In this section :
Case Study: Naturally Occurring Retirement Communities, Ontario
Background: Aging-in-place model and setting
The NORC Innovation Centre (NIC) has created a pioneering aging-in-place model called the NORC program that is designed to enhance quality of life, social connection, personal well-being and access to healthcare for older adults. NORC, which stands for “naturally occurring retirement community,” refers to geographic areas – often residential buildings such as condos, co-ops and apartments – that were not originally planned for older adults but have naturally evolved to house a significant proportion of them.
NORC programs take a bottom-up approach, embedding health, social and physical support directly within these communities. While the concept is not new – it dates back to 1986, when Hunt and Gunter Hunt coined the term – NORC programs have been implemented globally, leveraging the density of older adults living in one place with social and health programs.
The NIC at University Health Network (UHN) is currently advancing an Ontario-based model, building on work initiated by Jen Recknagel, Director of Innovation and Design at the NIC and Senior Design Lead at UHN OpenLab. Her 2015 project Senior Social Living: An Exploration of Grassroots Models, laid the foundation for this approach. This model was rooted in learnings from NORC Supportive Service Program models trialed in the US and Canada, and learnings from the co-housing movement, village-to-village network model and the relational care model from UHN and York University’s Dotsa Bitove Wellness Academy. UHN OpenLab began piloting new approaches to supporting NORC communities through various tests of change, including building a NORC database across Ontario in 2017, starting the NORC Ambassadors Program in 2019 and publishing concept models in Vertical Aging: The Future of Aging in Place in Canada in 2020. This set the stage for the creation of the NIC, which is a partnership with UHN Connected Care.
The UHN NORC program takes a partnership-based approach, working with residents, building partners and publicly funded health and social service agencies to deliver customized local programming in each NORC community. These programs include health talks and workshops, drop-in wellness classes, computer training, social events and group health clinics. At the heart of the model is a group of motivated resident volunteers known as ambassadors. These volunteers receive training to work alongside other residents and NIC staff, transforming high-rise buildings into vibrant communities that support healthy aging in place.
For communities using the Staffed Model, additional support is offered through an onsite NORC coordinator and access to a nurse practitioner (NP)-led virtual clinic, staffed by integrated care leads (ICLs):
- The onsite NORC coordinator is available to speak with residents about social, health and wellness needs. This person works closely with residents to coordinate community events and programs, while linking residents with higher needs to the virtual care hub for one-on-one health and social services.
- The NP provides health assessment, escalates care when necessary, creates tailored care plans and makes referrals to necessary services and resources in consultation with primary care providers.
- The ICL works with older adults to support continuity of care and provides in-person, values-based assessments to determine unmet needs. The ICL also creates a personal wellness plan focused on self-management tools and education and brings together health and social care providers as one team.
Together, the NORC coordinator, the ICL and the NP form the NORC team, working collaboratively to support care planning. The NORC coordinator remains onsite as a consistent resource for residents, while UHN’s Connected Care Hub enables rapid access to diagnostic testing, specialist referrals and specialized programs. In addition to onsite support, the staffed model provides a continuum of integrated healthcare, with deep and comprehensive access to one-on-one health and social care interventions.
The NIC leverages insights from each NORC community to create a model that can accommodate diverse community contexts and integrate into health and social care systems across Canada. UHN’s NORC program is founded on the principles of capacity building and connection. The NIC team works as a catalyst empowering motivated resident ambassadors to build aging-in-place networks in their own NORC communities where they can initiate and lead resident-led activities.
NIC staff support this process through co-design activities, surveys and needs assessments, helping residents identify and address their aging-in-place needs and preferences. Based on these insights, NIC staff may also connect each NORC community to local health and social services to deliver group programming, such as falls prevention or wellness education workshops.
Engagement approach with community
The environmental scan
A data-driven approach was used to identify where NORCs existed and which ones have the potential to be a NORC site. The first step included creating a NORC registry, identifying all the NORC buildings (buildings with at least 30% and at least 50 residents aged 65 and older). This list was used to help understand which buildings and neighbourhoods might have higher health needs, be lower income, or have higher diversity, thereby identifying buildings that may have more of a need for supportive programming.
The NIC team then reached out to potential building partners who met the criteria and introduced their management teams to the UHN NORC program, highlighting the benefits of supporting older adults to age in place with proper community supports. Interested building partners were asked to distribute information materials, such as posters, within the buildings to engage residents. The goal was to recruit resident volunteers to form an aging-in-place committee or ambassadors group.
Awareness: Reaching out
The NIC hosted an information session with residents to build awareness about aging in place and how a NORC program might benefit them. During these early sessions, attendees were introduced to the NORC ambassador program.
When the NIC team received an expression of interest from older adults within a building, they undertook ethnographic observations and group interviews to understand a community’s context. The NIC identified which communities were equity-deserving groups (such as low-income and racialized communities), and which might particularly benefit from a NORC program. This initial outreach was founded on trust and a commitment to taking the time necessary to build new relationships. The NORC team sought to build relationships with communities, particularly in areas unfamiliar with the NORC concept.
The Ambassador Program
Using a bottom-up approach, the NIC staff looked for groups of four to five older adults living in the same building and interested in starting an aging-in-place committee or ambassadors’ group. These ambassadors would become the key piece of the NIC’s engagement strategy, acting as connectors to outside resources and capacity-builders within their own buildings. Ambassadors would liaise with NIC coordinators to bring attention to their NORC building’s wants and needs, as well as bringing to the forefront the unique skills residents might possess.
For example, ambassadors might know residents who could teach Aquafit or who had expertise in finance. These initial sessions were built on the premise that engaging first with the community is essential for everyone’s needs to be met. The ambassadors’ knowledge was respected and relied upon, positioning them as experts in their own NORC buildings before a NORC program was formally begun. By discovering the needs and wants of the community through its own residents, each NORC program gained a sense of proprietorship and belonging to a unique community made of and for the residents.
The key takeaway from this step in the engagement process was the NIC coordinators’ significant time investment in building relationships and trust with the ambassadors before launching any support services or projects in the building. Similarly, the ambassadors needed additional time to build trust with other older adults in the NORC building. The NIC actively supported the ideas and priorities put forward by ambassadors, fostering a sense of responsibility among them for their fellow residents. This interdependence kept both parties engaged, ensuring that they were constantly connected and working towards the same goals.
Relational care and social capital
Coordinators drew on the principles and philosophy of relational care in their engagement approach. Relational care, an approach where growing meaningful relationships with one another is key to providing the best support possible, became a lens through which the NIC staff, ambassadors and residents would view their common commitments. Relational care was inspired by the Dotsa Bitove Wellness Academy, as well as Inspiring Communities a New Zealand community development model, and the Tamarack Institute.
The NIC knew that listening was key to building relationships and they fully embraced the process. Each NORC building, with the help of coordinators, gave itself the space needed for relations to develop, nurturing the complexity of interpersonal dynamics and diverse perspectives. Checking assumptions and suspending judgment before hearing from others was part of this deep listening, and allowed for a space that felt welcoming yet effective in its ability to move forward. In addition, a willingness to work through emotional discomfort was key in NIC’s bottom-up approach.
A key feature of the ambassador-facilitator relationship was social capital and its role in relational care. Social capital recognizes and respects that networks of relationships in a given community are crucial to the community’s functioning. In NIC’s case, this meant valuing how the assets of the older people involved (either as ambassadors or community members) brought unique strengths to the table. NIC recognized this and worked to engage ambassadors based on an understanding of each person’s unique offering. Alongside the ambassador relationships, NIC expanded its understanding of social capital to other community assets and connections by including them in conversations about future needs. The NIC also worked to build capacity amongst ambassadors and prioritize their NORCs needs.
Ambassadors and NIC coordinators met monthly, typically over a nine-month period to maintain momentum and provide consistent physical presence and support. Meetings started with a check-in and icebreaker to build trust and connection, offering respite from more difficult conversations, such as disagreements about priorities. The NIC emphasized a community-led approach, positioning itself as a supporter and enabler of the process, using its own social and financial capital to maximize support while giving ambassadors space to lead. Adequate time was allowed between meetings, enabling ambassadors to work within their own contexts while the NIC staff team maintained a lighter, supportive presence. Coordinators engaged with the building community by staying open and flexible to ambassadors’ ideas. This intentional yet adaptable environment empowered ambassadors to take ownership of their NORC program. After completing nine months in the program, ambassadors had the option to join the NORC Ambassadors Alumni Network, a peer group for continued connection, story-sharing and mutual support.
Ambassadors Alumni Network
Within the Alumni Network, representative ambassadors are involved in every level of governance, from shaping policies with UHN committees to advocating for their NORCs and broader aging-in-place initiatives with a community-first mindset. This collaborative approach ensures that the NORC’s bottom-up model influences top-down decision-making in healthcare and government. Engaging ambassadors in this way not only empowers residents to become self-determined agents of change for their communities, but also to advocate more formally for local priorities. The NIC supports this process by enabling older adults to exercise their social citizenship and drive meaningful change.
For instance, the NIC gathered feedback from communities indicating that having a dedicated NORC staff member embedded in each community would greatly enhance integrated health and social care support. While the details of this staffed model would align with UHN’s Connected Care Hub model, its inception was rooted in discussions with the ambassadors. Communities determined that a part-time NORC coordinator based in the building would not only fast-track services, but also build trust with the community in an accessible, in-person way. The NIC’s foresight in taking a data-driven approach – incorporating needs assessments, asset mapping and strategic evaluation – provided useful background information to make a business case for the proposed staffed model.
“Connecting” and creating partnerships
“Connecting” became a strategy for the NIC to engage with the community, fostering relationships between NORC buildings and local service providers. NIC staff and the resident ambassador groups did this by engaging with external community organizations that could address specific needs within a building. This matchmaking involved assessing existing services and programs, and identifying where a program could benefit a specific NORC building. NIC staff and ambassadors met with program representatives to explain how the program might be a good fit for the NORC program.
Although the existing programs weren’t specifically built to support NORCs, once connected, many had the flexibility to pivot towards the identified needs of a particular NORC community. Thus, existing programs altered their services to optimize for residents’ needs. While these partnerships had an element of formal service provision, they helped establish the presence and visible support of older adults, empowering NORC buildings to make their own unique communities based on their distinctive wants and needs. These informal engagements were open-ended and collaborative, followed by multiple rounds of co-design sessions with ambassadors and other residents to identify and refine the design of potential programs and services. The NIC has developed more than 50 informal partnerships, which provide residents with community wellness programs and one-on-one support.
Conclusion
The NIC’s key insight for successful community engagement is the importance of fostering connections within older adults' unique local contexts. The NIC’s success and sustainability stems from constant communication between communities – including the health system, community organizations and ambassador groups – to change or implement new models that better serve the population. This relationship-centered care is founded on trust, commitment to the community, and a true understanding of community priorities. For example, these trusting relationships were leveraged to enable a timely vaccine rollout in NORC buildings, with mobile on-site clinics prioritizing at-risk residents. This example illustrates the impact and value of NORC programs and expansion at a system level.
As part of UHN, the NIC leveraged its embedded position to drive innovation and amplify the NORC model’s accomplishments at government levels. The NIC is also connecting communities and facilitating learning across different NORCs in Toronto. The NIC therefore acts as a supporter of the NORC model, showcasing it as an aging-in-place initiative worthy of attention from the Ministry of Health and other levels of government. The NIC’s sustainability is strengthened by its unique team of people with diverse skills, spanning community development to evaluation. Acting as a backbone organization, the NIC has elevated the NORC model to governance and policy discussions, empowering them to be change-makers at the macro-level, fueled by residents at the local level.
In sustaining and co-creating the NORC program, the NIC has launched NORC Talks – in-person events focused on getting new NORC programs started, accompanied by a Do It Yourself (DIY) guide and toolkit. These resources, developed in consultation with residents and ambassadors, are accessible online and position older adults as central figures in shaping their communities. By challenging ageism, these tools empower older adults to take leadership roles and design solutions for their own needs.
Today, potential NORCs often approach the NIC directly, inspired by ambassador alumni success stories. The NIC’s approach – recognizing residents as leaders and engaging them from the start – has enabled communities to become self-actualized, with changes reflecting their unique identities. By prioritizing accessibility and local leadership, the NIC has nurtured a model where communities drive their own evolution.
The NIC’s NORC program is unique because it is a catalyst for connection. The program’s presence makes visible the threads of community that can connect older people across geographies and services, fostering a sense of shared purpose. By building the capacity of each NORC building and inspiring community-led aging-in-place solutions, the NIC has shown that the answers to community needs have always been within reach. The NIC’s role was simply to set the table.
