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Journal of Gerontological Social Work

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Resident-Managed Elder IntentionalNeighborhoods: Do They Promote SocialResources for Older Adults?

Anne P. Glass

To cite this article: Anne P. Glass (2016) Resident-Managed Elder Intentional Neighborhoods:Do They Promote Social Resources for Older Adults?, Journal of Gerontological Social Work,59:7-8, 554-571, DOI: 10.1080/01634372.2016.1246501

To link to this article: http://dx.doi.org/10.1080/01634372.2016.1246501

Accepted author version posted online: 17Oct 2016.Published online: 17 Oct 2016.

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Resident-Managed Elder Intentional Neighborhoods: DoThey Promote Social Resources for Older Adults?Anne P. Glass

School of Health and Applied Human Sciences, College of Health and Human Services, University ofNorth Carolina Wilmington, Wilmington, North Carolina, USA.

ABSTRACTSocial isolation has serious negative public health impacts forolder adults. Survey data were collected at three resident-mana-ged elder intentional neighborhoods in the United States (n = 59),to determine if these neighborhoods, each based on the cohous-ing model, promote development of social resources for theirresidents. Social resources were measured on three dimensions:social networks, neighborly support, and satisfaction with theneighborhood community. Respondents were White, mean ageof 73.3 (range = 63–91), primarily female (76.3%), and generallyhad high levels of education and self-reported health. Almost half(47%) were never married/divorced and 37% were childless.Inclusion of neighborhood ties ameliorated risk of social isolation.Satisfaction with support and a variety of neighboring behaviorswere reported. These neighborhoods are meeting the needs of apotentially at-risk population as an avenue to promote socialresources and reduce social isolation. The implications for geron-tological social workers include a role in helping to mobilize andsupport these types of neighborhoods as a way to encouragemutual support among older adults. With the increase in theaging population, such models of proactive interdependenceand communal coping have the potential to lessen or delay thedemands that socially isolated elders place on social workers.

ARTICLE HISTORYReceived 31 May 2016Revised 4 October 2016Accepted 5 October 2016

KEYWORDSSenior cohousing; mutualsupport; social isolation;living arrangements;community

The prevalence of social isolation among older adults is a significant public healthconcern. Evidence is mounting that isolation can have serious negative effects onthe health of older adults (Cacioppo & Hawkley, 2003; Cornwell & Waite, 2009;Tomaka, Thompson, & Palicios, 2006), and on their cognitive functioning(DiNapoli,Wu, & Scogin, 2014). The associated health risks are now thought tobe comparable to cigarette smoking and other significant high risk factors (Holt-Lunstad, Smith, Layton,&Brayne, 2010). Social isolation is considered an objectiveexperience typified by a “reduced support network size and low frequency of socialcontacts” (Cloutier-Fischer, Kobayashi& Smith, 2011, p. 407). Generally, the socialnetworks of older people tend to decrease and it is more difficult for them to buildnew networks (Pettigrew, Donovan, Boldy, & Newton, 2014; Wrzus, Hanel,

CONTACT Anne P. Glass, PhD glassa@uncw.edu Professor and Gerontology Program Coordinator, Schoolof Health and Applied Human Sciences, College of Health and Human Services, University of North CarolinaWilmington, 601 S. College Road, Wilmington, NC 28403, USA.

JOURNAL OF GERONTOLOGICAL SOCIAL WORK2016, VOL. 59, NOS. 7–8, 554–571http://dx.doi.org/10.1080/01634372.2016.1246501

© 2016 Taylor & Francis

Wagner, & Neyer, 2013). Various estimates of the prevalence of social isolationamong older adults range between 10% and 40% (Lubben et al., 2006; Nicholson,2012; Rubenstein, Lubben, & Mintzer, 1994). People who are socially isolated aremore likely to require assessment and support from social workers (Lubben &Gironda, 2003), so any interventions that help alleviate social isolation have thepotential to relieve demands on overstretched social workers. Evaluation of inter-ventions designed to address social isolation has been challenging, due to theheterogeneity of both the individuals (Machielse, 2015) and programs (Dickens,Richards,Greaves, & Campbell, 2011). This evaluation of the role of a new housingalternative in promoting social resources for older adults adds to this literature.

Of those aged 65 and above residing in the community, over 12 million (28%)lived alone in 2013 (Administration on Aging, 2013). Merely living alone does notnecessarily indicate that an individual is isolated, but it is a risk factor (Greenfield& Russell, 2011; Portacolone, 2013). Little attention has been given to childlessolder adults, who have been called an invisible population (Dykstra & Hagestad,2007), yet the numbers who are childless will accelerate with the Baby Boomers(National Center forHealth Statistics, 2005). One third of Boomers are unmarried,with most of these living alone and either never married or divorced (Lin &Brown, 2012). Older adults who never married and those who are childless aremore likely to have friends as a source of help (Barrett & Lynch, 1999) and/or toend up in institutions (Freedman, 1996). Research on ways in which oldercommunity-dwelling friends and neighbors help each other (e.g., Barker, 2002)has not received wide attention, but considering the growing older populationwithout family to care for them, the prospect of nonkin peer support is crucial toexamine. This study adds to the field of gerontological social work by addressingthe dearth of research on support among unrelated older neighbors, as well as thegenerally neglected impact of the neighborhood environment on the lives of olderadults (Krause, 2006; Wrzus, Hanel, Wagner, & Neyer, 2013).

Observers have expressed concerns about the lack of social interaction andsense of community in the United States (e.g., McPherson, Smith-Lovin, &Brashears, 2006; Stafford, 2009).Wrzus et al. (2013) noted that studies of neighborsocial networks are scarce and urged that such studies are important lines of futureresearch. The role of the neighborhood expands as an individual ages (Greenfield,2016; Krause, 2006), and neighbors become increasingly important as peoplebecome more “neighborhood-bound” (Lubben & Gironda, 2003, p. 325). Oneof many questions still unresolved is what kinds of environments and neighbor-hoods strengthen the social resources of older adults.

The environment is the foundation for the development of social capital, which, inturn, mobilizes needed resources and supports for older adults. An environmentcan either increase social capital by providing support to network building ordecrease social capital by restricting access to available or potential resources (Luo,2016, p. 18).

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In a study of Chinese elders living in two types of settings, Luo (2016) founda difference in their interactions with their peer neighbors. One housingsetting was specifically for Chinese older adults; the other was a more hetero-geneous, mainstream arrangement. Despite the greater homogeneity in thefirst site, friendships among neighbors were not supported due to a lessinviting environment that was unclean and had few windows, and by a lackof trust in the management. Not specific to older adults, Wilkerson andcolleagues (2012) found that neighborliness “increases with the cumulativepresence of physical-environment characteristics that provide semiprivatespace for informal interaction, including front porches, continuous sidewalks,and freedom from high-traffic streets, bars on windows, and litter and graffiti”(pp. 605–606). Farrell, Aubry, and Coulombe (2004) also noted that physicalaspects of the neighborhood, including proximity of homes and orientation ofdoors, can affect neighboring behavior. They encouraged city planners to “findways to facilitate increased opportunities for neighbors to interact with eachother, thus increasing their sense of community” (p. 22). The results of theirstudy also show the importance of neighborhood stability in fostering neigh-boring behaviors and sense of community.

A new housing option has emerged in the past decade that has the promise ofpromoting social resources for older adults, while allowing them to live indepen-dently in intentional neighborhoods they developed and manage themselves. Theterm neighborhood is used in this sense: “neighborhood refers to a geographic unitof limited size, with relative homogeneity in housing and population, as well assome level of social interaction and symbolic significance to residents” (Weiss,Ompad, Galea, & Vlahov, 2007, p. S154). Although the neighborhoods understudy are based on the cohousing model, I am calling them resident-managedelder intentional neighborhoods (REINs) to more precisely describe them. Thisevaluation, whichwas part of a larger study, is designed to answer the question: Dothese intentional neighborhoods deliver on the promise of providing an environ-ment that strengthens social resources for residents?

The cohousing model

In the past decade, a new alternative living arrangement has emerged in theUnited States, in which older adults proactively choose how they want tolive, in a close-knit community where neighbors look out for each other.Thus far, at least 10 such REINs exist, each adapting the cohousing model,a concept borrowed from the Dutch “living group” (Brenton, 2008, p. 9).Older people, themselves, envision and implement the arrangement, withno administrator setting the rules. These arrangements hold the potential toenrich residents’ lives in many ways, one of which is the possibility ofstrengthening their social resources.

556 A. P. GLASS

Earlier American cohousing has been intergenerational, although seniorcohousing is well established in Northern Europe (Brenton, 1998; Choi, 2004).Dutch elder cohousing studies found neighborhoods averaged 20–30 units, with24 units suggested to be ideal (Brenton, 1998). Each neighborhood has acommon house where meals are shared one or two times a week. The physicaldesign is typically meant to foster social contact and a sense of community,through the close proximity of the units and the need to walk past one’sneighbors to get to one’s car (McCamant & Durrett, 1994). In each case, acore group came together and started to create a sense of community as plans forthe physical structure were discussed. The residents self-manage the commu-nities, with decisions usually made by consensus.

Mutual support in REINs

The concept of elders helping take care of each other is a noninstitutionaland nontraditional approach. It opens the possibility for provision of mutualsupport that would, through interdependence, simultaneously encouragemore independence at more advanced ages. In another setting, Brown andcolleagues (2003) found that elders who provide support may, themselves,gain more in health benefits than those who receive support. Gottlieb andBergen (2010) further observed that for many people, the sense of perceivedsupport is as important as the actual support they receive. Support is also tiedto greater feelings of safety and security, and researchers, including Pain(2000), have advocated that local social relationships play an important rolein reducing feelings of unsafety. Feeling safe and secure is greatly valued byolder adults (Parmelee & Lawton, 1990). A conceptual model of aging bettertogether intentionally (Glass & Vander Plaats, 2013) theorizes that thesefoundations first need to be present: (a) elder only, (b) aging is viewed as astressor, (c) there is both a shared solidarity in aging and (d) openness toaging; and (e) people are living in close proximity. Then, through theprocesses of frequent interaction and communal coping, positive outcomes,such as mutual support and feelings of security, can occur. This explanatorymodel has already been tested in a REIN.

Of the three REINs, Neighborhood A has embraced mutual support as avalue from the beginning, and combined with a longer history, it is the mostevolved in determining ways to promote it. Four essential componentsnecessary to help a neighborhood of mutual support succeed have beenidentified. The components are the degree to which individuals are ableand willing to (a) provide help to their neighbors; (b) ask for help whenneeded, and (c) accept help. Additionally, (d) individuals must take respon-sibility for their own self-care (Glass, 2013).

In the first years of existence, Neighborhood A relied on a buddy system, withthe buddy being the next-door neighbor. Due to concerns that a single neighbor

JOURNAL OF GERONTOLOGICAL SOCIAL WORK 557

could get burned out, however, this REIN developed the idea of each residentchoosing one or two neighbors to be their health care coordinators (HCCs).When individuals require assistance due to illness or hospitalization, they needonly ask their HCCs to solicit meals, visitors, or whatever is needed, on theirbehalf. Thus, individuals do not, themselves, have to call all over the neighbor-hood to arrange for help, at a time when they are not well. This process hascontinued to evolve and the current term now in use is neighborly supportcoordinators. Although the other two neighborhoods have been responsive toneeds of their neighbors, this response has been more loosely organized;Neighborhood B recently assigned care partners, and Neighborhood C has aHealth and Wellness Committee. However, many of the neighboring behaviorsin all three REINS occur informally.

Research design

“One key to building a supportive environment for older adults is the creationand improvement of the infrastructure that supports familiar social networks”(Luo, 2016, p. 19). One can now begin to evaluate if these new REINs areachieving the goal of becoming environments that promote social resources.This research was conducted on-site at three REINs, one in the eastern UnitedStates and two in the western United States, which will be labelled A, B, and C.Do these intentional neighborhoods deliver on this promise of providing asupportive environment that strengthens social resources for residents? Todetermine an answer, I focused on collecting quantitative measures of the socialnetwork, with specific attention to the neighbors; the ways these neighbors arehelping each other; and their satisfaction with this neighborly support.

Research sites

Neighborhood A has 29 units, with most units oriented to the common greenspace. Thirteen one-story houses are grouped in duplexes and triplexes on oneside of the space, with 16 income-eligible rental units in two-story buildings onthe other. Second-floor units face away from the common space and haveparking at the front door, with back decks overlooking the common area.Other residents park in lots at either end of the community. Additionally, twoof the original planners have lived in a house adjacent to the property for yearsbefore the community was physically constructed. Two other women havemoved into an apartment in this house. These four individuals are very involvedwith the community, thus adding two more units, to make 31 the total numberof units on campus, housing 36 residents. At the time of data collection, thisneighborhood had been open seven years.

Neighborhood B is comprised of six pods, each of which contain fourapartment units of varying sizes, for a total of 24 one-story units. The four

558 A. P. GLASS

units are the same in each pod but are arranged in different configurations.This community of 31 residents was able to use an existing house on theproperty as the common house, with remodeling to add a spacious kitchen anddining room. Carports for all units are to one side of the common house. At thetime of data collection, this neighborhood had been open less than two years.

The 28 one-story duplex units of Neighborhood C are laid out in tworows, and the primary common space is a lot to one side of the commonhouse. Thirty-one residents live here. Cars are parked on the perimeter ontwo sides of the community. At the time of data collection, this neighbor-hood had been open four years.

Methods

The approval of the University of Georgia Institutional Review Board to conductthis research was obtained. The data reported here were collected at the threeREINs by surveys during 2013 to 2014 as part of a larger study. The researchertravelled to each site and was able to spend one to two nights at each site whileconducting the research, with full cooperation from neighborhood residents.Residents received notice of the study from their residents’ associations. AllREIN residents were potential participants. Data was collected from a conve-nience sample targeting the residents attending a common meal. Informedconsent was reviewed and obtained, participation was voluntary, and responseswere confidential. If an individual did not have time to complete the survey afterthe dinner, or wanted to participate but was not at the dinner, arrangementsweremade for them to complete a survey at home and return it to the researcher.The survey addressed basic demographic data, as well as self-reported physicaland mental health. In addition, measures of three types of social resources wereincorporated: social networks, neighborly support, and satisfaction.

Social resourcesSocial networks. The Lubben Social Network Scale (LSNS), designed for usewith older adults, was utilized. Low scores indicatemarginal ties and increased riskof social isolation, and have been associated with negative effects on cognition(DiNapoli et al., 2014) and on physical health and mortality (Hawton et al., 2011).The LSNSs are available online with permission to use (Boston College, 2011). Theoriginal scale (LSNS-18) has six questions for each of three categories: family,neighbors (who live in your neighborhood), and friends (those who do not live inyour neighborhood). With responses coded from zero to five, the total possiblescore is 90, with lower scores indicating more risk. Lubben and colleagues (2006)later revised and tested a six-item version (LSNS-6), with three items related tofamily and three items related to friends. These items are: “How many [relatives/friends] do you see or hear from at least once a month?” “How many [relatives/friends] do you feel at ease with that you can talk about private matters?”, and

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“How many [relatives/friends] do you feel close to such that you could call onthem for help?” The LSNS has been used since the 1980s and has been extensivelytested and validated (Gottlieb & Bergen, 2010; Lubben & Gironda, 2003); speci-fically, the internal consistency for the LSNS-6 and the subscales has beendocumented to be between .80 and .89 across multiple sites (Lubben et al.,2006), and it has strong validity. The LSNS-6 was used here, but because of myparticular interest in this study concerning the distinction between neighborsversus friends outside the neighborhood, the differentiation made in the originalLSNS-18 scale was maintained. Thus, a third parallel set of three items was addedregarding cohousing neighbors, distinct from other friends. The differentiationbetween friends and neighbors made it an ideal instrument for this study.

Neighboring support. Neighboring, a behavioral measure commonly consid-ered to reflect the exchange of social support between neighbors, can involveoffering three types of support: functional/instrumental, personal/emotional, orinformational (Kahn & Antonucci, 1980; Weiss, 1982). A list of specific neigh-boring tasks reflecting these three types of support was created for this research,similar to the list developed and tested by Farrell et al. (2004), who built uponscales used in prior research (e.g., Unger &Wandersman, 1985).Whereas Farrelland colleagues asked only about what help was given, the respondents in mystudy were asked to report what types of help they had both given to andreceived from their neighbors in the REIN. Eight of the 13 types of help listedin the survey were instrumental: providing rides, lending/borrowing things,helping with household maintenance, responding to an emergency, preparingmeals, picking up mail, looking out for others on a daily basis, and providinghands-on care. Three tasks reflected emotional support: going with a neighbor toa doctor’s appointment, visiting at the hospital, and listening and providingsupport when needed. Informational support was represented by two tasks:giving/receiving information about a doctor or other professional service, andsharing knowledge or advice to help someone.

For the following four statements, respondents were asked about their agree-ment with each, with a response set from strongly agree to strongly disagree: (a)“We depend on each other for support here.” (b) “My neighbors and I look outfor each other.” (d) “I have a neighbor who I can count on as my carecoordinator or “buddy” to help me get help if I need it.” (d) “Living heremakes me feel safe.”

Satisfaction with the neighborhood community. Finally, questions about satis-faction with the following seven items related to the neighborhood and supportwere included: (a) living with friends and compatible people; (b) mutual support(helping self and each other); (c) security and safety from crime; (d) sense ofcommunity/feeling part of the community; (e) socializing/companionship; (f)someone close by to help in an emergency; and (g) overall satisfaction. Possible

560 A. P. GLASS

responses were very satisfied, somewhat satisfied, somewhat dissatisfied, andstrongly dissatisfied.

AnalysisThe LSNS was analyzed separately by each of the three subcategories—family,friends, and neighbors—as well as in the three possible combinations: family/friends, family/neighbors, and friends/neighbors. A final summative score acrossall three domains was also calculated. The numbers and percentages at risk ofsocial isolation are reported. For the other measures, reliability was calculatedand reported, using Cronbach’s alpha. Descriptive statistics are reported for allresults. Descriptive statistical data are appropriate at this point; this was a pilotstudy, little comparable data exists, and the sample is small. Future larger scalestudies could provide inferential statistics.

Results

Description of the sampleThe sample included 23 respondents from Neighborhood A, 23 fromNeighborhood B, and 13 from Neighborhood C, for a total sample size of 59(see Table 1). The overall response rate was 60.2%, with response rates varyingacross the three sites from 41.9% to 74.2%. The mean age was 73.3 (SD = 7.2)with a range from 63 to 91. All respondents were White and the majority werefemale (n = 45, 76.3%) and highly educated, with almost three-quarters (n = 43,72.9%) having at least some graduate work. The majority also reported being invery good to excellent physical (n = 41, 69.5%) and mental (n = 45, 77.6%)health. Income varied widely, with almost half (n = 27, 46.6%) reporting incomesless than $35,000, and almost one-quarter (n = 13, 22.4%) reporting incomes of$75,000 or higher. Half (n = 27, 47.3%) of the respondents were divorced/nevermarried; almost two-thirds (n = 36, 63.2%) had children. All were independentin their activities of daily living.

Social resourcesSocial networks. Each item on the LSNS is scored from zero to five; scores on athree-item scale range from zero to 15, from zero to 30 for a six-item scale, andfrom zero to 45 for the complete nine-item scale used in this study. Lower scoresindicated greater risk of social isolation. Fifty-one respondents answered all nineitems. Overall means (Table 2) ranged from 6.84 (SD = 3.5) for the three-itemfamily subscale, to 10.98 (SD = 1.9) for the neighbor subscale. The mean for thetotal nine-item scale equaled 25.53 (SD = 6.6).

For the three-item scales, using scores of less than six to identify those at riskof social isolation, per Lubben et al. (2006), 32.1% and 21.1% were at risk whenlooking at the family scale and the friends scale respectively (Table 3). No one

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scored under six on the neighbors scale. For the six-item scales, using the cutpoint of less than 12 (Lubben et al., 2006), 25.5% were at risk of social isolationwhen looking at the family/friends scales combined. Adding the neighbormeasure to the family or to the friends subscale reduced the percentage at riskto less than 10%, or 9.6% and 9.4% respectively. For the total LSNS scorecombining the three subscales, with less than 16 as the cut point, five respon-dents (9.8%) were at risk of social isolation.

Table 1. Demographic characteristics of participants.Neighborhood A B C Total

Mean age (SD) 75.5 7.6 71.7 7.2 72.4 5.5 73.3 7.2Range 64–91 63–88 66–84 63–91

Mean age at move-in (SD) 69.8 7.5 69.9 7.2 68.8 4.1 69.6 6.7Range 56–87 61–86 63–79 56–87Female n (%) 19 82.6 16 69.6 10 76.9 45 76.3

Marital status n (%)Never married 5 21.7 3 13.6 2 16.7 10 17.5Married/partner 5 21.7 12 54.6 2 16.7 19 33.3Divorced/separated 7 30.4 4 18.2 6 50.0 17 29.8Widowed 6 26.1 3 13.6 2 16.7 11 19.2

Children n (% yes) 13 59.1 16 69.6 7 58.3 36 63.2Education n (%)High school graduate 2 8.7 0 0.0 0 0.0 2 3.3College 4 17.3 6 26.8 4 30.8 14 23.6Post graduate work 17 73.9 17 73.9 9 69.3 43 72.8

Income n (%)< $35,000 14 63.6 1 21.7 8 61.5 27 46.6$35,000 to < $75,000 6 27.3 8 34.7 4 30.8 18 30.9$75,000 + 2 9.1 10 43.5 1 7.7 13 22.4

Self-reported Health n (%)Physical HealthExcellent 1 4.3 8 34.8 3 23.1 12 20.3Very Good 13 56.5 10 43.5 6 46.2 29 49.2Good or Fair 9 39.1 5 21.7 4 30.8 18 30.5

Mental HealthExcellent 3 13.0 8 36.4 7 53.8 18 31.0Very Good 13 56.5 10 45.5 4 30.8 27 46.6Good or Fair 7 30.4 4 18.1 2 15.4 13 22.4Sample size 23 23 13 59

Table 2. Lubben Social Network Scale means and standard deviations by site and sub-scaleA B C Total

Neighborhood M SD M SD M SD M SD

3-item Family Sub-Scale (n = 56) 6.41 2.7 8.48 3.7 4.92 3.5 6.84 3.53-item Friend Sub-Scale (n = 57) 7.00 2.8 8.10 4.1 8.38 2.4 7.72 3.33-item Neighbor Sub-Scale (n = 54) 10.81 1.5 11.29 2.3 10.75 2.0 10.98 1.96-item Family/Friend Sub-Scale (n = 55) 13.36 4.6 16.75 6.6 13.31 3.7 14.58 5.46-item Family/Neighbor Sub-Scale (n = 52) 17.45 2.9 19.80 4.9 15.42 4.2 17.88 4.46-item Friend/Neighbor Sub-Scale (n = 53) 17.71 3.5 19.25 6.0 19.08 3.3 18.60 4.59-item Total Scale (n = 51) 24.30 5.1 27.95 8.4 23.75 4.4 25.53 6.6

Notes: Lower scores on the Lubben Social Network Scales indicate marginal ties and more risk of socialisolation. Total possible score = 15 for three-item sub-scales, 30 for the six-item sub-scales, and 45 for thecombined 18-item scale.

562 A. P. GLASS

Neighboring support. The most common types of reported neighboringbehaviors (Table 4), both given and received, were sharing of knowledge tohelp someone (informational), lending/borrowing things (functional), andlistening/supporting when someone had a personal problem (emotional).The least common types of neighboring help reported were visiting someonein the hospital and providing hands-on personal care. The tasks are listed inthe table in order from those with the highest percentages to lowest percen-tages in both lists. Internal consistency among the 13 items in the gave helplist was .794. There were too few instances of receiving help to be able tocalculate a Cronbach’s alpha for these items.

Reliability for the four statements related to neighboring support wasacceptable with a Cronbach’s alpha of .765. When responses from all siteswere combined, there was strong agreement for each of the statements. For“We depend on each other for support here,” the majority (89.7%) strongly(n = 24, 41.4%) or somewhat (n = 28, 48.3%) agreed. Similarly, 95% strongly(n = 28, 47.5%) or somewhat (n = 28, 47.5%) agreed with the statement, “Myneighbors and I look out for each other.” A comparable majority (94.9%),including an even higher percentage of strongly agree (n = 36, 62.1%),concurred with the statement, “I have a neighbor who I can count on asmy care coordinator or ‘buddy’ to help me get help if I need it.” “Living heremakes me feel safe” also received solid support, with 87.3% strongly (n = 28,47.5%) or somewhat (n = 28, 47.5%) in agreement.

There were differences across sites, however. Most notably, over 20% ofrespondents at Neighborhood C strongly or somewhat disagreed with three ofthe four statements. The only statement that received less than 10% disagree-ment at Neighborhood C was, “My neighbors and I look out for each other.”In contrast, there was zero disagreement reported at Neighborhood B withany of the statements. Neighborhood B also had the highest percentage ofmarried couples as well as the highest scores on the family-related network

Table 3. Lubben Social Network Scale: number and percentage considered to be at risk of socialisolation by site and sub-scale

A B C Total

Neighborhood n % n % n % n %

3-item Family Sub-Scale (n = 56) 6 27.3 4 19.1 8 61.5 18 32.13-item Friend Sub-Scale (n = 57) 4 17.4 6 28.6 2 15.4 12 21.13-item Neighbor Sub-Scale (n = 54) 0 0.0 0 0.0 0 0.0 0 0.06-item Family/Friend Sub-Scale (n = 55) 6 27.3 4 20.0 4 30.8 14 25.56-item Family/Neighbor Sub-Scale (n = 52) 1 5.0 1 5.0 3 25.0 5 9.66-item Friend/Neighbor Sub-Scale (n = 53) 2 9.5 3 15.0 0 0.0 5 9.49-item Total Scale (n = 51) 3 15.0 2 10.5 0 0.0 5 9.8

Notes: Lower scores on the Lubben Social Network Scales indicate marginal ties and more risk of socialisolation. Identification of those at most risk is made by using the following cut points: < 6 for three-itemscales (total possible score = 15); <12 for the six-item scales (total possible score = 30); and < 16 (totalpossible score = 45) for the combined 18-item scale.

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Table 4. Neighboring behaviors: number and percentage of respondents who gave or receivedhelp from neighbors

A B C Total

Neighborhood n % n % n % n %

How I helped my neighbors (% Yes)Lent things 21 95.4 22 100.0 11 91.7 54 100.0I shared knowledge to helpsomeone

21 100.0 22 100.0 11 91.7 54 98.2

Listened and providedsupport when someonehad a personal problem

21 95.4 23 100.0 11 91.7 55 96.5

Helped with householdmaintenance, lifting, orfixing things

17 80.9 23 100.0 9 75.0 49 87.5

Given informationabout a doctor or otherprofessional service

21 91.3 18 78.3 9 81.9 48 84.2

Picked up mail or wateredplants

19 82.6 19 82.6 9 81.9 47 82.6

Provided meals, shoppedfor food

21 91.2 19 82.6 7 63.6 47 82.5

Provided ride to store,doctor, or other

18 81.8 18 78.3 10 83.3 46 80.8

Responded to emergency 20 95.2 12 54.5 10 83.4 42 76.3Looked out for others ondaily basis

17 77.2 19 82.5 6 50.0 42 73.6

Went with someone tohealthcare appointment

19 86.4 8 34.7 11 91.7 38 66.6

Visited someone inhospital

21 91.3 11 47.8 6 50.0 38 65.6

Hands-on personal care 15 68.1 8 36.3 4 33.4 27 48.2How Neighbors Helped Me (%Yes)Someone shared helpfulknowledge with me

22 100.0 19 90.5 13 100.0 54 96.5

I have borrowed things 21 95.5 19 86.3 11 91.6 51 91.1I was supported when Ihad a personal problem

21 95.5 15 71.4 10 83.4 46 83.7

Mail was picked up orplants were watered

17 85.0 17 73.9 11 91.7 45 81.8

A ride to store, doctor,other

17 85.0 17 73.9 11 91.7 45 81.8

Someone helped withhousehold maintenance,lifting, or fixing things

17 73.9 20 90.9 8 66.7 45 78.9

Received informationabout a doctor or otherprofessional service

20 95.3 13 56.5 11 91.6 44 78.6

Meals shopped food 15 68.1 15 68.2 6 50.0 36 64.3Someone responded andhelped in emergency

16 76.2 8 38.1 7 58.4 31 57.5

Someone looks out for medaily

11 50.0 12 52.1 3 25.0 26 45.6

Someone went to healthcare appointment with me

13 59.1 5 23.8 7 58.3 25 45.5

Someone visited me inhospital

8 42.2 2 10.6 2 16.7 12 24.0

Received hands-onpersonal care

4 19.0 2 9.1 1 8.3 7 12.7

564 A. P. GLASS

scales. At Neighborhood A, disagreement ranged from 8.7% for the state-ment, “My neighbors and I look out for each other,” to 18.2% for “Livinghere makes me feel safe.” The only statement garnering no disagreement atNeighborhood A was the statement about having a care coordinator orbuddy.

Satisfaction with the neighborhood community. Finally, seven questionsabout satisfaction were included. Internal consistency among the items was.871. Reported satisfaction was generally high, with all mean scores at 3.4 orabove on a scale of 1 (very dissatisfied) to 4 (very satisfied). Over 90% ofrespondents were very or somewhat satisfied with each item, with each receiving49% or more respondents choosing very satisfied. “Security and safety fromcrime” and “Someone close by to help in an emergency” received the highestmean scores at 3.8 and 3.7 respectively, and had the highest percentages report-ing being very satisfiedwith these aspects, at 77.6% and 70.7%, respectively. Onlytwo items received any very dissatisfied responses, with one participant provid-ing this answer in each case. These two items were “Sense of community/feelingpart of community,” and “Overall satisfaction with living arrangements.” Thesepatterns of satisfaction were found at all three sites, although the percentages ofvery satisfied was highest on all items at Neighborhood B.

Discussion

In these REINs, residents are challenging the social construction of aging.Instead of being dependent and needy, as older adults are often depicted inAmerica’s ageist society, these individuals have proactively chosen a livingarrangement that acknowledges their personal strengths, and are actively takingresponsibility to look out for each other. Promoting living arrangements inwhich elders can help each other remain relatively self-reliant is important foran aging population. For increasing numbers of elders, especially those who livealone and/or have no children, one fall or hospitalization could mean spendingthe rest of their lives in a nursing facility (Portacolone, 2013), highlighting thevalue of mutual support among neighbors.

Given the results of this study, living in a REIN has great potential to lessensocial isolation and strengthen social resources. In relation to family or outsidefriend connections, 32.1% and 21.1% respectively of participants were at risk ofsocial isolation, yet no respondents scored at risk of social isolation in relation totheir REIN neighbors. Residents have created an intentional neighborhood whereall neighbors know each other and interact regularly, which is not a given in astandard subdivision or apartment building (Farrell, Aubry, & Couloombe, 2004),nor is it effectively promoted by the Naturally Occurring Retirement CommunitySupportive Service (NORC) Program (Greenfield, 2016). Both the physical designand the social organization encourage contact between neighbors, so that they feel

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comfortable asking for, accepting, and giving help to their neighbors, as needed.The adapted cohousing design is one way to address the need highlighted byFarrell and colleagues (2004): “Finding ways of increasing the sense of communityof residents in neighborhoods remains an elusive goal. Consistent with previousresearch, our results are indicative of facilitating contact between neighbors as oneway of helping to achieve this goal” (p. 22). Almost every respondent (56 of 59,95%) reported having at least one neighbor whom they could count on as a carecoordinator or buddy to recruit help for them if needed. Respondents clearlyperceive they have support, and that may be as important as the actual support,as suggested by Gottlieb and Bergen (2010). Satisfaction is high, and living in theseinterdependent neighborhoods also promotes feelings of safety and securityamong residents.

Limitations

Limitations include the small sample size and the fact that only individualsliving in REINs are represented. Respondents were White, relatively healthy,and generally well-educated; they are not a representative sample of the olderpopulation. Not everyone participated, and possibly those most supportive ofthe neighborhood were more likely to participate, which might have skewedthe findings. The inclusion of three such neighborhoods increases the potentialrepresentativeness, but only among REINs. The three REINS have also beenopen for varying lengths of time, which could affect experiences and responses.Neighborhood A has been open the longest, and had the most formalizedneighborly support coordinator/buddy system; these two factors may haveinfluenced their higher reported rates of hospital visiting and hands-on care.The newest neighborhood exhibited the highest satisfaction, which could beattributed to a honeymoon effect. Other research (Glass, 2013), however, hasshown that the first years of establishing a REIN can be very challenging, andthus could have a negative effect. Neighborhood B also had the highest rate ofmarried residents; having a spouse could explain their notably lower rates ofresponding to others’ emergencies, as well as accompanying residents tohealthcare appointments.

Implications

The residents are not quite as homogeneous as they appear at first glance.Income levels vary, reflecting, in part, the goal of one neighborhood to targetelders of low/moderate income. Many residents have spouses and other familyand local friends on whom they depend. Overall, however, these respondentsreported fewer family connections than the national average, with much higherpercentages who never married (17.5%) or are divorced/separated (29.8%),compared to national figures of 4.3% and 10%, respectively (Federal

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Interagency Forum on Aging-Related Statistics, 2012). The percentage who arechildless (36.8%) is almost twice as high as the national average (20%; Dykstra &Hagestad, 2007). Without their neighbors, one out of four respondents would beat risk of social isolation, which compares to the broad range of nationalestimates of 10% to 40% (Lubben et al., 2006; Nicholson, 2012; Rubenstein,Lubben, & Mintzer, 1994). With their neighbors, the percentage at risk dropsbelow 10%. It appears that many of these individuals can especially benefit fromthe enhanced social resources that they have found in these neighborhoods. Anumber of these individuals were at risk of social isolation, and they created anenvironment that helps themmeet their needs. Respondents have shown that inthis supportive setting, older people can successfully build new social networksat a time in life when many find it challenging (Pettigrew et al., 2014).

Luo (2016) noted the need for more information and research to help socialwork practice understand how to help promote social networks and supportiveenvironments. From a policy standpoint, arguably of greatest significance is thepotential for the REIN to promote nonkin mutual support, lessen social isola-tion, and thereby decrease reliance on gerontological social workers who arealready in great demand. REINs are innovative in several ways, but especially inrecognizing that many older adults can actively help care for each other to theextent that they are able. Caring relationships and a sense of communityundoubtedly develop in other settings, such as other retirement communities.One of the aspects that differentiates the REIN, however, is the strong sense ofmutual responsibility and the residents’ realization of their interdependence oneach other. The residents serve as each other’s safety net; no administration orservice staff are standing by. As demonstrated here, much of the help that olderadults need is not skilled care, it is simple neighboring support.

However, there is an important potential role for social workers and alliedprofessionals to help those in REINs in several ways, including providingconsultation, education, assessment, and assistance in connecting with formalservices. If social workers built relationships with a REIN, they could offereducation on topics such as consensus building, getting along with difficultpeople, caring for each other, and how to plan for later stages when more caremight be needed beyond what neighbors can provide. They could be liaisons toconnect residents with resources in the larger community when needed. Theseintentional neighborhoods also hold significant potential to be designed forspecific populations, such as sexual minorities and immigrant populations,that are at elevated risk in old age, and therefore of concern to gerontologicalsocial workers. Gerontological social workers also have a role in the broadercommunity in helping educate older adults about the importance and benefits ofsocial networking and its relationship to health and well-being. Next researchsteps include exploring the possibility of taking what has been learned in theseneighborhoods and testing the model in other settings. Gerontological socialworkers could play an important role in helping mobilize and supporting such

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“families of friends” based on the conceptual model for aging better togetherintentionally (Glass & Vander Plaats, 2013).

Whether and how elders could help support each other is an important areaof research, and REINs are an innovative arrangement conducive to promotingsocial resources. These individuals are still struggling to define the limits of thesupport they can provide. This study contributes to the scant literature oninterventions to tackle social isolation, and the even rarer studies that considerthe role of the environment (Cattan, White, Bond, & Learmouth, 2005). Theresults support findings by Cattan and colleagues (2005) that group interven-tions, especially when planned and delivered by the older adults themselves, areamong the most effective at combatting social isolation. This sample includedmany individuals who could potentially be at risk of social isolation. Theysucceeded in creating an environment that meets their needs for strengtheningsocial resources, in the midst of the macro-level hindrances such as ageism andthe medicalization of old age. Supporting these initiatives of elders to take aginginto their own hands is a fitting task for social workers, as they forward theprinciples of social justice, dignity and worth of the person, and the importanceof human relationships (National Association of Social Workers, 2008).

Funding

Funding for portions of this research provided by the Retirement Research Foundation(2012-13B).

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