The Discovery of Naturally Occurring Living Communities (NOLC’s)

The Discovery of Naturally Occurring Living Communities (NOLC’s)

 Historical Perspective:

(excerpt taken from Force, L.T. (2010). Mental Health, Specialized needs and Care found in Gerontology: An Interactive Text,  NSS Press.

“Over the last century, the treatment for persons with specialized needs, i.e., residential programs and day treatment options has changed dramatically. From a historical perspective, transitions in the family system, the ending of World War II, the impact of changes in the economy and the increase in life expectancy all play a role in the modification of the support system for persons with specialized needs. The early days of large scale institutional care has been replaced with a community-based approach for program and resources.

In 1946, the National Mental Health Act was signed establishing the National Institute of Mental Health (NIMH). In 1963, the Community Mental Health Centers Act of 1963 was established. The latter part of the twentieth-century saw a revision in what constituted the best-practices of the day; large state mental hospitals were considered to be outdated and the locus of control for treatment shifted to a community-based model.  The Community Mental Health Centers Act of 1963 became the symbol for deinstitutionalization. No longer would the mentally ill suffer mere incarceration (Grob 1994, 2008). The depiction of institutional care provided at Willowbrook State School in New York provided an additional catalyst for change (see Internet Sites below). As the de-institutionalization movement gained favor with advocates, providers, state and legislative policy makers, the development of formalized, certified and government funded services were developed and organized into a community service model administered with oversight by a state entity.

Beginning in the late 1970’s, as a result of litigation and awareness of care and services in state operated institutions for individuals with specialized needs, efforts nationwide were begun to de-institutionalize individuals resulting in the placement and discharge of individuals into the community. Initial aspects of this change in care included: individuals removed from institutional care by their families and requests by individuals to voluntarily leave institutional care. Of the people in the latter group some were discharged and lived on their own while others moved into generic adult homes or privately operated homes. Some individuals in fact chose to live with staff from the institutions with whom they were familiar. Throughout the 1970’s, 80’s and 90’s, practices and regulations governing the health and safety of individuals with specialized needs, in both institutions and the community, were codified. Specific regulations for ensuring adequate and appropriate care were developed based upon national and local standards of care.

Discharge from state institutions, in most cases, during this period occurred as a result of court ordered discharges or followed hospital discharge practices which included review of the individual’s health, skills and abilities, after-care services, and success of the after-care system to ensure health and safety.  The discharge and after-care planning generally followed the medical model of inpatient hospital care in use during this time period (Dennis, Monthie, & Force 2009).

The debate about the strength and quality of community based care continues to this day. Advocates and policymakers speak about the strengths but also comment on the inherent weaknesses found in community based care. A major criticism surrounds the issue of accessibility and the lack of a seamless integration of services. The overarching comments regarding the view of community based services have centered on the separation of care and treatment. As Grub indicates, “We have yet to define a mental health policy that integrated decent and humane care with access to medical services for severely and chronically mentally ill persons”.

The question remains: Are there better ways to provide care to persons with specialized needs? The answer is: yes. There are lessons that can be learned from a cross-system perspective. For instance, in the aging network and gerontological field there is an emphasis placed on the development of Naturally Occurring Retirement Communities (NORC’s). The benefit of the NORC’s affords older individuals the opportunities to age successfully in place. As indicated by Masotti, 2006 and Lun, 2008, the increase in the aging population has provided new opportunities for practice interventions on both the micro-practice and macro-practice level. New strategies of treatment and service delivery have been developed.

Based upon the NORC model, (which is focused on a means-test of age 60 and above), Force, Monthie, Dennis, and Rogers (2009) developed a Naturally Occurring Living Communities (NOLC’s)  model. The NOLC’s provide support to adults with specialized needs across the lifespan. A Naturally Occurring Living Community (NOLC) is defined as a neighborhood, community support network, and/or informal support system that enhances community integration, the sense of belonging and or supports the citizen’s independence, inclusion, self-worth, identity, value for the respondent and to the Naturally Occurring Living Community (NOLC). In essence, the objective of the NOLC is to increase independence and personal choice by further developing an understanding of the needs of persons with specialized needs and their family members and by identifying interventions that can be implemented on both the micro-practice and macro-practice level.

The NOLC model places emphasis on increasing individual knowledge-base regarding existing services and programs for older adults with specialized needs and their family members, as well as, developing practical strategies on how to access the existing networks and supports for older adults with specialized needs. Within a NOLC, emphasis is also placed on highlighting “the role and voice” of the persons with specialized needs, their families and their self-selected health providers.  In addition, a dialogue between public/private partnerships is encouraged; in order to develop creative “out of the box” thinking as it relates to identifying the components of what constitutes a Naturally Occurring Living Community (NOLC). In essence, the NOLC decreases isolation and stigma for individuals. It is essential that individuals, family members, practitioners and policymakers gain an understanding of the various networks that provide support to people as they age, in their own communities of choice, thereby further enhancing the role of independence found in the power of a Naturally Occurring Living Communities (NOLC).

The question is, “collectively, what are we doing to promote successful and healthy aging in the community?” and “what are we doing to promote successful aging in the community for persons with specialized needs?”  As a worldwide society, from the frontier of compassion, we have created sophisticated medical interventions to sustain and increase the length of life. However, we appear to be silent and without a clear unified voice regarding the quality of one’s life. Our presence and advocacy must be built upon: knowledge, justice, equity, fairness and human dignity; a true commitment will ultimately enrich the value of one’s own life. We need to harness our resources, reduce our duplication of effort across systems, learn from our history and act like it matters… because it does.”