University of Wisconsin–Madison

Healthy Aging in Rural Towns

Strategies, Programs, Models and Projects

  • The following is a list of different strategies, programs, models and projects that have been implemented in other communities to support older adults and caregivers. Listings do not indicate endorsement from HeART project staff. The purpose of the list is to describe different strategies that may be of interest for your community. Not all programs have the end goal of Aging-in-Place, but all programs are related to at least one of the Age-Friendly domains. Some programs may belong to more than one category. A few of the items below are ideas or programs mentioned during the cross-coalition meeting held on Oct. 17, 2018. If you are interested in pursuing one of these strategies, we can provide more detailed information.
  • Housing

    Alternative Housing Models

    Two very useful documents from the AARP that helped with constructing this section of the list are: 6 Creative Housing Options by Melissa Stanton and Aging in Place- A Toolkit for Local Governments

    1.Village model

    Villages are a membership-driven model in which members form a community non-profit through which they coordinate access to vetted services, and provide volunteer services and discounts to members. These organizations are usually run by volunteers and paid staff, and have the end goal to help members age successfully in their home.

     Example: Sharing Active Independent Lives, a village operating in the greater Madison, WI area

    Additional information:

    Impact of the Village Model: Results of a National Survey

    Village to Village Network

    2. NORCs

    Naturally occurring retirement communities (NORCs) are communities that were not originally designed as retirement communities, but have a high concentration of older adults. The high concentration of older adults allows for community support and economies of scale for delivery of services and programs. In some NORCs, private and public services are provided on-site (NORC supportive services programs).

    Example:  East Point NORC, Atlanta Georgia

    Additional information:

    NORC Blueprint from New York State Office for the Aging

    Naturally Occurring Retirement Community (NORC) Services Program

    Information on Community-Centered Solutions for Aging at Home from the U.S. Department of Housing and Urban Development

    3. Co-housing

    The cohousing model refers to neighborhoods in which each resident or family owns their individual residence, but the homes in the community share a common space that can be used for gatherings, events, meals, etc. Cohousing models are not always geared toward seniors, but several cohousing neighborhoods for seniors have been built, and provide access to services to assist with aging-in-place.

    Example: Oakcreek Community, a senior co-housing community in Stillwater, OK.

     Additional information:

    What is Co-Housing? (AARP)

    The Cohousing Association of the United States

    4. House Sharing

     House sharing refers to a variety of arrangements in which an older adult may have a friend, family member, or other adult as a housemate. The housemate may help in with expenses, chores, or transportation. Housemates can share rent or own a residence together. In other situations, a younger adult may live with an older adult and provide some caregiving assistance in exchange for affordable housing.

     Example: Golden Girls Network – An online network of single, mature adults seeking housemates

     Additional information:

    House Sharing for Boomer Women– an AARP article

    National Shared Housing Resource Center

    5. Co-ops

     Resident-owned and governed communities who make arrangements to share services.

     Example: The Home of the Future, a Time magazine article on Sleepy Hollow, a Florida-based senior-owned mobile home community

    Additional information:

    Senior Cooperative Housing

    Home Safety & Modifications

    6. Home safety assessments

    Home safety assessments can be done by occupational therapists, home health nurses, volunteers, or homeowners themselves to identify potential modifications they can make to  reduce risk of falls and maximize functionality within a home.

    Example: SAFE at Home, a United Way of Dane County and SSM Health partnership to prevent falls and injuries at home.  Volunteers conduct in-home safety assessments, and the program provides a medication review by a pharmacist, safety aids like night lights, home safety recommendations, information about community resources, and 6 months of follow up by a social worker.

    Additional information:

    Aging in Place: Tips on Making Home Safe and Accessible from the National Institute on Aging

    CDC’s Checklist for Home Fall Prevention

    Safe at Home Suggestions for Homeowners

    Safe at Home Suggestions for Homeowners- Rebuilding Greater Milwaukee version

    7. Universal and “lifelong” design

    Various organizations have outlined design principles for new construction and modification checklists for existing constructions to homes, environments and products accessible to everyone (universal design). Lifelong design is a similar concept but is applied to make homes and the environment accessible to individuals across the lifespan.

    Examples:

    AARP HomeFit – A homeowner’s toolkit to assess their home for “lifelong” modifications.

    Certified Aging-in-Place Specialist (CAPS)- A designation from the National Association of Home Builders for remodelers and builders certifying completion of training on universal design and aging-in-place remodeling.

    Additional information:

    National Association of Home Builders- Understanding Aging-in-Place and Universal Design

    Universal Design / Aging-In-Place Slides

    8. Home modification assistance programs

    Home modifications that require a professional contractor can range from a few hundred dollars to several thousand dollars. Various programs and non-profits can help older adults identify which home modifications are needed and provide those services at a low-cost to increase access to home repairs.

     Examples:

    Community Aging in Place-Advancing Better Living for Elders (CAPABLE program)- A team consisting of a nurse, occupational therapist & handyman/contractor work together with low-income older adults in their homes to improve function and adapt the home environment to facilitate aging-in-place. This program was developed at Johns Hopkins School of Nursing, they offer training for other organizations to deliver the CAPABLE program.

    Home Modification Education for States  (Homes) Program- Pilot program of an online education program on home modification from the USC Leonard Davis School of Gerontology. A Wisconsin program is anticipated for 2019. This educational program targets individuals representing the elderly and those with disabilities, occupational therapists, policy makers, remodelers and contractors.

    Project Home- A non-profit operating in Dane and Green Counties in WI with a mission to improve the quality and affordability of housing for low income residents. Services provided include home repairs, accessibility modifications, energy improvements and home maintenance classes.

    Additional Info:

    WI Department of Health Services- Housing and Architectural Accessibility Resources

    WI Department of Health Services  – Universal Home Design Benefits Everyone

    Local Government Policies and Community Design

    9. Zoning bylaws and building codes

    Zoning rules and bylaws can help communities create “age friendly” community design and housing stock. Changes at the policy level can allow for the construction of affordable housing, encourage mixed use of land, include of accessibility standards for new construction, and infrastructure to make a community walkable.

    Examples:

    Private builders constructing legal basement apartments or separate living suites in Ontario, Canada, which can be used as affordable rental units or for housing of relatives.

    The Atlanta Regional Commission held a charrette with multiple community stakeholders and design exports to develop conceptual master plans for five Atlanta-area communities; and identify “lifelong” community standards, zoning codes & development principles.

    Additional info:

    Aging Success Stories from the Canada Mortgage and Housing Corporation

    Information on Accessory Apartments form the University of Missouri Extension

    10. Property tax codes

    Policies related to property taxes can be modified at county levels to allow for tax postponements, tax assistance, limiting assessed values  and homestead exemptions to promote housing affordability.

    Additional info:   Aging in Place- A Toolkit for Local Governments.

  • Transportation

    Two resources that were helpful in compiling this list are the Rural Information Hub (RHIhub) and Grantmakers in Aging (GIA). The RHIhub website has a great Rural Transportation Toolkit available online, which includes a list of transportation models and exemplars. GIA released a report targeting funders on Mobility & Aging in Rural America.  This document summarizes some information available through these websites, but we encourage further exploration and will help you narrow down resources if any of these models or programs are of interest to you.

    Public & Alternative Forms of Transportation

    1.Public transportation

    According to the Rural Information Hub, the principle form of public transportation are fixed-route buses. In rural areas, systems may have additional modifications and services to complement buses, such as demand-response transportation or connector services.

    Demand-response transportation involves flexible routes and schedules based on rider needs. Hailing a ride would be an example of demand-response transportation. Connector services are transportation services to connect transit systems to a final destination that may be out of their service area. Several of the examples and models listed throughout this document use these types of transportation systems.

    Example: Marble Valley Regional Transit District – Operates a non-urban public transport system. It offers fixed route buses with pre-arranged stops and flag-down stops at which drivers only stop if the circumstances are safe to do so. It also offers on-demand transport services to medical, hearing and social service appointments for Medicaid recipients.

    Additional info & examples: RHIhub

    2.Volunteer programs

    Some communities rely on volunteer driver programs. Volunteers may drive their own vehicles or vehicles belonging to an organization. They may provide door-to-door assistance/drop-off, waiting with individuals during appointments, and assistance during the trip if needed (such as help grocery shopping). Some transportation programs provide medical flight transport. Volunteers may or may not be reimbursed with money or other incentives. One challenge with volunteer programs is recruiting enough volunteers to meet demand of services.

    Examples:

    Vernon County here in Wisconsin provides demand-response volunteer rides within a 100 mile radius of the county seat, Viroqua. Co-payment for a ride depends on mileage.

    The TRIP model was designed to help with recruitment of volunteer drivers and to empower older adults to recruit their own volunteer drivers. The main components of the model are: managing organizations identify riders in needs; riders identify their own volunteer drivers; riders and the volunteer drivers arrange the rides independently; riders then provide documentation of transportation to the managing organization; and reimbursement is given to riders to give back to the volunteer drivers.

     Additional information:

    RHIHub

    National Volunteer Transportation Center – More promising practices and link to online volunteer driver training

     3. Voucher programs

    In voucher programs, riders are provided with coupons or vouchers to provide transportation providers reimbursement. Organizations managing the voucher program determine who is eligible to receive vouchers, and if vouchers are provided for free or for a reduced cost to riders. Transportation providers may be existing businesses or volunteer services. Vouchers serve as an incentive for drivers to continue to provide transportation services.

    Example: Wyoming Independent Living – Provides reimbursement of mileage to transportation providers who provide rides to eligible individuals with disabilities.

     Additional information:

    Additional examples on RHIhub

    Michigan Developmental Disabilities Council’s Transportation Voucher Replication Handbook

    4. Coordinated Services Programs

     In this model, different community service programs share resources and responsibilities to increase availability and access to transport, essentially creating economies of scale. These programs require planning and cooperation on a large scale, and involve stakeholders from non-profits, government, and technical support.

    Examples:

    RYDE Transit  (Reach Your Destination Easily) Public Transportation – This program, operated out of Kearney, NE, provides low-cost public transportation in 7 counties to medical appointments, shopping, congregate dinners, and social activities. RYDE operates 12-passenger, lift-equipped buses for riders who call and schedule pickup times 24 hour in advance. The program started in the year 2000 after 4 years of planning by the Buffalo County Community Health Partners Transportation Goal Work Group, which included stakeholders from over 20 local government and service organizations.

  • Community Connectedness

    Community programming, classes and events can encourage intergenerational interactions and social interaction. Programs and events are varied; examples include community programming, technology training, intergenerational housing, creative use of public school spaces, and outreach to homebound adults.

     1. Intergenerational housing

    Local governments and community organizations can create programs and housing arrangements to encourage intergenerational collaboration and support. Programs may look like low-income housing with shared community spaces and activities, college students living with older adults and providing companionship in exchange for housing.

    Examples:

    Humanitas retirement home in Deventer, Netherlands: College-aged students receive free housing in small apartments at the Humanitas retirement home in the Netherlands. In exchange, the student is required to spend 30 hours per month as a “good neighbor” to older residents. As a good neighbor, the student may watch sports, eat meals, and provide general companionship to residents.

    Housing for young mothers and seniors in Beekmos, The Netherlands: In this project, young mothers and teen girls who are no longer able to live with their families live in “assisted living” type apartments. The same facility also reserves a number of apartments for older adults who serve as coaches for the younger residents. In this case, the coaches are the “good neighbors.” They may assist the younger residents with babysitting, emotional support, etc. There is also programming for social activities to include all residents. Additional info on p. 28 of this report.

    Bridge Meadows: An inter-generational housing development that offers housing for families adopting children from foster homes. The community also offers reduced rent apartments for adults age 55 and over in exchange for their time volunteering with families in community activities.

    Additional information: This report from a UK-based writer and researcher is on intergenerational housing practices in the U.S., but also contains case studies from other countries.

    2. Phone outreach programs

    Isolated or homebound adults can be checked on through a weekly scheduled phone call. This has been facilitated in other communities through the 211 service.

    Example:

    The Helpline Center’s Outreach Support Program in South Dakota: The Helpline Center manages the Outreach Support Program. This program provides support and assistance through a weekly scheduled phone call to homebound adults. Program enrollees can dial 211 at any time if they require additional support.

    3. Volunteer Companion programs

    Programs like these are similar to the Senior Companion program (see previous section), in which volunteers are matched with homebound adults to provide companionship and support with at-home visits.

    Example:

    Better Together: This program trains and screens volunteers in South Dakota, and matches them with people aged 65 and older living, with the end goal of promoting companionship and social activities. Volunteers have a minimum commitment of four hours per month for at least one year. More info here.

    4. Senior Centers & Space for Programming

    Senior Centers provide a gathering space for older adults to access activities, programming, learning and services. Senior Centers offer similar services to ADRCs in some aspects, but usually have larger areas for recreational use and programming. Sometimes Senior Centers will share space with other community organizations or rent out the facility for events.

    Example of a traditional senior center:

    Summit County Colorado: The Community & Senior Center offers activities and services including free 10-minute appointments with a lawyer, care navigation, a caregiver support group, a phone tree providing check-in calls to seniors who live alone, quilting group, mahjong and bridge groups, and outdoor activities.

    Shared-spaces senior centers:

    AARP has a wonderful list of examples of innovative ways communities have developed shared spaces that include senior centers.

    5. Teach SD: An Age-Friendly Tech Connection

    This program was created by South Dakota State University Extension. This program pairs tech-savvy volunteers with adults who want to learn how to use new devices, apps and programs. Although volunteers between the ages of 14 and 24 are targeted, volunteers of all ages are welcome. SDSU Extension has created a toolkit for this program.

    6. Music and Memory Student Volunteer Program:

    This program was piloted in 2016. This program connected high school and college students with volunteer opportunities in local nursing homes with Music & Memory certifications.  The Music and Memory program is a separate nursing home-based program to provide engagement for residents through music. The student volunteers received some training with a brain health mini-unit on mental health, the brain, and the benefits of music for patients. They then are partnered with nursing home residents and patients with Alzheimer’s to create personalized playlists for the residents and their families. This program aims to increase younger generations’ awareness of brain health and dementia, increase intergenerational collaboration, increase socialization for nursing home residents, and improve quality of life. More articles on these pilot programs here, and here. 

    7. Fishing for Everyone

    Fishing Has No Boundaries is a non-profit with multiple chapters throughout the country, including chapters in Madison, Milwaukee and Hayward County. This organization provides recreational fishing opportunities for people with disabilities, and offers information on adaptive fishing equipment. The Chippewa Valley Chapter holds an annual two-day fishing event in Holcombe, Wisconsin.

    8. Senior Cooking Classes

    Classes focusing on how to prepare meals is an opportunity to socialize, learn about nutrition, and increase self-sufficiency.

    Examples:

    Men Who Cook: This program does not appear to still be active. However, it appears that it was successful in Broome County, New York. This cooking and nutrition class focused on men caring for ailing partners and widowers.

    Senior Chef: This eight-session cooking and nutrition class is led by Age Concern, a charitable organization in Otago, New Zealand. The free course includes tips on nutritious and economical meal planning, and participants get to eat what they prepare.

    9. Brain health classes

    Brain health classes usually focus on maintaining cognitive function through brain teasers and critical thinking exercises. Evidence for these types of programs is mixed, so programs are often “evidence-informed.”

    Examples:

    Brown County’s ADRC implemented BE! Brain Enrichment Course. They offered four ten-week courses to approximately 80 participants. Two facilitators, one of which was an intern, were recruited. This program is not evidence-based.

    Barron, Rusk & Washburn Counties’ ADRC implemented Breakfast for your Brain. This was a 20-month pilot with monthly meetings limited to 20 participants. The ADRC made all necessary copies and took registrations. The program included brain teasers and exercises, provided healthy snack samples and recipes for people to take home.

    10. Healthy Aging Lecture Series

    Lectures or seminars can be a way for older adults to continue learning about healthy aging, common medical issues and resources available in the community. Seminars and lectures are typically held in locations where older adults live or congregate.

    Examples:

     Wisconsin Alumni Association’s Healthy Aging Series: This lecture series is free and open to the public, and is held at the Capitol Lakes Retirement Community in Madison, Wisconsin. It features the expertise and research of UW-Madison faculty, researchers and alumni to provide content on healthy aging.

    Independent Living Seminars: Age Concern, a charitable organization in Otago, New Zealand, delivers this program in conjunction with older adults, community services and support agencies. The seminars offer information, resources, and expert speakers on how to remain connected to activities, friends and community, how to live safely at home and maintain a healthy mind and body. Sessions are two-hours long, and free lunch is provided to attendees.

    11. Learning and living with technology

    Training and access to technology can help older adults remain connected. Technology allows individuals to manage and control aspects of daily life like medical information, ordering goods, and networking.

    Example:

    Building a Broadband Adoption Ecosystem in New York’s North Country: This project involved construction of a Senior Planet Exploration Center in a shopping mall to: provide training for six rural counties; design a technology “pod” for partner locations with access to laptops, tablets, video conferencing, and health devices; develop Senior Planet U, an online learning platform for older adults to connect with from home; and offer training in labs across the upstate New York region. This project was a collaboration between the organization Older Adults Technology Services (OATS) and private and public funders. OATS partners with government agencies, community-based organizations, advocacy groups, and corporations to engineer solutions to make technology accessible to older adults.

    Civic Engagement

     1. Volunteer time banks

    Volunteer time banks are networks of individuals who exchange services.  An individual “banks” the time they spend providing volunteer services to others, and can then redeem that time to receive services from other individuals in the network.

    Example:

    Onion River Exchange: The Reach Rural Elder Assistance for Care and Health (REACH) project was done in rural Vermont with goals very similar to HeART. REACH joined with an existing time bank in the Montpelier, Vermont area, the Onion River Exchange, to provide a supplemental program to address the needs of older and disabled adults. In their model, all members’ hours and talents are valued equally. For example, one hour of mowing a lawn could be cashed in for an hour-long cooking class. Here is a case study on the REACH project, which was funded by Community Innovations for Aging in Place.

    2. Mentoring of children and adolescents

    These types of programs involve adult volunteers mentoring children and teens, often in school settings.

    Example:

    Baltimore Experience Corps (Evidence-based): This program involves the placement of volunteers aged 60 and over in public schools in Baltimore, Maryland. Volunteers receive training and are placed as tutors for grades K–3. This program has been in place for 20 years, and has shown an increase in children’s testing scores on reading, as well as decreasing office referrals for behavioral issues. The program has grown to other urban areas throughout the U.S.  More information here.

    3. Workplace Policies to Support Older Workers

    Workplace policies can support the retention of older workers and prevent early retirement. The City of Stoke-on-Trent in England piloted an employment program to engage with older employees and increase retention. AARP published an article on this pilot on their website. This project was part of a larger study in the European Union about workplace innovation and policy to support and retain older workers.

    4. Wisconsin Department of Health Services Programs

    The Senior Corps has three programs designed to engage adults age 55 in volunteer activities in their community. The Senior Corps is part of the Corporation for National and Community Service, the federal agency that leads volunteer and related grant-making efforts in the United States. At a local level, the Wisconsin Department of Health Services runs Senior Corps programs. The three Senior Corps programs available in some counties in Wisconsin are Foster Grandparents, Senior Companion Program, and Retired and Senior Volunteer Program.  Not all of these programs are available in all Wisconsin counties, so there may be potential for expansion of these programs or similar services in your area.  Grant information is available through Serve Wisconsin.

    Foster Grandparents

    Adults over the age of 55 volunteer with minors, some with special needs, in different settings. Some volunteers may be eligible for a small stipend, reimbursement for transportation, meals during service, and accident and liability insurance while on duty.

    Retired and Senior Volunteer Program (RSVP)

    This program helps adults over the age of 55 find service opportunities in their community based on their personal interests and skills. Projects may be in schools, police stations, hospitals, recreation centers, etc.

    Senior Companion Program

    This program arranges for adults age 60 and over to provide assistance and companionship to homebound adults. This program aims to increase social contact for homebound adults; helps keep adults in their home by providing assistance with chores, shopping, transportation, etc.; and provides respite for live-in caretakers.

Healthy Aging in Rural Towns – HeART

How can communities support older adults and their caregivers to thrive in rural areas, while leveraging the benefits of rural living and minimizing issues such as lack of health care providers, scarce public transportation and social isolation? Three Wisconsin communities – Iowa County, Landglade County, and the city of Waupun – want to meet that challenge.  Find out how CARE is collaborating with these communities and the Wisconsin Office of Rural Health to improve the livability of their communities for older adults and their caregivers. Read about their work below.

Nursing students and older adults in northern Wisconsin

HeART Advisory Group

Ralph Beck, Chief Operating Officer, United Healthcare Community Plan – WI

Pamela Crouse, Former Director of Clinical and Quality Improvement, Wisconsin Primary Health Care Association (WPHCA)

Pamela Guthman, Clinical Assistant Professor, UW-Eau Claire and UW-Madison

Jeremy Levin, Advocacy Director, Rural Wisconsin Health Cooperative

Kristin Litzelman, Assistant Professor/State Specialist, Family Living Programs, Human Development and Family Studies, School of Human Ecology/UW Cooperative Extension

Jane Mahoney, Older Americans Act Consultant – Caregiving Specialist, Greater Wisconsin Agency on Aging Resources

Kathryn Miller, Outreach Specialist, Wisconsin Office of Rural Health