Understanding the Service Landscape of Naturally Occurring Retirement Community Supportive Service Programs (NORC-SSPs) in New York State

Abstract

Background: As global ageing accelerates, countries worldwide are increasingly facing social and economic challenges posed by rising older populations. Many nations are responding by optimizing healthcare systems, strengthening community-based ageing models, and promoting healthy ageing policies. The Naturally Occurring Retirement Community (NORC) is gaining recognition as a promising approach due to its cost efficiency and ability to meet diverse ageing-related needs. However, systematic research on the service models of NORCs remains scarce. Objective: This study aims to systematically examine the service offerings of Naturally Occurring Retirement Community Supportive Service Programs (NORC-SSPs) and analyze how these programs contribute to supporting ageing in place. Methods: A qualitative content analysis was conducted on official website information from 60 NORC-SSPs in New York State. Service categories were identified, coded, and compared across different geographic and structural contexts. Results: The analysis shows that education, healthcare management, and recreational activities are the most frequently provided services, with health-related services playing a central role in supporting older adults to age in place. Differences in service priorities were also observed between rural and non-rural settings, as well as between vertical and horizontal built environments, reflecting the adaptability of NORC-SSPs to varying community conditions. Conclusions: By identifying key service characteristics, this study provides insights for policymakers and practitioners in Australia and other countries seeking to implement sustainable, community-based models of ageing support. Grounded in the concept of “ageing in place”, the findings contribute to the development of inclusive and flexible service systems for older adults.

1. Introduction

By 2050, the global population aged 65 and over will reach 1.6 billion, constituting 16% of the total population [1]. This rapid ageing trend presents substantial challenges to the social security and healthcare systems of countries worldwide [2]. In this context, “Ageing in Place” has emerged as a popular model of senior care, emphasizing that older adults live in familiar environments while receiving the necessary support and services. Studies have shown that ageing in one’s own home or community not only enhances quality of life but also reduces medical and care-giving costs [3]. Thus, unsurprisingly, a growing number of older adults express their strong preference for ageing in place. Numerous qualitative studies have consistently shown that older adults prefer ageing in place–remaining in their own homes and familiar communities–due to enhanced autonomy, emotional security, and maintained social roles, rather than relocating to institutional care settings. According to a 2021 survey in Canada, 96% of respondents reported that they “will do everything possible” to avoid moving into institutional care settings [4].

In recent years, as the challenges posed by population ageing have garnered global attention, countries worldwide have increasingly adjusted urban policies to better accommodate this demographic shift. In Europe, as some cities experience population decline, urban planning strategies are being re-evaluated to address the dual pressures of population reduction and a growing proportion of older residents [5]. Numerous European cities are at the forefront of developing “age-friendly cities,” implementing accessible environments, fostering social inclusion, and expanding healthcare services to support older residents. For example, Manchester has implemented age-friendly policies through its “Valuing Older People” initiative, integrating considerations for older residents into housing, transport, and urban planning strategies [6]. In Barcelona, the city government has established age-friendly community hubs and participatory councils that actively involve older adults in decision-making processes and promote access to services and public spaces, particularly through its “superblock” model and the WHO Age-Friendly City framework [7]. Additionally, European countries have introduced diverse co-housing models, such as Denmark’s co-housing initiatives and Germany’s “multigenerational housing,” which foster shared public facilities and mutual support among residents, strengthening social bonds and reducing social isolation [8]. Japan improves accessibility design through urban renewal projects to foster community adaptability and social interaction, while emphasizing natural connectivity in urban planning, which has been shown to enhance the quality of life of older adults [9]. In the case of Copenhagen, by inviting older residents to co-design new community spaces, strategic measures like placing seating areas and creating intergenerational community gardens have proven effective in improving accessibility and fostering social engagement [10].

To support older adults ageing in place, Naturally Occurring Retirement Communities (NORCs) have emerged as an innovative model of community-based senior care, providing comprehensive support and services for older adults. The concept of NORC was first introduced by the American researcher Hunt in 1986 [11], who noted that these communities gradually evolve to predominantly house older adults, even though they were not originally designed for them. Hunt defined NORCs as communities where at least 50% of the residents are aged 60 or older. These communities provide older adults with the opportunity to actively choose their living environment rather than passively adapt to it, which aligns with the goal of ageing in place [12]. Since then, NORCs have received significantly more attention in the United States compared to other countries.

Currently, various types of NORC programs have been piloted across North America, mainly through collaborations between governments and nonprofit organizations, achieving significant outcomes. In particular, NORC-SSPs have been specifically designed to provide comprehensive support services to older adults within these NORC communities. Although the term Naturally Occurring Retirement Community (NORC) was not formally defined until 1986 by Hunt, community-based service initiatives targeting ageing populations in organically ageing neighborhoods had already emerged in the early 1980s, particularly in New York. These early efforts laid the foundation for what later became known as NORC-SSPs. The concept of NORC-SSP was formally proposed by the United Jewish Communities (now known as the Jewish Federations of North America) in the late 1980s [13]. It aims to offer necessary support and services (such as healthcare, social activities, and daily living assistance) through community collaboration and resource integration, enabling older residents to continue living independently in their familiar neighborhoods. Although the terms NORC and NORC-SSP are often used interchangeably, they are not synonymous [14].

It is well noted that existing studies have primarily focused on concepts, theoretical frameworks, and legal systems related to NORC-SSPs, providing a foundation for understanding these communities. However, there is a significant gap in research exploring the practical operations and implementation of NORC-SSPs. Furthermore, apart from the 2004 U.S. government report, “A Good Place to Grow Old: New York’s Model for NORC Supportive Service Programs”, which systematically reviewed 28 NORC-SSPs in New York City, there has been little comprehensive analysis of NORC-SSP initiatives, highlighting the need for further investigation, especially given the two decades of the evolution since the 2004 report.

To address the research gap, this article integrates and analyzes the operations of 60 NORC-SSPs currently active in New York State, further enriching the field and providing critical reference and empirical evidence for future policy development and program optimization. More specifically, this article will (1) analyze the operational models of NORC-SSPs, examining the range of services provided and their sources of funding, and (2) identify the distribution characteristics of these services to understand the adaptability of NORC-SSPs across different contexts.

2. Background

The NORC-SSP originated and primarily evolved in New York State, U.S. The first NORC-SSP was established in 1986 at Penn South Houses in New York City, a cooperative housing development consisting of ten buildings. It was funded by the United Jewish Appeal (UJA) and supported by the United Hospital Fund [15]. The complex comprises 2820 units with nearly 5000 residents. Currently, there are 2234 residents aged 60 and older within the Penn South community. The Penn South NORC offers a range of services, including case management, healthcare coordination, wellness programs, and social activities, to support older adults in maintaining independence and community engagement. These services help residents access essential resources, manage their health, and stay socially active within their community.

In 1994, New York State passed legislation to support and fund NORC projects, becoming the first state to formally recognize and fund NORC-SSP initiatives. This led to the establishment of 10 NORC-SSPs statewide [16]. In 1999, New York City enacted its own NORC legislation, further expanding the scope and services of NORC programs and providing additional funding and resources. From 2002 to 2008, the federal government funded 45 NORC communities across 26 states to pilot innovative ageing-in-place programs. After 2008, despite federal funding cuts, many original NORC projects and new initiatives continued to operate, supported by local governments and community organizations, providing continuous services to older adults. NORC-SSP programs are generally led by private, nonprofit organizations, with professional staff responsible for managing the day-to-day activities and services [17]. These NORC programs leverage innovative service design and extensive community partnerships to successfully promote independence and ageing in place for older adults, highlighting the broad applicability and impact of the NORC model nationwide. In the 2024 plan, the New York City Department for the Aging (DFTA) provided USD 15,236,521 in funding to support 36 NORC-SSPs [18]. Currently, New York State funds 43 NORCs, serving thousands of clients.

NORC programs in New York State are divided into Classic NORCs and Neighborhood NORCs [16]. A Classic NORC typically consists of a single apartment building or residential complex, while a Neighborhood NORC includes geographically contiguous residences across one or more neighborhoods. Funding is provided through the New York State executive budget, with contracts awarded via a competitive Request for Applications (RFA) process for five-year terms. Programs must provide at least 25% matching funds, conduct a needs assessment, offer core services like case management and healthcare management, and hire full-time staff for larger projects.

Residents typically move into NORCs through natural residential patterns rather than formal relocation procedures, such as ageing in place, housing affordability, or proximity to family. There is no centralized admission process, as these communities evolve organically over time. NORC-SSPs are usually coordinated by local nonprofit organizations in partnership with public agencies and are managed by on-site program directors or social workers who oversee service delivery, community engagement, and resource coordination.

Apart from the United States, there are few records of NORC-SSP projects in other countries. Many similar initiatives do exist, though. In 2011, Kingston, Ontario, Canada, launched the first Oasis Project, supported by community volunteers and partners to provide social, health, and life support services, promoting their independent living and physical and mental well-being, reducing loneliness, and helping them maintain close connections with the community. This project gradually developed into a successful model, serving as the Canadian version of NORC [19]. By 2021, the Oasis Project had expanded to 12 communities [20]. Ambition for Ageing, a seven-year program (2015 to 2022) in the Greater Manchester area of the United Kingdom, was part of the National Lottery Community Fund’s national Ageing Better initiative. This GBP 78 million investment is aimed at improving the lives of people over 50 by tackling social isolation and loneliness within local communities [21]. In Japan, the concept of Community-Based Integrated Care System (CBICS) was first officially introduced in a 2013 report by the Elderly Long-Term Care Study Group. However, it was not until 2013 that CBICS was explicitly defined under Japan’s Long-Term Care Insurance Law and other related legislation. The CBICS aims to provide comprehensive care support by integrating medical and social services, led by the government, to help individuals—particularly senior citizens—maintain health and independence within their communities [22].

E and Xia [23] defined NORCs as areas where residents aged 65 and older constitute at least 40% of the population, based on census data from the Australian Bureau of Statistics. Using spatial analysis and geographic visualization methods, Shu and Xia mapped the spatial distribution of NORCs in Australia while also examining the temporal evolution and the impact of geographic features on NORCs [24]. Although NORC-SSP programs have been widely promoted in the United States, their presence in Australia remains limited. Currently, only two “virtual retirement communities”, located in Sydney and Perth, claim to be inspired by the U.S. NORC movement. These communities provide online local networks to support older adults living independently at home and help them access local services [25].

3. Materials and Methods

All NORC-SSP programs included in this study were identified from official listings published by the New York State Office for the Aging (https://aging.ny.gov, accessed on 20 July 2024) and the New York City Department for the Aging (https://www.nyc.gov, accessed on 20 July 2024). A total of 60 NORC-SSPs with publicly available and detailed service information were selected by reviewing either their official websites or the websites of their operating nonprofit organizations. This selection process represents a purposive sampling strategy based on the availability and relevance of data.

Website content was collected between July and October 2024. Extracted textual content was analyzed using NVivo 14. The study employed an open coding approach, allowing service categories to emerge inductively. The initial coding categories were based on the “Standard Definitions of Service: Naturally Occurring Retirement Community Program” issued by the New York State Office for the Aging and were refined during the coding process to accommodate variations in terminology. All coding was conducted by the first author. To ensure reliability, the second author independently coded 20% of the data; inter-coder agreement was high, and discrepancies were resolved through discussion.

This study extracted information from websites into document format and analyzed it using NVivo14 software. Each NORC-SSP’s type (classic or neighborhood), geographic area (including non-rural and rural), and physical form (vertical or horizontal) were recorded. Services with different names but the same function were categorized and coded under the same category. To enhance transparency, an example of coding for the category Education Activities is also provided, as shown in

Table 1. Example of Coding for the Category Education Activities.

Service Category	Definition	Example Coding (Original Phrases from Websites)
Educational Activities	Structured group learning opportunities that aim to inform, teach, or intellectually stimulate older adults.	- “PEP provides ongoing group education on a variety of important topics concerning older adults such as: changes in government benefits, economic issues, elder law, Medicare changes.” - “Educational workshops” - “Nutrition education” - “Computer instruction” - “Book club” - “Lectures” - “Educational programs include discussion groups”

.

The study also performed a statistical analysis to compare the number of services provided by the different types of NORC-SSPs. A Mann–Whitney U test (for two groups) was employed to determine whether there were significant differences in the number of services between classic and neighborhood NORC-SSPs. The Mann–Whitney U test is a non-parametric statistical test, first proposed by two statisticians, Henry B. Mann and Donald R. Whitney, in 1947 to compare whether there is a significant difference between the distributions of two independent samples. It is suitable for cases where data do not meet the assumption of normal distribution or are ordinal in scale [21].

4. Results

As demonstrated in

Table 2. Summary of NORC-SSP information.

NORC-SSP Features for the Content Analysis		Number
NORC-SSPs		60
NORC-SSP Type	Classic	34
	Neighborhood	26
NORC-SSP Geographic Area	Non-rural	53
	Rural	7
NORC-SSP Physical Form	Vertical	42
	Horizontal	18
Lead agency/Provider		42
NORC-SSPs with partners		12
Volunteer		47

, the number of classic NORCs (34 out of 60) slightly exceeds that of neighborhood NORCs. The majority of these NORCs are located in non-rural areas (53 out of 60), with a predominant vertical physical form (42 out of 60).

A Classic NORC typically refers to a single apartment building or housing complex, while a Neighborhood NORC generally covers a larger geographic area consisting of multiple homes or neighborhoods, without being characterized by high-rise buildings. The classification of vertical and horizontal NORCs primarily describes the physical structure of the community: vertical NORCs refer to high-rise buildings, while horizontal NORCs are more dispersed communities. Although Classic NORCs are often associated with vertical structures, they may also include low-rise buildings. Similarly, most Neighborhood NORCs are horizontal, but there are exceptions. For example, the Pelham Parkway NORC includes several mid- to high-rise apartment buildings (usually six stories or more), creating a dense vertical living environment. Despite geographically fitting the description of a Neighborhood NORC, its physical structure is characteristic of a vertical NORC. The key distinction between Classic and Neighborhood NORCs lies in their geographic scope and cooperative model of service provision, rather than the height or type of buildings.

Out of the 60 NORC-SSP samples, 12 programs explicitly mentioned partnerships with various organizations to provide services. These partners typically include nonprofit organizations, healthcare providers, housing management companies, or community groups, which help to enhance the program’s resources and service offerings. Among the 60 NORC-SSPs studied, 47 specifically mentioned offering volunteer services. This highlights the important role volunteers play in most NORC-SSPs, supporting various community services such as social activities, health management, and case assistance. Volunteer involvement not only strengthens the programs’ service capacity but also fosters connections and interactions within the community, helping to improve quality of life and social support networks for older adults.

4.1. Service Provision Across NORC-SSPs

Table 3. Summary of services provided in NORC-SSPs.

Services	Frequency (%)	Type		Geographic Area		Physical Form
		Classic	Neighborhood	Non-Rural	Rural	Vertical	Horizontal
Educational activities	86.67	85.29	88.46	86.79	85.71	88.10	83.33
Healthcare management	83.33	91.18	73.08	84.91	71.43	90.48	66.67
Recreational activities	83.33	85.29	80.77	86.79	57.14	88.10	72.22
Health promotion	71.67	82.35	57.69	75.47	42.86	76.19	61.11
Healthcare assistance/monitoring	70.00	79.41	57.69	79.25	0.00	80.95	44.44
Case management	61.67	76.47	42.31	69.81	0.00	71.43	38.89
Case assistance	53.33	70.59	30.77	60.38	0.00	66.67	22.22
Information and assistance	48.33	29.41	73.08	47.17	57.14	40.48	66.67
Transportation	48.33	41.18	57.69	45.28	71.43	40.48	66.67
Friendly visiting	38.33	50.00	23.08	43.40	0.00	47.62	16.67
Telephone reassurance	38.33	47.06	26.92	37.74	42.86	42.86	27.78
Housekeeping	33.33	44.12	19.23	37.74	0.00	35.71	27.78
Social connect	28.33	23.53	34.62	26.42	42.86	16.67	55.56
Food	23.33	23.53	23.08	20.75	42.86	23.81	22.22
Shopping assistance	23.33	23.53	23.08	16.98	71.43	19.05	33.33
Counseling	15.00	8.82	23.08	13.21	28.57	11.90	22.22
Wellness programs	15.00	8.82	23.08	9.43	57.14	4.76	38.89
Home care	11.67	5.88	19.23	13.21	0.00	14.29	5.56
Trip	11.67	17.65	3.85	13.21	0.00	16.67	0.00
Personal Emergency Response System	8.33	8.82	7.69	7.55	14.29	4.76	16.67
Residential repair/maintenance	8.33	2.94	15.38	7.55	14.29	4.76	16.67
Support groups	8.33	2.94	15.38	9.43	0.00	9.52	5.56
Telephone services	8.33	8.82	7.69	9.43	0.00	9.52	5.56
Escort	5.00	8.82	0.00	5.66	0.00	7.14	0.00

outlines the service provision across NORC-SSPs in New York State. Overall, the most frequently provided services include education activities (86.67%), healthcare management (83.33%), and recreational activities (83.33%). This indicates a strong focus on promoting ongoing learning and maintaining the physical and mental health of older adults. Health promotion (71.67%) and healthcare assistance/monitoring (70.00%) follow closely, underscoring the importance of health-related services in these programs. Case management (61.67%) and case assistance (53.33%) also rank high, reflecting the need to address individual support requirements. On the other hand, lower-frequency services like escort (5%) and support groups (8.33%) have a smaller presence. In summary, health, education, and recreational services form the core priorities of NORC-SSP programs.

Over 80% of NORC-SSPs provide services related to education, healthcare management, and recreational activities. Education is the most frequently mentioned service, suggesting that these free courses have become an essential component of NORC programs. The most commonly offered classes include art, writing, computer, and exercise courses. NORC-SSPs primarily deliver education-related services to older adults through classes, lectures, or workshops. The other two high-prevalence services in NORC-SSPs are healthcare management and recreation. Healthcare management services are typically delivered by qualified health professionals who provide targeted medical care, including free personal health consultations, chronic disease management, acute episode response, and assistance in accessing the healthcare system. Key services include doctor and nursing support, addressing older adults’ specific medical needs. Recreational activities vary significantly depending on the community’s needs, offering diverse options such as dancing, movies, yoga, and various games.

More than half of NORC-SSPs provide services such as health promotion, healthcare assistance, and case management. Unlike healthcare management, which mainly focuses on personalized professional health services and emphasizes overall health, proactive maintenance, and self-management, health promotion primarily aims to prevent diseases and improve overall health levels. It places a greater emphasis on education, environmental support, and policy advocacy, encouraging lifestyle changes towards healthier habits, and includes both evidence-based and non-evidence-based health promotion services. Healthcare assistance focuses on monitoring and support of individual health conditions, providing direct medical services such as blood pressure screening and flu shots.

Case Management and Case Assistance both focus on connecting residents to external resources to meet their needs. Case Management emphasizes continuity and comprehensiveness, suitable for complex, long-term needs. Case managers assist in creating personalized plans, such as medical management, home care services, and social support, involving ongoing coordination and adjustments. Case Assistance, on the other hand, is a short-term, quick problem-solving approach, suitable for simple and immediate needs. It includes tasks like making appointments, filling out forms, providing information, or referring to community services. Both approaches are designed to ensure that residents receive the appropriate help, but they differ in their depth and duration of involvement.

Data reveal the distribution characteristics of services across different types of NORCs. For instance, 50% of Classic NORCs provide friendly visiting services, whereas only 23.08% of Neighborhood NORCs offer the same. On the other hand, information and assistance services are frequent in Neighborhood NORCs, covering 73.08%, compared to just 29.41% in Classic NORCs. This difference is closely related to the structure of these communities. Classic NORCs usually consist of a single building or a group of high-rise buildings, creating a concentrated living environment where residents have close social networks. As a result, residents often rely on neighbor relationships or internal resources, reducing the need for dedicated information and assistance services. The concentrated spatial layout also explains why friendly visiting is more common in Classic NORCs.

Classic NORCs provide a wider range of services than Neighborhood NORCs, and NORC projects in non-rural areas tend to offer more services compared to those in rural areas. Likewise, NORCs in vertical forms generally deliver more services than those in horizontal forms. It is noteworthy that the types of NORCs are strongly associated with their geographic location: all 34 Classic NORCs are situated in non-rural areas, whereas all 7 rural NORCs fall under the Neighborhood NORC type.

These distribution patterns are also reflected in geographic and physical forms; friendly visiting services are more widespread in non-rural and vertical settings compared to rural and horizontal ones. Similar trends are observed with housekeeping, homecare, and trip, showing a clear connection between service types and community structures. The data indicates that information and assistance services are significantly less common in non-rural and vertical settings compared to rural and horizontal ones. In rural NORCs, transportation and shopping assistance services each account for over 71%, highlighting the crucial need for accessibility and shopping support in remote areas, making these the primary services in rural NORCs. In horizontal settings, transportation services account for 66%. Services and facilities like medical centers and social activity locations are relatively dispersed across different areas of the community, necessitating transportation services for residents to access these resources. This contrasts sharply with vertical settings, where services and facilities are often concentrated within the building or within walking distance, reducing the reliance on transportation services.

The services provided by NORC-SSP demonstrate high adaptability, characterized by inclusivity and flexibility. The AmPark NORC community is a multi-ethnic and multicultural enclave, home to a significant number of Holocaust survivors. Pelham Parkway NORC primarily serves the Spanish-speaking community, where about 90% of residents speak Spanish and only half are bilingual. Vision Urbana NORC’s participants are predominantly immigrants, with 50% being Hispanic, 40% being Asian, and 10% being White. Knickerbocker Village Senior Services is located in Manhattan’s Lower East Side near Chinatown, a region densely populated by Chinese immigrants and residents of Chinese descent, many of whom have limited English proficiency and live in linguistically isolated environments.

Based on the hypothesis test results shown in

Table 4. Hypothesis Test Summary.

Hypothesis	Test	Significance	Decision
In the category of type, the distribution of services is the same	Independent Samples–Mann–Whitney U Test	0.007	Reject the null hypothesis

, the Mann–Whitney U test was performed to determine if the distribution of services is the same across the type categories. The p-value for this test is 0.007, which is less than the significance level of 0.05. As a result, the null hypothesis, which assumes that the distribution of services across the Classic NORCs and Neighborhood NORCs is the same, is rejected. This implies that there is a statistically significant difference in the distribution of services between the different types.

To meet the communication needs of older adults from diverse linguistic backgrounds, particularly immigrants and those with limited English skills, NORC projects offer language support in multiple languages. Among the study subjects, 20% of the projects provide language assistance, with the most common languages being Chinese (Mandarin and Cantonese), Spanish, and Polish. To better accommodate the cultural and religious diversity of the older population, NORC-SSP respects and embraces various faiths, ensuring that services align with individual religious practices and cultural backgrounds. Additionally, 10% of the projects promote cultural integration and respect for multiculturalism through cultural activities, tours, and programs. These services not only enhance the sense of community participation and comfort for older adults but also enable them to enjoy their later years in a familiar and respectful environment, effectively achieving the adaptability and inclusivity of community services.

4.2. Funding Sources of NORC-SSPs

In the previous analysis, the focus was primarily on the services provided by NORC-SSPs as outlined on their respective websites, providing an initial understanding of the project implementations. However, the ongoing provision and quality assurance of these services depend not only on the execution of the projects themselves but also on stable and sufficient funding. On the legislative front, the New York State Legislature passed Elder Law Section 209 in 1994, which was signed into law by the Governor of New York State. This law is administered by the New York State Office for the Ageing (NYSOFA) and explicitly states that eligible communities and organizations can apply for funding to support NORC service projects through a competitive application process.

Funded projects typically require applicants to provide matching funds. Specifically, New York State’s NORC funding mandates that applicants must provide matching funds that constitute at least 25% of the state’s funding. This means that applicants must secure equivalent funding sources. For example, support can come from local governments, nonprofit organizations, private donations, or other private entities. These contributions can be in the form of financial resources, fixed assets, or labor services.

Table 5. Financial contributors to the NORC-SSPs.

Financial Contributors to the NORC-SSPs	Frequency (%)
Partially funded by the New York City government	78.33
Partially funded by the New York State government	71.67
Partially funded by a nonprofit organization	15
Partially funded by private donors	5
Partially funded by the Federal government	3.33
Partially funded by a for-profit organization	3.33

offers a detailed statistical analysis of the financial contributors to NORC-SSPs. The New York City government and the New York State government are the dominant funders, contributing at rates of 78.33% and 71.67%, respectively. Nonprofit organizations, private donors, the federal government, and for-profit organizations provide additional funding, though to a lesser extent. Nonprofits account for 15%, private donors account for 5%, and both the federal government and for-profit organizations contribute 3.33% each. These findings indicate that public funding, particularly from local governments, plays a crucial role in the financial support of NORC-SSPs. While contributions from private and non-governmental sources are comparatively lower, the data reflect a certain level of funding diversity within the program. While government funding remains the main source, diversified funding combinations, particularly involving nonprofits and private donors, positively impact the sustainability and resource integration of these projects. The limited number of projects funded by non-governmental sources may reflect constraints in funding matching and resource integration.

5. Discussion

In New York State’s NORC-SSP services, education, healthcare, and case management are commonly provided, aligning with the core program components of NORC-SSPs. Educational activities not only bring health and economic benefits to older adults but also effectively reduce government and societal costs related to home care for older adults [26]. Health-related services receive significant attention within NORC-SSPs, including health management (83.33%), health promotion (71.67%), and healthcare assistance/monitoring (70.00%). NORC-SSPs are designed based on the social determinants of health and preventive care theories [27]. NORC-SSPs typically prioritize health management and preventive programs, which assist in managing chronic diseases and promote the well-being of the seniors through preventive measures such as exercise and health screenings [28].

Additionally, social services such as recreational activities (83.33%) and education (86.67%) are equally critical in addressing the issue of loneliness among older adults [29]. Research shows that NORC-SSPs help reduce feelings of loneliness, which is a significant risk factor for diseases such as Alzheimer’s [30]. These services help older adults stay mentally and physically active, contributing to the improvement of long-term health outcomes [31]. In terms of daily convenience, the provision of case management (61.67%) and case assistance (53.33%) further supports the ongoing need for older adults to receive continuous assistance in their daily lives. Case management services not only offer support in healthcare but may also provide comprehensive assistance in areas such as housing, legal aid, and other aspects of daily living.

Due to variations in geographic location and physical structure, the services offered by NORC-SSPs differ accordingly. For instance, NORCs in rural areas with horizontal configurations typically provide more transportation and shopping services. Barrett and Skubic [32] highlight that transportation needs are a critical factor enabling older adults in rural settings to age in place. Conversely, non-rural NORCs with vertical configurations tend to offer more friendly visiting services, driven by the issues of loneliness and social isolation commonly experienced by older adults in densely populated apartment buildings. These visiting services are particularly vital in non-rural settings, as older adults in vertical NORCs often reside in socially constrained environments and face heightened risks of inadequate social support. Research conducted by OpenLab indicates that friendly visiting programs not only facilitate the development of community connections among older adults but also enhance their ability to access support in daily life, thereby strengthening their capacity for independent living [33]. NORC-SSPs have unique advantages in providing a healthy built environment for older adults, ensuring that everyone has equal opportunities to maintain their health and access the same services and facilities. This helps address health equity issues, particularly those arising from factors such as age, race, gender, or geographic location (rural or urban environments) [34].

These findings reveal that horizontal NORCs generally offer fewer services compared to vertical NORCs. One possible explanation is that horizontal NORCs, often composed of dispersed single-family homes or low-rise buildings, face greater logistical challenges in coordinating centralized services and attracting providers. Lower population density may also hinder economies of scale, making it difficult to sustain a wide range of programs.

Regarding the project’s sustainability, NORC-SSPs utilize government funding, human capital, partnerships, and volunteer services to provide support to older adults in the community while actively engaging them in the program’s activities. This reciprocal dynamic generates a feedback loop [35], potentially attracting further resources to the project. NORC-SSPs rely not only on financial capital but also on human capital, such as volunteer contributions, and social capital through partnerships with other organizations [36]. The sustainability of NORC-SSPs likely stems from the combined efforts of these various forms of capital.

In other U.S. states, such as Missouri and Georgia, the core services of NORCs closely align with those in New York, encompassing health management, transportation, social activities, and volunteer services, all aimed at supporting older adults in maintaining independence and social connections. However, in contrast to New York’s more standardized and mature NORC service system, these states demonstrate greater flexibility and innovation in their approaches. For instance, Pennsylvania’s Age Well Pittsburgh NORC offers programs like “Active Living with Chronic Conditions” and the “Home Meds Medication Assurance” program, which excel in managing chronic illnesses and ensuring medication safety. Similarly, Georgia’s Ardsley Park NORC implements the Summer Angels Program [37], a collaborative initiative with a local middle school in which students provide yard work and household support for older adults in Ardsley Park. This program has engaged over 100 older adults and numerous students, resulting in more than 1000 h of service that meets the needs of seniors while providing a life-changing experience for young participants. In terms of funding sources and project sustainability, NORCs in New York State typically benefit from consistent government funding and support from community organizations, which provides a relatively stable financial foundation. Even when membership models are adopted, services are generally free for individuals aged 60 and above. In contrast, Maryland’s Montgomery County Community Partners NORC transitioned to a fee-based model in 2008 due to funding constraints, with an annual charge of USD 120, prorated monthly. Similarly, the Philadelphia NORC [38] operates under a fee-based structure, with 1700 members paying USD 50 per individual or USD 80 per household of two or more members. These models illustrate adaptive strategies for maintaining operations in the face of financial challenges.

Driven by the global ageing trend, the NORC model in the United States stands out as a successful example of supporting ageing in place. However, similar innovative practices are also found in other countries. For instance, Canada’s Oasis project enhances the quality of life of older adults through community engagement and integrated services [39]. In the United Kingdom, the Circles of Support project reduces social isolation among older adults through a volunteer network [40], and the Ambition for Ageing initiative improves age-friendliness in communities by enhancing public spaces and promoting inter-generational interaction. These projects offer diverse support models for addressing the challenges of an ageing society [41].

In terms of services, the United States emphasizes community health services and basic living support. Canada focuses more on nutrition and physical activities, encouraging older adults to engage in health management through initiatives like community kitchens and communal dining [42]. The United Kingdom highlights technical training and social action projects, encouraging older adults to participate in volunteer services and community activities, while also providing emotional support and psychological interventions. These are all in line with the characteristics of an age-friendly community, where services can be accessed and provided within one’s own home [43]. In terms of funding support, NORC projects in the United States typically rely mainly on local and federal government grants. The Oasis project in Canada receives funding from various sources, including government health departments and health innovation centers. The Ambition for Ageing project in the UK is primarily funded by the National Lottery Fund, which supports hundreds of small projects to promote community transformation and social connections. The project’s funding is abundant and diversified, enabling customized support tailored to the needs of different communities.

Australia currently lacks funding programs specifically designed for NORCs, as seen in the United States. Unlike the U.S. NORC Supportive Services Programs, which allocate targeted funding to assist communities where older populations have organically concentrated, enabling residents to maintain independent living, Australia’s aged care policies are implemented through nationwide initiatives such as the Home Care Packages and the Commonwealth Home Support Program. These programs deliver services to all older adults, regardless of their community type or demographic characteristics. Australia’s government-led approach prioritizes standardized and personalized care services, rather than providing tailored support to naturally occurring retirement communities. While this model ensures extensive coverage, it lacks the flexibility and responsiveness of community-specific programs.

Older adults in Australia are showing a trend toward settling in coastal areas [24], with 66% residing in non-rural regions. In comparison, about 23% of older adults live in regional inland cities, while only a small portion reside in remote areas [44]. Regarding housing patterns, older adults in Australia currently prefer horizontal living arrangements, such as single-family homes or low-rise buildings. Research by the Australian Housing and Urban Research Institute (AHURI) indicates that two- or three-story standalone homes remain the most favored option among older adults, while high-rise apartments are relatively unpopular, with only about 4–5% expressing a willingness to live in them [45]. Although horizontal housing remains the preference for most older adults in Australia, high-rise apartments may become a more popular choice in the future as population ageing and urbanization advance, particularly in large cities like Sydney and Melbourne.

Therefore, the NORC model in Australia needs to place greater emphasis on horizontal communities in coastal and urban area, with localized designs tailored to the specific needs of these communities, such as transportation, health management, and social support. This ensures that the model aligns with Australia’s unique geographical and social characteristics. Additionally, Australia’s multicultural background necessitates that NORC services be further localized to address the needs of diverse cultural groups, such as providing language support and services that respect cultural customs.

In considering international replication of the NORC-SSP model, it is important to recognize regional differences that may pose practical barriers. For instance, countries like Australia and parts of Europe differ significantly from the United States in terms of housing structure, ageing policy frameworks, and funding mechanisms. In many of these contexts, dedicated funding streams for ageing-in-place services are limited or absent. Specifically, in Australia, the NORC concept has not yet received official recognition, and related policy and service developments remain in an exploratory phase. The absence of formal recognition may present challenges to the adaptation of the NORC-SSP model across different international policy and service landscapes.

While traditional NORC-SSPs focus on service coordination and human support systems, recent technological advancements offer complementary pathways to support ageing in place. In particular, assistive technologies are emerging as critical tools that can enhance the effectiveness of NORC service models. In addition to wearables and socially assistive robots, technologies such as smart home systems, AI-powered voice assistants, and sensor-based fall detection networks are increasingly embedded in ageing-in-place frameworks. These technologies promote autonomy, safety, and well-being by enabling continuous health monitoring, detecting emergencies in real time, and supporting daily routines with minimal human intervention. Importantly, their successful adoption depends not only on usability and affordability but also on older adults’ trust in technology and perceptions of privacy and control [46,47].

The primary limitation of this study is its reliance on website-based information, which may result in incomplete or outdated service details from some NORC-SSPs, potentially leading to an incomplete portrayal of the services offered. Additionally, the study lacks an analysis of feedback on these services. While the focus of this research is on the types of services provided by NORC-SSPs, it does not categorize older adults by age group (e.g., young-old, middle-old, oldest-old) or by levels of functional capacity. Future research could benefit from exploring how service provision aligns with the diverse needs of subgroups such as the young-old, middle-old, and oldest-old. Future research should integrate more in-depth field studies and case examples to better understand how these services function in practice, while exploring residents’ actual needs through an analysis of service usage and preferences.

6. Conclusions

In NORC-SSPs, education, healthcare management, and recreation are the most frequently provided service categories. Health-related services play a crucial role in these programs, specifically including healthcare management, health promotion, and healthcare assistance/monitoring. These figures indicate that health management is a central component in supporting older adults to ageing in place, ensuring their continued independence and access to essential healthcare services. The services offered by different types of NORC-SSPs are closely linked to their geographic location and physical structure, yet they all demonstrate strong adaptability by addressing the actual needs of older residents, reflecting both inclusivity and flexibility. In New York State’s 60 NORC-SSPs, local governments play a central role in funding. However, a diversified funding mix, particularly the involvement of nonprofit organizations and donations, contributes positively to the sustainability of these programs and the integration of resources.

This study analyzes the service offerings and funding structures of NORC-SSPs in New York State, filling a recent gap in research within this field. The findings reveal a close connection between service design and both geographic location and physical structure across different programs. Additionally, by examining the diversity of funding sources, the study highlights the positive role of nonprofit organizations and donations in enhancing program sustainability. In promoting the NORC-SSP model in Australia, it is recommended that greater attention be given to clarifying and formally recognizing the concept of the “NORC” at the governmental level. Currently, the concept has not yet been formally defined within Australia’s policy framework. This situation may pose challenges to developing standardized practices and integrating them with current policy frameworks. To support the long-term development of this model, it is suggested that the government gradually establish clear identification criteria, providing a policy foundation for future institutional development.

Based on a clear policy foundation, local governments and service providers can explore more adaptable local service models. Policy-makers may also refine funding mechanisms to better support ageing-in-place at the local level. In parallel, future research could focus on assessing the effectiveness of specific service components within NORC-SSPs. This may include user satisfaction surveys, cost-effectiveness analyses, or outcome-based evaluations to understand how different services impact residents, quality of life, social engagement, or health outcomes. Such studies would provide valuable evidence to guide program improvement and policy decisions.