Promoting Equity in the Distribution of Innovations in Long Term Services & Supports: The Role of Grass-Roots Models

Background and purpose: The Village model is an innovative initiative to support aging in place that has spread rapidly across communities in the US. Villages are grass-roots, self-governing, community-based, member-driven organizations that coordinate access to services, offer vetted discounted providers, and directly provide select services to support older adults to remain in their homes as they age. However, distributive justice concerns have arisen related to access to such innovations in a variety of communities. Past research has demonstrated that access to health care innovations is inequitably distributed to people with greater income, knowledge, power and prestige and this contributes to disparities in health care (Phelan & Link, 2001). Furthermore, research has shown that health disparities are widely influenced by place, that is, poor access to protective factors and heightened exposure to risk factors where one lives (LaVeist, et al., 2012). Given the community-based focus of Villages, a critical question is whether such programs have the potential to address or exacerbate disparities in access to long term services and supports.

Methods: This paper presents results from the first national survey of operational Villages (N=69; 86% response rate), which was conducted in 2012 as part of a larger survey of community aging initiatives. The survey consisted of both open and closed-ended questions administered via telephone interviews with the Village director. Both quantitative and qualitative methods were used to analyze the data. This presentation will focus on Villages’ ability to engage diverse participants, the factors associated with member diversity, the challenges they report in doing so and the strategies employed to enhance member diversity.

Results: Members of Villages in our sample were predominantly white and of middle to upper income. Overall, the members were less diverse racially/ethnically and economically than the general 65+ US population. Factors associated with greater member diversity, including location, program size, and ability to offer discounted memberships, will be discussed. In addition, we will present Villages’ strategies and challenges to enhancing diversity,  including: employing multilingual or culturally concordant staff/volunteers, offering ESL classes, offering discounted or sliding fee memberships, and outreach to other organizations/groups serving low-income or racial and ethnic minorities.

Conclusions and Implications: The presentation will conclude with implications for expanding access to such innovative models in less-resourced communities, including the role of social work in facilitating these community-based empowerment models. Policy implications to enhance equitable access to services and supports that promote aging in place will also be discussed.