Moreover, Philadelphia’s elderly race composition is expected to shift within the next decade with the current White majority becoming a minority ( Glicksman & Norstrand, 2004). Philadelphia exceeds national trends, with African Americans representing the largest racial/ethnic minority group (35%) of the aging population. Furthermore, African Americans represent an increasing percentage of the aging population and the oldest old, a group at greatest risk for chronic diseases and the highest users of health services. Additionally, compared to Whites, African Americans have limited access to chronic disease self-management programs ( Becker, Gates, & Newsom, 2004) due to multiple social structural barriers including low income, low home ownership, and high unmet housing needs, all contributors to health problems ( Kelley-Moore & Ferraro, 2004).

African Americans have poorer physical health and greater functional disability ( Gitlin, Hauck, Dennis, & Schulz, 2007) are at higher risk for disabling conditions ( Ory, Lipman, Barr, Harden, & Stahl, 2000) and have more serious conditions, including stroke, diabetes, cancer, and cardiovascular disease ( Committee on Quality of Health Care in America, 2001 Swift, 2002). Chronic health conditions are the major causes of illness, disability, and death among older people, with African Americans bearing a greater burden compared to Whites ( Robert Wood Johnson Foundation and the Foundation for Accountability, 2001).

Harvest health care