereas those depending more on professionals may be better equipped to provide assistance to those with predominantly physical health needs (Handy & Srinivasan, 2004). In addition, Villages with more
Downloaded from jag.sagepub.com at University of Sussex Library on June 5, 2016
5
Lehning et al.
funding from membership dues and fees may be more responsive to the needs and wants of their members than those depending on donations and grants, which can be accompanied by restrictions and requirements (Nonprofit Finance Fund, 2001). However, non-membership sources of funding may be necessary for Villages serving those with more intensive and expensive service needs. In light of this uncertainty, the second aim of our study is to develop a typology of existing Villages that can inform future research assessing the model’s sustainability and effectiveness in different environments.
Method Sample and Data Collection Procedures The sample for this study, part of a larger project examining organizational characteristics of Villages (Greenfield, Scharlach, Graham, Davitt, & Lehning, 2012), was drawn from 80 Villages listed on the VtV website and providing services in January of 2012. A representative from each Village, often the executive director or board president, completed an emailed questionnaire and follow-up telephone interview. A total of 69 of 80 (86.3%) Villages participated. The study was deemed not human subjects research by Rutgers University Institutional Review Board.
Measures To address our first aim, we used indicators from our survey to measure the seven core characteristics of the Village model (see Table 1). To address our second aim of creating a typology of Villages, we selected three dimensions reflecting variations in Villages’ consumer-driven approach: (a) extent of member involvement, (b) means of providing support and services, and (c) mix of funding sources (see Table 2). We used these three dimensions following the recommendation of D.H. Doty and Glick (1994) to create a typology based on organizational attributes related to the outcomes of interest. Specifically, we propose that types derived from these consumer-driven attributes may be more effective and sustainable in certain contexts and less so in others. As a first step toward understanding the relationship between Village type and these outcomes, we examined whether Village types differ by selected member, community, and organizational characteristics (see Tables 3-5).
Analysis Plan To address our first aim, we calculated the percentage of Villages with each of the seven core characteristics. To address our second aim, we placed Downloaded from jag.sagepub.com at University of Sussex Library on June 5, 2016
6
Journal of Applied Gerontology
Table 2. Typology of Villages (N = 59). Extent of member involvement High member involvement: (a) older adults were very/extremely involved in creating the Village, (b) ≥50% of board members are Village members, and (c) at least 50% of members volunteer with the organization. Low member involvement: (a) older adults were somewhat/not involved in creating the Village, (b)
JAGXXX10.1177/0733464815584667Journal of Applied GerontologyLehning et al.
Article
Variations on the Village Model: An Emerging Typology of a ConsumerDriven CommunityBased Initiative for Older Adults
Journal of Applied Gerontology 1–14 © The Author(s) 2015 Reprints and permissions: sagepub.com/journalsPermissions.nav DOI: 10.1177/0733464815584667 jag.sagepub.com
Amanda J. Lehning1, Andrew E. Scharlach2, and Joan K. Davitt1
Abstract Villages, which are community-based initiatives designed to help older adults age in place through a combination of services, participant engagement, and peer support, have expanded rapidly since their initial development in the early 2000s. Using a sample of Villages in the United States, we examined variations from characteristics of the Village model as portrayed by media and organizational leaders. Results indicate there is no uniform Village model that can be implemented and evaluated by policy makers, funders, service providers, and researchers. Based on the extent of member involvement, methods of service provision, and funding sources, we developed a conceptually and empirically informed typology of Villages that reflects the model’s focus on consumer involvement. Descriptive analyses indicate potential differences in member, community, and organizational characteristics. This emerging typology has implications for understanding Manuscript received: July 3, 2014; final revision received: January 26, 2015; accepted: March 12, 2015. 1University 2University
of Maryland, Baltimore, USA of California at Berkeley, USA
Corresponding Author: Amanda J. Lehning, School of Social Work, University of Maryland, 525 West Redwood Street, Baltimore, MD 21201, USA. Email: [email protected]
Downloaded from jag.sagepub.com at University of Sussex Library on June 5, 2016
2
Journal of Applied Gerontology
the implementation and sustainability of Villages, including whether specific Village types are best suited to certain community contexts. Keywords home- and community-based services, aging in place, Villages Villages are community-based initiatives that aim to help older adults age in place by combining services, participant engagement, and peer support (Scharlach, Graham, & Lehning, 2011). Since the Village model was first launched by Beacon Hill Village (BHV) in 2002, it has achieved widespread adoption across the United States. Articles in the popular press (e.g., The New York Times, The Washington Post), national news features (e.g., PBS News Hour, NBC Nightly News), and descriptions on organizational websites suggest Villages share core characteristics. However, because Villages are described as adapting to the needs and conditions of the neighborhoods they serve (Poor, Baldwin, & Willett, 2012), questions remain regarding whether there is a uniform Village model that can be implemented, supported, and evaluated by policy makers and other stakeholders. Furthermore, the model’s emphasis on member involvement distinguishes its approach from many other aging services. Research indicates that Village leaders are concerned about their ability to support members with varying resources and needs, and perceive challenges to their organizations’ long-term sustainability (Guengerich, 2009; Poor et al., 2012). It remains unclear whether this consumer-driven community-based model for older adults can be sustainable and contribute to positive member outcomes in different environmental contexts. To inform future research and theory development for Villages, the present study examines (a) whether individual Villages implement core characteristics of the Village model and (b) whether a typology based on consumer-driven dimensions has implications for the model’s suitability and effectiveness across different communities and populations.
Background and Literature Review The Village model was first developed in the Beacon Hill neighborhood of Boston by older residents who wanted to remain in their homes for as long as possible (BHV, 2014). BHV aims to address the multiple needs of older adults, encourage mutual assistance, and honor individual choice. BHV offers access to vetted discounted providers, volunteer-provided services and support, and social and cultural activities (Greenfield, Scharlach, Lehning, &
Downloaded from jag.sagepub.com at University of Sussex Library on June 5, 2016
3
Lehning et al.
Davitt, 2012). Members provide financial resources through their dues and donations, and human resources through their leadership on the board. The Village model has expanded rapidly, with more than 125 Villages open in the U.S. in 2014 (Village to Village Network [VtV], personal communication, 2014). In 2010, the VtV was formed to offer technical assistance, facilitate resource sharing, and organize national and regional meetings. According to a recent report by Grantmakers in Aging (2013), VtV “is the largest and fastest growing of all the age-friendly development networks” (p. 16). Based on our review of the BHV and VtV websites, and publications authored by leaders in these two organizations (McWhinney-Morse, 2009; Poor et al., 2012), Villages are portrayed as sharing seven core characteristics (see Table 1). First, Villages are grassroots organizations, developed “by those who are going to use them” (Poor et al., 2012, p. 112). Second, Villages are membership-driven in terms of the governance and design of services and support (BHV, 2014). Third, Villages are self-governing, independent nonprofit organizations. Fourth, Villages are self-supporting through funding from a combination of membership dues and contributions (McWhinneyMorse, 2009). Fifth, Villages coordinate access to external services through vetted discounted providers (VtV, 2014). Sixth, Villages provide services directly through staff or volunteers (Poor et al., 2012). Finally, Villages focus on the “whole person” (BHV, 2014), offering access to many services typically available through aging services (e.g., in-home assistance) as well as social activities and engagement. These same characteristics have been identified in a variety of scholarly articles (e.g., Bookman, 2008; Gupta, 2012; McDonough & Davitt, 2011; Scharlach, Graham, & Lehning, 2012) and newspaper stories (Bahrampour, 2014; Colliver, 2013; Fitzgerald, 2012; Gross, 2006; Pomerance Berl, 2013; Shaw, 2014). However, it is likely that not all Villages will share all seven of these characteristics, since prior research has found differences among individual Villages (Scharlach et al., 2011) and the model is described as adaptable to the local environment (Poor et al., 2012). The first aim of our study is therefore to document variations from the Village model. While many programs for older adults offer referrals to external providers, deliver direct services, and include social activities, a theme in the Villages literature is the model’s focus on consumer participation through the direct involvement of members (McDonough & Davitt, 2011; Poor et al., 2012). Empowerment and choice have become common themes in long-term services and supports for older adults (P. Doty et al., 2012), reflecting American values of independence and individual choice, as well as empirical and theoretical work on the importance of control (and perceived control) for quality of life in later life (e.g., Heckhausen, 1997). Unlike other consumer-directed
Downloaded from jag.sagepub.com at University of Sussex Library on June 5, 2016
4
Journal of Applied Gerontology
Table 1. Core Characteristics of the Village Model (N = 69). Core characteristic Grassroots Membership driven
Self-governing Self-supporting
Vetted discounted providers Provides services Social activities and engagement
Measure
Frequency (%)
Older adults from the community “very” or “extremely” involved in creating the program Any older adult members on governing boards Members involved “at all” in administrative tasks, providing support and services, and advocacy Freestanding organization not operating as a division or program within another organization At least 50% of total budget covered by membership dues, fees for individual services, and/or individual donations At least one preferred provider offers discounts to members Any of a list of 25 services provided by Village staff and/or volunteers Any social, cultural, or recreational gatherings provided by Village staff and/or volunteers
61 (88.4) 53 (76.8) 62 (89.8) 54 (78.3) 52 (75.4)
52 (75.4) 69 (100) 59 (85.5)
Note. Valid responses for each characteristic range from 63 to 69 Villages due to missing data. Percentages are calculated based on a total of 69 Villages.
services, however, Villages focus on member involvement, whether in creating or governing the initiative, delivering assistance, or offering financial support. This consumer-driven approach raises questions about the effectiveness and sustainability of Villages across different community contexts. For example, member involvement in the development, administration, and support activities of the Village may enhance organizational capacity (Chaskin, 2001) and confer benefits on Village members who volunteer (Hinterlong, MorrowHowell, & Rozario, 2007). It may, however, be detrimental to the Village’s survival if members lack time, expertise, or resources (Greenfield, Scharlach, Lehning, Davitt, & Graham, 2013). Villages depending more on volunteers to deliver services and supports may be better equipped to support those with primarily social needs, whereas those depending more on professionals may be better equipped to provide assistance to those with predominantly physical health needs (Handy & Srinivasan, 2004). In addition, Villages with more
Downloaded from jag.sagepub.com at University of Sussex Library on June 5, 2016
5
Lehning et al.
funding from membership dues and fees may be more responsive to the needs and wants of their members than those depending on donations and grants, which can be accompanied by restrictions and requirements (Nonprofit Finance Fund, 2001). However, non-membership sources of funding may be necessary for Villages serving those with more intensive and expensive service needs. In light of this uncertainty, the second aim of our study is to develop a typology of existing Villages that can inform future research assessing the model’s sustainability and effectiveness in different environments.
Method Sample and Data Collection Procedures The sample for this study, part of a larger project examining organizational characteristics of Villages (Greenfield, Scharlach, Graham, Davitt, & Lehning, 2012), was drawn from 80 Villages listed on the VtV website and providing services in January of 2012. A representative from each Village, often the executive director or board president, completed an emailed questionnaire and follow-up telephone interview. A total of 69 of 80 (86.3%) Villages participated. The study was deemed not human subjects research by Rutgers University Institutional Review Board.
Measures To address our first aim, we used indicators from our survey to measure the seven core characteristics of the Village model (see Table 1). To address our second aim of creating a typology of Villages, we selected three dimensions reflecting variations in Villages’ consumer-driven approach: (a) extent of member involvement, (b) means of providing support and services, and (c) mix of funding sources (see Table 2). We used these three dimensions following the recommendation of D.H. Doty and Glick (1994) to create a typology based on organizational attributes related to the outcomes of interest. Specifically, we propose that types derived from these consumer-driven attributes may be more effective and sustainable in certain contexts and less so in others. As a first step toward understanding the relationship between Village type and these outcomes, we examined whether Village types differ by selected member, community, and organizational characteristics (see Tables 3-5).
Analysis Plan To address our first aim, we calculated the percentage of Villages with each of the seven core characteristics. To address our second aim, we placed Downloaded from jag.sagepub.com at University of Sussex Library on June 5, 2016
6
Journal of Applied Gerontology
Table 2. Typology of Villages (N = 59). Extent of member involvement High member involvement: (a) older adults were very/extremely involved in creating the Village, (b) ≥50% of board members are Village members, and (c) at least 50% of members volunteer with the organization. Low member involvement: (a) older adults were somewhat/not involved in creating the Village, (b)
