Health

The Big Idea: Help seniors age at home

“Seniors want to continue to live among young people and families—not just play golf or be entertained to death”
Jen Recknagel
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Jen Recknagel is the director of innovation and design at the University Health Network’s NORC Innovation Centre in Toronto.

My grandmother lived in the same house in Cleveland for 50 years. After my grandfather died, she spent 11 of those years alone. Eventually, she developed dementia and had her driver’s licence taken away, which upset her. She soon went to live in Cape Cod with my aunt, who had offered to take care of her. Moving is hard enough, but imagine migrating to a different state in your 80s. Her health declined quickly after that. I knew there had to be a better way to support people at this stage of life. 

Right now, if you’re a senior living in Canada who can no longer live independently, there are two main paths. For those who require around-the-clock medical supervision, there are highly regulated, government-funded long-term care facilities. The other option is retirement homes, which are seniors-only private residences with set meal plans and regularly scheduled activities. But what about seniors who’d prefer to live out their days in the comfort of their own homes? At the University Health Network in Toronto, where I work, we’re exploring another avenue: bringing support directly into areas where high numbers of seniors already live. There’s even a name for these places: naturally occurring retirement communities, or NORCs. 

NORCs might be regular residential apartments, condos, co-ops or even entire neighbourhoods—geographic areas that weren’t specifically designed with older adults in mind, but which have a lot of them regardless. Many seniors who have decided to age in place might not require the intensive support of long-term care. Perhaps they cannot afford retirement homes. What my team at UHN proposes is to bring programming to them, right where they live. This could involve connecting them to health services, organizing community dinner parties or even using space in a condo building’s rec room to set up a wellness hub. NORC programs are tailored to what residents need (and want).

The NORC movement isn’t new. Programs started popping up in buildings around New York City as early as the 1980s. By 1994, New York State had passed legislation to subsidize 10 NORC programs; today, it funds 41, which serve thousands of clients. The concept has been much slower to catch on in Canadian cities, which offer no funding for NORC programs. But currently, in Ontario alone, there are more older adults living in NORCs than in long-term care and retirement homes combined. Almost 2,000 buildings across the province qualify as NORCs. Together, they house more than 200,000 seniors.

While studying NORCs, my team came across a program called Oasis Senior Supportive Living in Kingston, Ontario. Back in 2009, a forward-looking community leader named Christine McMillan—then president of the Frontenac Kingston Council on Aging—got together with residents of the city’s Bowling Green II apartment complex to discuss how to improve their living conditions. They were tired of feeling disconnected from their community, spending days in their houseclothes, and eating tea and toast for dinner because they were too tired to cook. 

With the help of McMillan and her team, the seniors paid a local community college to bring in three-course meals three times a week. Later, they convinced their landlord to let them convert an unused space in the building’s basement into a seniors’ lounge. People living at Oasis were less likely to experience emergency department visits, hospital admissions and falls. Now, Oasis operates similar programs in NORCs in London and Hamilton, Ontario, through a mix of donations and grants. There’s no reason why this kind of customized programming couldn’t be adopted (and funded) by the Canadian health care system at large.

More than ever, Canadians are keen to explore alternative models of senior care. By 2051, one in four of us will be 65 or older. Institutionalizing a quarter of the population isn’t feasible or affordable—for the government, for taxpayers or for families. The pandemic only further strained our already understaffed and overcrowded long-term care facilities. And then there are the demographic shifts: recent data from Statistics Canada shows that more adults over 65 are moving to urban areas than ever before, choosing to live in high-rises instead of detached homes. 

The NORC model addresses some of the most common issues with senior care, the first being financial. The average cost of a hospital bed is $842 per day, while care at home costs the government $42 a day, on average. Spots at retirement homes, on the other hand, can run up to $6,000 a month. If programming comes directly into NORCs, many seniors could delay going into long-term care—or possibly even avoid it altogether. They could continue to pay their own utilities and rent, and the government wouldn’t need to build as many new facilities. Most importantly, all the NORC services—from the flu clinics to the group exercise classes—could be offered at no cost to residents. 

Another good thing about the NORC model is that it allows older adults to maintain their autonomy. We’ve heard from front-desk staff in senior-heavy buildings who say they regularly get calls like, “I can still cook, but can you open this jar for me?” These are small tasks, but ones that usually fall to adult children or neighbours. A well-funded NORC might employ on-site staff to help out with the little things, particularly for adults whose mobility is challenged but not altogether gone. In buildings where higher levels of support are needed, we’re looking into connecting residents with experts who can address issues like hearing loss, fall risks or even mental health. 

Most importantly, NORC programming is driven by seniors themselves. In many cultures, elders are seen as wisdom keepers, but in North America, we ignore them. It’s almost like, “You’re obsolete now.” The NORC model recognizes that seniors have great ideas worth listening to­­­­—that they are the experts when it comes to understanding their own quality of life. 

NORCs aren’t communes, where people are always in your business. Residents can opt in and out of programming. That said, there’s an even greater need for connection as spouses and friends pass away; NORC programs can offer that. We hear from many seniors that they want to continue to live among young people and families—not just play golf or be entertained to death in seniors-only communities. Because NORCs are regular residential areas, they are inherently intergenerational. We’ve seen younger seniors—those who might have recently retired—pitching in to help those who are less mobile. NORC programs can also be customized to suit a building’s age breakdown and evolve over time. What people need between 65 and 75 is very different from what they need (and want) in their 80s.

As it stands, there is no public funding for NORC programming, but we’ve been championing the model at all levels of government. It’s been encouraging to see that, more and more, everyday Canadians are hearing about NORCs. Seniors have told us how programs have transformed their cold high-rises into real communities, and about how their neighbours stop them in the hallway to excitedly grill them about upcoming events. As you age, your world doesn’t have to get smaller. In fact, a lot of fun could be happening right downstairs.


This article appears in print in the March 2023 issue of Maclean’s magazine. Buy the issue for $9.99 or better yet, subscribe to the monthly print magazine for just $29.99.