The funding crunch
From 2002-2010, Congress funded NORC program grants under a provision in the Older Americans Act, pouring about $30 million into pilot programs across the country. But since the programs ended, federal funding is no longer available.
"They're doing well in places that have been hotbeds for thinking about senior issues," Greenfield says. "In New York, for example, it's a permanent line item in state and city budgets, and has been for some time.
"Nationally it's more mixed, but the fact that many have kept going is encouraging," she adds. "A lot are really committed to the model, even if they don't have the budgets they had before."
"I remain convinced that this is a very good model," Vladeck says, "but without sufficient funding, I am not optimistic it will reach its potential."
Meanwhile, conventional care for seniors is costly, with nursing home and assisted living facilities beyond the reach of most. Just 8 million Americans have some form of long-term care insurance coverage, according to the American Association for Long-Term Care Insurance, and Medicaid generally picks up the tab, with seniors relegated to a government-certified facility.
"We're going to need to get serious as a country at some point about the investment that needs to be made in our communities," says Vladeck. "The role of NORCs in the lives of their residents is to reweave the social fabric of the community."