Abstract
Guided by resource dependence theory, this mixed-methods study examined organizational characteristics contributing to the perceived sustainability of Villages, a rapidly proliferating grassroots approach for promoting social participation and service access for community-dwelling older adults. Surveys conducted with leaders of 86% of Villages in the United States in 2012 found that higher predicted confidence in their Village’s 10-year survival was associated with greater financial reserves, human resources, number of Village members, formal policies and procedures, and formal collaboration agreements. Respondents’ explanations of their confidence ratings revealed additional themes of organizational leadership and perceived community need. Member resource inputs were not found to be as salient for Village leaders’ perceptions of sustainability as was anticipated given the Village model’s emphasis on consumer involvement. Despite the lack of longitudinal prospective data, study findings suggest potential limitations of consumer-driven organizational models such as Villages, including the need for a more stable resource base.
The Village model is a rapidly proliferating grassroots, consumer-driven initiative for meeting the material and social needs of older persons, particularly those who are not Medicaid-eligible (U.S. Senate, Commission on Long-Term Care, 2013). The model has grown from a single Village in 2002 to more than 190 in the United States and at least 40 in other countries, with the number doubling every 3 to 4 years (Village to Village [VtV] Network, n.d.). However, 10% of Villages reportedly have closed their operations already (Gustke, 2014), raising concerns about the long-term sustainability of these organizations. The consumer-driven nature of the Village model, in particular, has been cited as a potential strength as well as a potential threat to organizational sustainability (Poor, Baldwin, & Willet, 2012; Scharlach, Graham, & Lehning, 2012). As an initial step toward understanding Villages’ sustainability, this study uses qualitative and quantitative data from a 2012 national survey to explore member resource inputs as well as other organizational characteristics potentially associated with Village leaders’ confidence in their organizations’ survival over the next 10 years.
The Village Model
Villages are described as “membership driven, grassroots organizations, run by volunteers and paid staff [to] coordinate access to affordable services . . . and offer vetted-discounted providers” (VtV Network, n.d.). The Village model originated with a group of older persons in Boston’s Beacon Hill neighborhood, who in 2001 began meeting to discuss the idea of pooling resources to overcome instrumental limitations which might otherwise necessitate relocating away from the neighborhood (Beacon Hill Village, 2014). The Village model is differentiated from other community-based service models, such as in-home care (National Association for Home Care & Hospice, n.d.), care management agencies (Center for Health Care Strategies, n.d.), aging and disability resource centers (Aging and Disability Resource Centers, n.d.), and integrated financing and care models (Medicare.gov, n.d.), in its emphasis on member responsibility for essential organizational tasks, such as organizational development, governance, funding through member dues and volunteer contributions, and direct provision of services (Graham, Scharlach, & Price Wolf, 2014; McDonough & Davitt, 2011; Poor et al., 2012). In the words of a prominent Village leader, members “govern the Village, design its offerings, and make it all happen” (Beacon Hill Village, 2014). In this way, the Village model promotes reciprocal responsibility among older adults and other community members for individual and communal well-being, as envisioned by the aging in community paradigm (Thomas & Blanchard, 2009).
In exchange for membership dues averaging US$429 per year, Villages provide participants with access to an array of social supports, including educational and recreational activities, transportation, emotional support, health care advocacy, shopping, technological assistance, and home maintenance and repair (Greenfield, Scharlach, Lehning, Davitt, & Graham, 2013). These services are most often provided by members or other community volunteers, rather than paid staff or referrals to outside providers. Preliminary evidence suggests that Village members perceive a variety of benefits, including reduced social isolation, expanded access to services, increased well-being, and increased member confidence in their ability to meet their physical and social needs (Graham et al., 2014).
Questions remain, however, regarding the implications—positive as well as negative—of the Village model’s heavy emphasis on consumer social and financial inputs, including the long-term sustainability of consumer-driven community-based senior support models such as this (Scharlach et al., 2012). The sustainability of individual Villages and the feasibility of the Village model as a whole are of particular interest given recent attention to consumer-based service delivery models, particularly in the context of limited public and philanthropic funding for nontraditional, community-based programs. In practice, there appear to be substantial variations among Villages regarding their reliance on member inputs. One recent analysis found that only 22% of Villages actually were primarily member-driven, as evidenced by high involvement of older community members in Village creation, Village members comprising the majority of seats on the organization’s governing body, membership dues and fees accounting for most of the organization’s budget, the majority of Village members assuming volunteer roles, and volunteers providing more services than staff or external providers (Lehning, Scharlach, & Davitt, 2015). These variations provide an opportunity to examine member inputs as well as other organizational characteristics potentially associated with organizational sustainability.
Theoretical and Empirical Background
Our analysis is informed by resource dependence theory (RDT), which hypothesizes that critical financial and social resources, as well as the ability to reduce uncertainties about resource control, influence organizational growth and sustainability (Davis & Cobb, 2010; Hillman, Withers, & Collins, 2009; Pfeffer & Salancik, 2003). Because resource dependencies can pose a threat to the power and autonomy required for effective organizational functioning (Davis & Cobb, 2010; Emerson, 1962), organizations may strive to limit reliance on external resources or attempt to limit potential deleterious repercussions by negotiating collaborative resource sharing arrangements (Carroll & Starter, 2008; Crittenden, 2000; Davis & Cobb, 2010; Hillman et al., 2009).
As applied to the Village model, RDT suggests a number of key characteristics that might influence organizational leaders’ perceptions about sustainability. Resource accumulation in general, whether financial, human, organizational, or community-based, should enhance confidence in a Village’s ability to survive and prosper. Securing more financial resources, for example, gives Villages the power to employ more staff, provide a wider array of programs, serve a greater number of people, provide subsidized memberships for those who are low income, and generally meet member needs more effectively while also fulfilling necessary administrative functions. Having more members and being in existence for more years also can increase the power of a Village relative to other organizations in its environment, enhancing confidence in its ability to access needed resources.
In Villages, members are a particularly important source of resource inputs. While nonprofit organizations usually are highly dependent on external funding due to their inability to rely substantially on user fees (Ruggiano & Taliaferro, 2012), membership associations such as Villages are designed to generate financial and social inputs directly from the persons they serve (Anheier & Themudo, 2005; Greenfield et al., 2013). Contributions of time and energy from members may reduce the need for external funding, potentially decreasing a Village’s reliance on other entities and thereby enhancing its relative autonomy and sustainability. Village leaders may therefore perceive their organization as more sustainable if members are more fully engaged in contributory roles and responsibilities (McPherson, Popielarz, & Drobnic, 1992). Stronger member involvement also can have a secondary benefit of enhancing member commitment to the organization, potentially reducing member attrition and thereby enhancing perceived sustainability (Costa & Kahn, 2003; McPherson et al., 1992). It also is possible, however, that reliance on consumer leadership and support may increase uncertainty about organizational survival, due to member limitations and the complexities of managing voluntary human capital.
Current Study
Using qualitative and quantitative data from a national survey of Villages operating in the United States in 2012, this study examines organizational characteristics associated with leaders’ confidence in their Village’s sustainability, with a particular focus on the role of member resource inputs. In addition, we also explore Village leaders’ own explanations regarding factors that they believe will influence their organization’s survival. The study examined two research questions: (1) To what extent is confidence in 10-year survival associated with member inputs as well as other financial, human, organizational, and community resources suggested by RDT? (2) What specific characteristics do Village leaders themselves identify as being most relevant for the long-term survival of their Village?
Method
Sample and Procedures
Data came from a national survey of Villages conducted from January to June of 2012, as part of a larger study examining the organizational characteristics of Villages and Naturally Occurring Retirement Community Supportive Service Programs in the United States (Greenfield et al., 2013). The sample frame of Villages consisted of organizations listed on the website of the VtV Network (n.d.), a national organization that provides technical assistance and facilitates resource sharing among Villages. Organizations were eligible if they identified as a Village and were currently providing services to older adults. Email invitations were sent to the 80 eligible organizations, and 69 Villages from more than 30 states agreed to participate, yielding a response rate of 86.3%. A representative from each participating Village, typically the executive director or president of the board of directors, completed a self-administered emailed questionnaire that included closed- and open-ended questions regarding organizational development and sustainability. Trained interviewers conducted follow-up telephone interviews with respondents to collect missing data and to provide an opportunity for them to elaborate on their responses to open-ended questions, inserting responses through a Computer Assisted Telephone Interview system. Interviewers asked participants for further explanation of open-ended responses when it was not clear how their response related to the specific question or if their response was so brief that additional information was required for full comprehension. Participants were offered a US$60 incentive to participate in the study. This study was deemed exempt by the Rutgers University Institutional Review Board.
Measures
Confidence in sustainability
The primary dependent variable was confidence in sustainability, which we assessed by asking respondents to rate how confident they were that their Village would still be in operation in 10 years on a scale of 0 to 100, with 100 indicating absolute certainty. We also provided space for respondents to briefly explain their confidence ratings, to better understand their perceptions regarding factors associated with the sustainability of their Village.
Financial resources
We asked respondents to specify the total annual budget for the most recently completed fiscal year, as well as the current number of members, which we used to calculate budget per member. We asked respondents to estimate the percentage of their total budget from membership dues and fees as opposed to other sources (e.g., government grants and contracts, private or nonprofit organizations, and charitable donations). Respondents also indicated whether they had an endowment or financial reserves.
Human resources
Respondents indicated the full-time equivalent (FTE) of the number of hours worked per week by paid staff employed by the Village and the number of volunteers contributing to the Village’s goals in a typical month. To assess member resource inputs, we also asked respondents to indicate the proportion of active volunteers who were Village members and the proportion of advisory committee members or board members who were Village members.
Organizational resources
Organizational age was calculated by subtracting the year that the Village first began providing services from 2012. Size was measured by the number of members at the beginning of 2012. Because organizations that have been in operation longer are likely to have more members, we created a measure of relative size by calculating the unstandardized residual for the number of members at the beginning of 2012 adjusted for organizational age. We asked whether the Village had a business plan, a mission statement, formal personnel policies, or a volunteer manual, and calculated an organizational policy index (0-4) as the sum of these four values.
Community resources
We calculated the number of formal collaborations by asking respondents to list up to three organizations with which their Village had formally collaborated or partnered in the past year (i.e., including a written contract or memorandum of understanding). Finally, we assessed the economic composition of the Village’s service area by asking respondents to estimate whether the service area’s population was primarily low income, low to middle income, middle income, middle to high income, or high income. For analysis purposes, data were recoded into three composite categories: (a) low or low–middle income, (b) middle income, and (c) middle–high or high income.
Data Analytic Strategy
All data were quantitative except for the confidence rating explanations and the names of collaborating organizations. With the quantitative data, we examined bivariate associations between confidence in 10-year survival and resources using correlation coefficients for ordinal (Spearman’s ranked) and continuous (Pearson’s r) variables and t tests for dichotomous variables. We used listwise deletion to address missing data, which did not exceed 10% of the sample for any variable. Sample size limitations and variable distributions precluded multivariate analyses.
We used a progressive multi-coder iterative process to identify themes from the participants’ open-ended explanations of their confidence ratings (Luborsky, 1994; Wolcott, 1994). In the initial phase, the first author reviewed all responses to identify and label themes that emerged in respondents’ explanations, refined the themes after multiple iterations through the data, and then reduced the number of codes by combining themes based on conceptual similarities (e.g., the themes of financial inflows and financial reserves were combined to create the higher order theme of financial stability). In identifying and combining these initial codes, the researcher employed inductive coding, informed by resource dependency and other concepts derived from the conceptual and empirical literature regarding organizational development, as suggested by Rubin and Babbie (2007). In the second phase, a trained research assistant independently coded each open-ended response based on the identified themes. The two then compared their codes, identified discrepancies, independently recoded those responses where differences existed, and then resolved the few remaining discrepancies through dialogue and consensus (Miles & Huberman, 1984). Throughout the process, the coders were informed by the quantitative results, but also open to emergent themes evidenced across a range of confidence ratings, reflecting both barriers and facilitators to perceived long-term sustainability.
Findings
Quantitative Analyses
As shown in Table 1, Villages had an average annual budget of US$108,035, or US$1,036 per member, with member dues and fees providing 50% of Village financial resources on average; in addition, about one quarter had endowments or reserve funds. Participating Villages had been in operation an average of 4 years at the time of this study and had 134 members, on average. Villages had an average of 1.1 paid staff members and 39.9 volunteers, with members comprising an average of 36% of volunteers and 52% of board members. Nearly all had mission statements, most had business plans and formal personnel policies, and about half had volunteer manuals. Villages had formal collaboration agreements with 2.3 other community organizations on average, including home health agencies, hospitals, social service agencies, and senior housing providers. Villages tended to serve communities whose economic composition was considered primarily to be middle to high or high. Respondents’ confidence ratings that their Village would still exist in 10 years ranged from 10% to 100%, with a mean of 74.5% and a median of 76%, reflecting a slight left skew.
Organizational Characteristics of Participating Villages (N = 69).
Note. FTE = full-time equivalent.
Bivariate associations
As shown in Table 2, in terms of financial resources, confidence in 10-year organizational survival was associated significantly with having an endowment (t = 2.20, p ≤ .05), but not with budget per member or the percentage of the budget from member dues and fees. Among human resources, confidence in 10-year survival was associated significantly with number of paid staff (r = .259, p ≤ .05) and number of volunteers (r = .304, p ≤ .05), but not with the proportion of Village members among volunteers or on boards of directors or other governance bodies. Among organizational characteristics and resources, confidence in 10-year survival was associated significantly with relative size (r = .292, p ≤ .05) and number of formal policies and procedures in place (r = .295, p ≤ .01), but not with the age of the Village. Finally, among community resources, confidence in 10-year survival was associated significantly with the number of formal collaboration agreements (r = .334, p ≤ .01), but not with receiving in-kind contributions or the reported economic composition of the organization’s service area.
Confidence in 10-Year Survival by Resource Types.
Note. FTE = full-time equivalent.
Explanations of Confidence in Village Sustainability
Our analysis of respondents’ explanations of their confidence ratings revealed six themes associated with organizational sustainability. Some echoed the quantitative results (i.e., consumer involvement, financial stability, operational plans and procedures, interorganizational collaborations), while others were raised only in the open-ended responses (i.e., leadership capacity, perceived community need).
Consumer involvement
Village members were identified as an important resource contributing to organizational sustainability by 38% of respondents, consistent with the Village model’s emphasis on consumer engagement. One respondent who indicated 100% confidence in sustainability asserted, “Our members are our greatest strength.” However, respondents also expressed concern about recruiting individuals with sufficient interest and ability to contribute substantially to Village operations. Some respondents indicated that their confidence in their Village’s sustainability would be greater if they could find a way “to attract younger members who are committed to investing in the Village earlier over a longer period of time.” A respondent who rated sustainability at 70%, for example, explained, “The village has focused on people who need services, not people who want to participate in and create community.”
Some respondents expressed concern regarding the sustainability of a volunteer-run organization. As one respondent indicated in explaining a 30% confidence rating, “I am not sure the small group of individuals doing most of the volunteer work will maintain interest enough to sustain the organization.” Another noted, “This organization is run entirely by volunteers. If I am no longer able to run it, I’m not sure how it will be operated.” Consequently, many Villages found it necessary to hire paid staff to fill key roles to assure the sustainability of the organization. One respondent, for example, explained that they became 100% confident in the Village’s survival only when it “raised money through local grants and membership dues for a paid part-time executive director” to replace the volunteer who had occupied that position previously.
Financial stability
The importance of having adequate financial resources, including stable funding or sufficient reserves, was mentioned by 48% of respondents. One respondent explained a 100% confidence rating in part by saying, “We have a financial cushion that will allow us to weather short periods of financial uncertainty while developing strategies to address those threats.” Some respondents emphasized the importance of being financially independent and not reliant on outside funding, as typified by a representative from a Village serving a suburban area in the Western United States: “We want the revenue to cover the costs, without outside grants.” Many other respondents, however, indicated that external funding was necessary for Village survival, as reflected by one leader of a predominantly suburban Village in the Southeast who rated confidence at only 50%: “Membership fees will not cover the cost of operation. Funding will need to come from foundations, corporations, donors, etc.”
Respondents varied regarding the most promising source of stable external funding. Some mentioned public funding: “With Medicaid or other public funding available, Villages will be quite viable.” Others discussed insurance reimbursement, such as one respondent with a 90% confidence rating who noted,
My hope is that insurance providers will someday recognize our efforts as a cost-effective health care option and cover some of the annual membership fee like they do now (for gyms, weight management groups). If that happens nothing can stop the Village movement.
Others questioned reliance on private foundations, noting that “most funders/foundations do not want to support organizations that mainly serve a middle-class population.” Whatever the source, devoting sufficient attention to obtaining adequate external funding was considered particularly important, as noted by one respondent who rated confidence in sustainability at 100%: “We are constantly looking at our funding sources and determining how to maintain/increase those sources and develop new streams of funding.”
Operational plans and procedures
The organizational resource of having formalized plans and procedures was identified by 29% of respondents in explaining their confidence in Village sustainability. Many respondents emphasized the importance of a strategic plan for both internal and external purposes, as one leader said in explaining a 90% confidence rating: “Utilizing our strategic plan has given us the credibility and stability to succeed as a Village.” A plan for slow, steady growth was considered the key to confidence in sustainability for many respondents, including one who rated Village survival at 100%: “We’ve laid a strong foundation for steady-but-sure growth.”
Formalized policies and procedures were seen by some respondents as essential for their organizations to transition from their initial informal operational model to a more standardized operational system and plan. As one respondent said in explaining a 100% confidence rating, “The founding board set up the proper electronic system, developed a training model with training material, recruited and vetted volunteers, and took the appropriate steps to establish a 501c3 [tax-exempt nonprofit tax status] before launching.”
Interorganizational collaborations
Relationships with other organizations were identified by 23% of respondents as an important community resource, providing tangible assistance, referrals, and recognition. This was underscored by one respondent with a 100% confidence rating, who said, “Community partnerships are central to all that we do.” Respondents indicated that the demands of organizational development and operations sometimes required capacities beyond the internal resources of small volunteer-led organizations such as Villages: “We are a stand-alone nonprofit. That gives us freedom but also leaves us open to risk . . .”
Collaborations also were seen as strategies for reducing competition with more successful organizations serving the same geographic area, as one respondent who rated confidence at 70% explained, “[Our] director would like to see collaboration with [another entity], who serves the same geographic area.” Partnerships with health care providers and funders were considered especially promising, in light of the Affordable Care Act 1 and other efforts to reduce utilization of expensive health care services. As noted by one respondent who rated confidence at only 50%, “We are currently working with some large insurance companies, hospitals, and physician groups to partner with them to decrease hospitalization and readmission rates.”
A number of respondents also expressed concern about the potential costs of collaborating with other organizations, including exposing the Village to outside influences that can alter the Village’s goals and program model, even leading the Village to dilute or abandon its original identity. For example, a respondent with only a 10% confidence rating suggested that their Village might need to merge with another organization to fit into the service environment: “It’s a very medically oriented county providing a lot of services, so I can imagine our village existing, just in another configuration.”
Leadership capacity
Having strong and capable governance, a factor not specifically addressed by our closed-ended questions, was mentioned by 29% of respondents in explaining their organizational sustainability ratings. One respondent explained a confidence rating of 100% by saying that “we continue to recruit a seasoned, diverse board of directors with strong leadership in place.” Respondents noted that board development was a continuous process, especially as organizational needs evolve from start-up status to more stable operations, and founders are replaced by new board members who may lack the same energy or skills. As explained by one respondent who rated 10-year survival at only 25%, “Original members were very committed and involved [and we] may not have [the] same skill set or commitment from newer members.” Another noted that “the board must reorganize and remodel.”
Perceived community need
Respondents’ perception that there was a recognized need and support for a Village in their community was mentioned by 46% of respondents, although not assessed in the study’s closed-ended questions. A Village leader who rated confidence in survival at 100% stated, “We have strong support from the community,” while another who rated confidence at 95% explained, “The Village concept fills a major need.” Especially reassuring to respondents were projections that the need would only increase in future years, as younger cohorts of community residents grow older. One respondent who rated confidence at 100% explained “30-40% of [community] members are currently age 50 or older,” so that “the need will only get stronger.” Some respondents, however, expressed concern about the difficulty promoting public awareness, as explained by a respondent from a Village serving a rural area in the Southwestern United States, who rated confidence at only 40%: “We are trying hard to . . . broaden awareness of the organization, but ours is a far flung, rural, somewhat transient population.”
Key to public recognition was the belief that the Village model is uniquely relevant and responsive to the needs and desires of aging community members. Of particular relevance was the model’s emphasis on helping older adults stay in their familiar homes and neighborhoods, as noted by a respondent who rated confidence at 100%: “The involved people have a lot of history in the neighborhood, and we want to stay.” A number of respondents mentioned the challenge of demonstrating the Village’s unique value to community residents and leaders. As one respondent noted, “We need to prove ourselves, and I think we are doing a good job.”
Respondents also perceived Villages to offer services and supports not available elsewhere. One respondent who rated confidence at 90% explained, “The personalized service [and] connections to neighbors through social events is a very important part of what Villages provide and not likely to be handled as well by for-profit vendors interested only in billable hours.” Some respondents also believed the public policy context to be especially favorable: “With the Affordable Care Act’s emphasis on aging in community, organizations such as ours will become increasingly necessary.” On the contrary, some respondents were concerned about potential overlap between their Village and other existing organizations. One respondent, in explaining a confidence rating of only 10%, noted that there already were “14 senior coalitions in our county, which are partially funded by the city and county, and they provide case management” and that consequently “it may make more sense for our model to merge with that coalition to combine resources.”
Discussion
In the context of increasing programmatic and public policy support for consumer direction, the Village model provides a useful platform for examining some of the potential strengths and limitations of increasing reliance on consumer inputs. In light of the model’s strong emphasis on member responsibility for program development, operation, and governance, we had anticipated that member resource inputs would make a major contribution to perceived organizational sustainability, providing some protection against the uncertainties of external dependencies. However, in this study, member dues and fees were found to cover only an average of 50% of the budget, and Village leaders’ confidence in organizational survival was not associated significantly with member financial inputs nor member social contributions, as evidenced by members’ relative representation on governance bodies or among volunteers. Moreover, member involvement was mentioned as an explanation of confidence ratings by only a minority of Village leaders, who were more likely to cite financial stability or perceived community need in their open-ended explanations. While to our knowledge our study is the first to examine the perceived sustainability of member-driven organizations specifically targeted to older adults, these findings are consistent with prior research indicating that survivability of member-driven organizations is similar to that of other nonprofit and for-profit entities (Archibald, 2007).
It seems possible that the potential organizational value of members’ contributions may not be as great as anticipated, relative to staff and other volunteers who are more likely to have specialized skills and experience critical to organizational growth and sustainability (Florin, Mitchell, Stevenson, & Klein, 2000). Community volunteers, for example, may be recruited intentionally because they have particular competencies necessary for organizational survival that exceed those of most Village members. Members, on the contrary, are more apt to have a transactional relationship with the Village, which could lead them to make resource demands on the organization in exchange for their financial and social contributions. In their explanations of confidence ratings, Village leaders noted the challenge of recruiting individuals with sufficient interest and ability to contribute substantially to Village operations. For these reasons, member-run organizations are at particular risk of becoming overextended and may benefit from targeted capacity-building efforts to prevent organizational demands from outpacing member resource contributions (Grant, 2013).
Other characteristics found to contribute to Village leaders’ perceptions of organizational survival were largely in accordance with the propositions of RDT regarding the importance of control over sufficient resources (Pfeffer & Salancik, 2003). Across the quantitative and qualitative findings, confidence in sustainability was found to be associated with financial resources (e.g., financial reserves), social resources (e.g., number of paid staff, number of volunteers, perception of strong leadership), organizational resources (e.g., Village relative size, strategic plan, and other formal policies and procedures), and community resources (e.g., number of collaborations, perceived need). Villages’ apparent reliance on external resources raises a number of concerns. Approximately 50% of external financial resources were from private donations, followed by grants from foundations and other philanthropic organizations. Sources such as these can be highly unstable, and require substantial ongoing attention (LeRoux, 2009), while exposing an organization to the risks inherent in external resource dependencies. In addition, many foundations target funds primarily to low-income and underserved populations. Despite the potential costs, some individual Villages have tried to access funding through more stable external sources such as Medicaid, health care contracts, and long-term care benefits (J. Handy & Poor, 2015). However, Villages generally remain outside existing financing systems for health care and long-term services and supports, especially capitated health and social care models such as the Program for All-Inclusive Care for the Elderly, and Cash and Counseling. Most such programs are targeted primarily to individuals with minimal financial resources, in contrast to the Village model’s explicit focus on nonpoor older adults. In addition, emerging community-based social service organizations such as Villages may lack sufficient power to negotiate resources in the larger health and social care arena (Chernof, 2015; James & Field, 1992). The lack of a consistent source of stable external funding prompts concerns about the viability of the Village model.
Villages’ need for financial resources may be offset somewhat by their potential access to nonfinancial human and social resources. The use of volunteers as a complement to paid staff, for example, may enhance organizational capacity and sustainability, while also having potential secondary benefits for service quality and enhanced community visibility (Hager & Brudney, 2005; F. Handy & Srinivasan, 2004). However, reliance on volunteers also requires substantial attention to volunteer recruitment and training and may limit the capacity of Villages to meet the needs of members with more complex or intensive care situations.
Indicators of organizational structure and stability, as evidenced by a Village’s size, formalization, and financial reserves, also emerged as important contributors to confidence in sustainability. Organizational size is a well-established indicator of organizational sustainability (Davis & Cobb, 2010). In the case of Villages, having a sufficient number of members may be especially important as a reliable source of funding that can remain relatively stable or even grow over time. Furthermore, having more members potentially means more persons available to provide assistance to other members, help with administrative and other operational tasks, and recruit new members. Membership growth also can be seen as a visible “vote of confidence” in the organization by community members who were not originally a part of the Village’s development, potentially enhancing a leader’s confidence in organizational survival.
The presence of formal procedures and strong leadership were two organizational characteristics contributing to leader confidence in sustainability. A number of respondents mentioned the challenges associated with transitioning from leadership by a few charismatic individuals during the initial phase of Village development, to a more stable organizational structure that is less dependent on a small number of individuals for its day-to-day operations and survival. Development of a strategic plan was considered especially important, as was having a realistic growth model, fiscally prudent governance, flexibility to respond to changing external forces, and financial reserves to fall back on during difficult times. These findings are congruent with classical organizational theories (e.g., Sobeck & Agius, 2007; Weber, 1968), which suggest that organizational growth and sustainability are dependent on appropriate organizational goals, structure, policies, procedures, and leadership. For an emerging business model such as this, fiscal stability in the form of adequate capitalization may contribute to confidence in an organization’s ability to weather periodic threats to its well-being and survival (Dunn & Cheatham, 1993). However, less than one quarter of the Villages in this study reported having an endowment or reserve fund.
Two types of community resources were identified by respondents as important contributors to organizational sustainability—interorganizational collaborations and perceived community support. Interorganizational collaborations may enhance the perceived value of an organization internally as well as externally, potentially reducing some of the risks associated with external resource dependence (Davis & Cobb, 2010). Given the model’s emphasis on linkage and referral rather than duplication of existing community services, collaborations with other service organizations may be especially important to Villages’ ability to achieve their goal of helping members to access needed services. Collaboration also may reduce competition with existing service providers and enhance Villages’ value as a referral source.
Collaborations with health care organizations were described as being especially promising. Villages may have a role to play in helping members access evidence-based cost-effective social care interventions such as hospital-to-home care transition programs, chronic disease self-management programs, and health promotion programs (Berwick, Nolan, & Whittington, 2008; Maggioncalda, 2014; Poor et al., 2012). Yet, a focus on health-related programs and health outcomes may require Villages to offer services with which they generally have little expertise or familiarity, produce measurable health benefits, and in many cases compete for limited resources with more established and better-funded health care organizations, challenges also faced by many other community-based aging service organizations (Tabbush, 2012).
Broad public awareness and support also were identified by Village leaders as important community resources, especially in the context of a growing demand for support services for nonpoor older adults, for whom Villages may be uniquely responsive. When a Village is perceived to have value to the target community and its older residents by occupying a particular service niche (Popielarz & Neal, 2007), Village leaders are likely to have greater leverage in accessing resources such as funding, in-kind support, and volunteers, and may have more confidence in their ability to recruit and retain members. Positive community recognition may facilitate a virtuous cycle, whereby visibility contributes to interest in membership as well as mutually beneficial partnerships and collaborations with other community entities, thereby further enhancing the perceived value of a Village in its local community, the number of constituents committed to its existence, and a Village leader’s confidence in organizational sustainability (Davis & Cobb, 2010).
Study Limitations and Research Implications
In this study, we examined Village leaders’ confidence that their organization would continue to be operational in 10 years; however, the accuracy of these predictions is unknown. Furthermore, our findings reflect the opinions of a single director or board member from 69 of 80 Villages known to exist at the time, and may not represent the perspectives of other key constituents, the 11 nonparticipating Villages, or other Villages that have since become operational. More inclusive prospective longitudinal studies of Villages’ growth and decline are essential for testing the hypotheses suggested by the current study, as are intensive organizational postmortems of Villages that terminate their operations or fail to launch. Longitudinal studies also are needed regarding the impact of Village membership on member well-being, health services utilization, and ability to resist undesired relocation using adequate comparison or control groups, especially in light of growing attention to the reciprocal relationship between organizational effectiveness and sustainability (Greenfield & Frantz, 2016; Sridharan, Campbell, & Zinzow, 2006).
Future research should collect and analyze more in-depth information about characteristics that may affect organizational sustainability, including stability of external funding, capacity and stability of Village leadership, organizational adaptability, benefits and costs of interorganizational collaborations, and other environmental pressures and supports. Further research also is needed regarding the tasks required to grow and sustain a successful Village, including recruiting and retaining volunteers, developing and maintaining collaborations with other community organizations, submitting grant applications and managing time-limited foundation-funded projects, and identifying and nurturing potential donors, as well as the training and skills required to effectively perform such tasks and the potential efficacy of targeted capacity-building interventions (Sobeck & Agius, 2007). Research also is needed regarding other indicators of organizational success such as goal achievement, input and output efficiency, and the impact on their communities. More broadly, research is needed to clarify the Village model’s unique role in the overall aging services system, to provide an empirical basis for federal or state policies affording formal recognition and potentially more stable economic support to Villages and other consumer-led models. New York’s Naturally Occurring Retirement Community Supportive Services Programs (Altman, 2006) and Israel’s Supportive Communities Program (Berg-Warman & Brodsky, 2006) provide examples of neighborhood-based senior support models that have demonstrated organizational sustainability through accessing a combination of national and local funds.
Nevertheless, despite this study’s findings regarding the importance of external resources, Villages operate in a context whereby health and social service delivery systems offer limited support for consumer-driven initiatives, especially those directed at older adults who are not Medicaid-eligible (Scharlach & Lehning, 2012). Our findings highlight the perceived need for program models that respond to these limitations, such as Villages, which aim to marshal a community’s financial, social, and human resources in support of residents’ health, well-being, and social inclusion. On the whole, the Village model appears to reflect a number of key paradigmatic shifts occurring in health and social services for older adults, including growing enthusiasm for leveraging public dollars to generate private funds, a simultaneous focus on long-term services and supports as well as health promotion and disease prevention, and the strengthening of interorganizational partnerships to more comprehensively meet diverse service needs (National Association of Area Agencies on Aging & Scripps Gerontology Center, 2014). As such, continued development of the Village model, accompanied by research on its sustainability and member outcomes, can contribute to a better understanding of potential responses to the challenges and opportunities evoked by a shifting landscape of services and supports for an aging society.
Footnotes
Declaration of Conflicting Interests
The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
Funding
The authors disclosed receipt of the following financial support for the research, authorship and/or publication of this article: This study was supported by a grant from the Louis and Samuel Silberman Fund for Social Work Faculty Research, which is administered by the New York Community Trust.