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Rose Finkelstein (left), who turns 100 next week, and Lillian Stanger have benefited from an array of services that are offered at The Village at Brookline apartment complex.
Rose Finkelstein (left), who turns 100 next week, and Lillian Stanger have benefited from an array of services that are offered at The Village at Brookline apartment complex. (John Tlumacki/ Globe Staff)

A senior-care concept redefines community

At-home services brighten lives

There's a new sense of security and community at a Brookline apartment complex where more than 180 seniors live.

Rose Finkelstein, who will turn 100 next week, regularly greets visitors to one of the buildings. Residents who previously kept to themselves gather every Tuesday to head to the supermarket together. Many drop down to the lobby to see a nurse practitioner who stops in once a week. And a social worker checks on those who haven't been seen out and about.

The services and camaraderie mimic assisted-living centers , but this was never designed as a retirement community. The Village at Brookline is a privately owned, federally subsidized apartment complex that's part of a national movement to bring services to seniors where they live, allowing them to grow old in familiar and comfortable surroundings.

This part of the movement serves ``naturally occurring retirement communities" that can form in apartment buildings, condominium complexes, and neighborhoods of private houses as residents age.

The communities were named by a Wisconsin professor who first noticed the trend in 1984. In each community, residents help determine what health and social services they need to stay well and live independently. Federal, state, and private funding subsidizes the services, which are provided by public and private agencies.

The programs, which are open to all members of the community regardless of income, are more comprehensive than the homemaking and home-health services the state provides to individual low-income seniors in their homes. Typically, the programs also include social and educational activities designed to reduce isolation and build community, as well as transportation, preventive care, exercise, and one-on-one help managing everyday problems.

Six such communities are serving more than 1,000 residents in Massachusetts, and money in the state budget will help fund several more. Nationally, more than 80 are thriving, driven by the boom in the over-65 population.

``This is one of the best ways to take care of seniors," said Rimma Zelfand, who oversees programs in Brookline and Malden. ``We do all we can to help them age well at home."

The program in Brookline, which began in late 2004, rescued Lillian Stanger after her husband died early last year. At 83, she had lived in the Village for 22 years, but she barely knew her neighbors. She fought to maintain her independence as spinal arthritis and fractures from osteoporosis made it difficult for her to run errands or get groceries. Stanger slipped into depression fueled by loneliness.

Social worker Donna Tarutz, who runs the program at the Village, reached out to her, offering a friendly ear and a link to a free shopping service provided by Brookline high school students. Tarutz arranged for subsidized housekeeping and coaxed Stanger to join a twice-weekly exercise class. She is helping Stanger manage her diabetes through a weekly cooking class and a dietician.

``Now, I have friends and family here," Stanger said, as she sat with Finkelstein on a couch in the building's living-room lobby. ``I like knowing I'm in charge of my life, but it's wonderful having a support system. I never feel hopeless or neglected. I feel cared for."

This model grew out of a program in New York City in 1986, where privately funded services were brought into a large apartment complex. A decade later, New York state and then New York City chipped in, and the programs now include 49,000 seniors, according to the United Hospital Fund of New York, a philanthropy that researches and supports healthcare initiatives. The concept spread nationwide with $22 million earmarked by Congress.

In 2004, Massachusetts' delegation secured nearly $800,000 over two years to establish pilot programs in Brookline, Malden, and Swampscott run by Jewish Family & Children's Service and its affiliates, which already had a large home-care program serving seniors of all backgrounds.

In Malden, many Chinese and Russian immigrants live in the two apartment buildings in the program, so translation is a big component of the services. A social worker meets regularly with residents to help manage their medical needs. In Swampscott, the program was established at the Summit Estates condominium complex on Route 1A, as a pilot in a middle-income community. About 75 percent of the condo residents are seniors.

Social programming ranges from book clubs and coffee klatches to computer and exercise classes. Some communities also bring in nutritionists to help seniors plan meals, while others offer health screening or a free weekly consultation with a nurse. Most have a staff member who helps seniors arrange other services, at a discount, to meet their needs, including house-cleaning, laundry, shopping, and health care.

Despite the successes, the federal money will run out at the end of August because fiscal conservatives in Congress blocked funding for a range of projects, including the naturally occurring retirement communities. Other members of Congress are pushing for permanent funding through the Older Americans Act, but the Bush administration has questioned whether the programs are the most efficient use of money.

``The concepts have a lot of potential, but people are duplicating activities," said Frank Burns, deputy assistant secretary of the US Administration on Aging. He said that similar referral and case-management services are already being provided by state and federally funded agencies and that the money would go further if spending is consolidated.

In Massachusetts, similar services are provided by the state through its $3.7 million supportive housing program, which operates in 22 public housing projects and will expand to eight more this fiscal year.

At these buildings, staff who provide personal care and homemaking services are on site 24 hours a day. A case manager helps link seniors with additional services, and contractors provide one meal a day. But these comprehensive services are not available to most seniors in private apartment buildings or houses, which are the focus of the new programs.

State lawmakers included $375,000 for naturally occurring retirement communities in the budget signed by Governor Mitt Romney two weeks ago, although they have yet to pass another measure that would entitle low-income seniors on Medicaid to more free home care. The budget funds the sites in Brookline and Malden and several new locations in Framingham, one of which began last year with private money.

``The Legislature is interested in programs that will help people remain in their residences and provide support services in a way that enhances the quality of life," said Representative Deborah Blumer, a Framingham Democrat, who lobbied for the funding. ``It's a lot less expensive to do that than to put people in nursing homes or other intensive, expensive settings."

But the budget inexplicably left out Swampscott. As state lawmakers and US Representative John F. Tierney continue lobbying for funding, the Positive Aging program in Swampscott is seeking private funding.

Private funding and fees from members are already sustaining Beacon Hill Village, a more spread-out naturally occurring retirement community that now serves 380 residents in and near Beacon Hill.

But the Swampscott program doesn't think it can raise money quickly enough to avoid scaling back services and reducing subsidies for home health care.

Sally Sugarman is crestfallen about the coming cutbacks. She has used the subsidized housekeeping services because of a bad hip, has joined a knitting and crafts group, and has thrived on the new social connections.

``This has opened up a whole new world for many of us," said Sugarman, who is 85. ``We feel alive and glad to be together. There is going to be quite a lot missing."

Alice Dembner can be reached at Dembner@globe.com.

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