January/February 2013 Issue
Aging in Place in the Village — Social Work Roles Shine
This model is highly compatible with social work practice values and a great fit with social workers’ skill sets.
Older adults overwhelmingly state that they want to age in place in their homes and communities, according to statistics presented by AARP in 2010. Although many people will age and need little support to remain in their community, the risk of chronic health and functional impairments certainly increases as one grows older.
The Older Americans Act of 1965 was intended to address the long term care needs of older adults and provide opportunities to remain meaningfully engaged in community life as one ages. However, gaps and fragmentation in long term services leave many without adequate support to remain independent. This traditional system has emphasized a social planning approach, with minimal input from older adults or community members regarding the design and delivery of services (Rothman, 1995).
Although several community-based support models have arisen, the Village model typically relies on an informal network of community members to provide assistance to aging populations within a specific geographic area. Although Villages can and have developed through existing social service agencies that use formal services, this article focuses on the grassroots, consumer-driven, volunteer-first model that is most prominent in the Village movement.
The Volunteer-First Model
Volunteer-first Village staff members are responsible for the administration of the program (i.e., vetting, training, and managing volunteers) and, in some Villages, provide care management. In some cases, professional services are accessed through vetted vendor lists, including home healthcare and professional home repairs. However, volunteers remain the backbone of the model, providing services such as transportation, shopping, household chores, gardening, and light home maintenance.
The Village focuses on the traditional concept of community as a geographically based entity (Warren, 1971), although membership typically is smaller than the actual population within that geographic area. Villages capitalize on community assets to achieve a shared vision among members and volunteers of older adults’ value to the community and the fundamental nature of interdependence and civic engagement. For example, many Villages offer opportunities for community engagement, such as potluck dinners, book clubs, and educational programs on relevant topics.
Villages also focus on external forces affecting a community and often become leaders in advocating for better services and resources by highlighting the gaps and fragmentation in formal service systems. Within this community practice frame, the Village model emphasizes an empowerment philosophy that focuses on participation and competence building at the individual and community level (O’Melia, Miley, & Dubois, 2004). Members lead the program and serve other members. Villages focus on enabling members to make choices about their support needs, thus preventing deterioration that might erode personal autonomy.
Social Work Roles
Broker and Coordinator
Because empowerment and person-centered approaches are central to their training, social workers proactively engage members and their families as partners. Ongoing coordination of services is vital in preventing deterioration in health or functional status. For example, the Village often becomes the natural coordinator among various agencies. Social workers manage this coordination by facilitating communication, assessing need, and identifying services in partnership with a member. Care coordination also provides the opportunity for social workers to educate members on available Village and external services and to assure that all needs have been addressed.
At the macro level, Village social workers and members together advocate with state and local leaders, social service agencies, and healthcare facilities to increase services for members. Often Village social workers advocate for a more comprehensive continuum of care in the community that affords Village members a variety of options to remain in the community. This may include establishing long term care facilities in the neighborhood or assuring access to primary care practices. Village social workers help represent members’ needs with local political officials in making communities more age and disability friendly with, for example, the inclusion of universal design in new construction and accessible neighborhoods.
Challenges for Social Work Practice
Social workers are tasked with responding at both the organizational and individual level to address these challenges. At the organizational level, social workers can collaborate with leaders and members to develop policies and procedures, and implement the best practices that address the maintenance of appropriate boundaries and confidentiality. Additionally, they must work at the individual level to help members and volunteers define and communicate boundaries in a person-centered manner. They can help build critical consciousness by training volunteers on the role of confidentiality in empowering the member to request services, reducing unhealthy dependency, and fostering reciprocal relationships that bolster feelings of dignity, self-efficacy, and mutuality.
Community buy-in also is essential to develop the organization’s membership, largely because most Villages rely significantly on membership dues for funding. Social workers must be able to clearly communicate the Village’s role, purpose, and function within the community and execute a creative, person-centered approach to help potential members determine how the Village can help them. Likewise, the need for an adequate number of volunteers and a range of volunteer skills requires ongoing education and raising consciousness to encourage community residents and members to share their skills and talents to support the Village members.
Because members do not have a vesting period prior to receiving services, Villages often find members who join only when they experience a crisis, requiring immediate services. Social workers and Village leaders must work to communicate and demonstrate why it is important for members to invest in membership benefits prior to such crises.
Expanding the model into low- and moderate-income communities is a critical challenge for social workers. Reliance on membership dues to support infrastructure and coordinate services is problematic. In lower-income communities, the dues would have to be subsidized or services scaled back to sustain a Village. Likewise, reliance on volunteers may be more challenging in lesser endowed or historically disempowered communities. Social workers need to focus on building external support from public and private sources to expand these initiatives.
Policy and Research Roles
Additionally, the impact of Villages at the community level, including their ability to build a sense of community, increase civic engagement, enhance personal and interpersonal empowerment, increase social capital, and engage the leadership of older adults, is not well understood. It’s necessary to determine the impact of a volunteer-first model, which includes the benefits to volunteers and members alike. This research is vital to conclude whether Villages are meeting the goals set forth in the model’s mission.
The Village Vision
The rapidly growing Village movement has presented a new community-based service medium for older adults who choose to age at home. Social work’s practice philosophy is particularly compatible with the empowerment and community-focused philosophy of the Village model.
Note: A more detailed discussion of the Village model can be found in the authors’ article “It Takes a Village: Community Practice, Social Work & Aging in Place,” published in the Journal of Gerontological Social Work (2011, 54(5), 528-541).
— Katie McDonough, MSW, LICSW, is executive director of Capitol Hill Village in Washington, DC.
— Joan K. Davitt, PhD, MSS, MLSP, is an associate professor and the Hartford Geriatric Faculty Scholar in the School of Social Work at the University of Maryland, Baltimore.
Rothman, J. (1995). Approaches to community intervention. In J. Rothman, J. L. Erlich, J. E. Tropman (Eds.), Strategies of community intervention. 5th edition. (pp. 26-63) Itasca, IL: F. E. Peacock.
Warren, R. L. (1971). The community in America. 2nd ed. Chicago, IL: Rand McNally.
Weil, M. (2005). Introduction: Contexts and challenges for 21st century communities. In M. Weil (Ed.), The handbook of community practice. (pp. 3-33). Thousand Oaks, CA: Sage Publications.