Institute on Aging — charity research

Summary

What do they do? The Friendship Line combines inbound emotional support and crisis intervention with outbound check-ins. For the specific pathway we model, staff or trained volunteers proactively call an enrolled older adult over six months. The intended mechanism is simple: reliable conversation and active listening may reduce acute isolation, create an ongoing relationship, and connect a caller to additional support. More

Why this approach interests us

Proactive, repeated human contact directly targets loneliness and removes access barriers.

Our main reservations

The observed 18-point decline may partly reflect selection, regression to the mean, pandemic-era change, or follow-up bias.

What do you get for your dollar?

Institute on Aging runs a free, multilingual 24/7 support line for older adults, adults with disabilities, and caregivers. A six-month pilot reported a substantial decline in loneliness, but it had no control group and only 78 of 175 baseline participants completed six months. Our native model estimates about $14,857 per additional six-month loneliness remission. A separate participant-level health-utility transfer produces a very-low-confidence central estimate of about $14.86M per 10 QALYs.

our best guess: $14,857 — per additional participant below the study’s loneliness threshold at six months
plausible range: $5,000–$78,000 — driven by unknown program cost and an uncontrolled effect estimate
cost per better life: ≈ $14.9M — per 10 QALYs; very-low-confidence loneliness-remission utility transfer
funding room: Not published — the modeled $100,000 is illustrative, not verified room

1. What do they do?

The Friendship Line combines inbound emotional support and crisis intervention with outbound check-ins. For the specific pathway we model, staff or trained volunteers proactively call an enrolled older adult over six months. The intended mechanism is simple: reliable conversation and active listening may reduce acute isolation, create an ongoing relationship, and connect a caller to additional support.

Identify

An older adult is referred or opts into proactive calls.

Connect

Trained staff or volunteers make repeated outbound calls.

Support

Conversation, listening, crisis response, and referral address immediate needs.

Measure

Loneliness and mental-health outcomes are followed over time.

Scope of this review. IOA reports more than 11,000 inbound and outbound calls per month. Calls are not unique participants, a standardized dose, resolved crises, or additional outcomes. This model covers only a hypothetical six-month proactive-call cohort.

2. Monitoring and information sharing

Older adults, adults with disabilities, and caregivers across San Francisco, other Bay Area counties, and California

Organization-reported current program and reach description. IOA describes more than 20 integrated programs and says its services touch more than 67,000 people annually. The Friendship Line reports more than 11,000 inbound and outbound calls each month, while the San Francisco Community Living Fund provides intensive case management to people leaving or at imminent risk of institutional care.

Our assessment. Portfolio reach, calls, referrals, assessments, and services use different units and may include repeat contacts. They do not establish unique people served, program completion, safe community tenure, reduced loneliness, avoided institutionalization, suicide prevention, or causal impact.

121 older adults identified as at risk for loneliness through a Medicare Advantage health plan and offered proactive outbound Friendship Line calls

2024 peer-reviewed six-month mixed-methods single-group pilot. The share reporting loneliness fell from 46% to 28%; anxiety fell from 63% to 43%; depression changed from 36% to 25% without meeting the conventional statistical-significance threshold; unhealthy mental-health and physical-health days also declined.

Our assessment. The pilot had no concurrent control group, assignment was not randomized, participation and follow-up can select respondents, and pandemic-era trends or regression to the mean could explain part of the change. It supports feasibility and measurement, not the causal effect, unit cost, or current marginal value of Friendship Line calls.

63 Friendship Line callers recruited by convenience sampling during 2020–2021, with 23 purposively sampled for qualitative interviews

2025 peer-reviewed mixed-methods observational study. Daily callers were more likely than non-daily callers to meet the study's chronic-loneliness definition (61% versus 18%) and reported high satisfaction and meaningful relationships with the line; the study documented distinct uses for chronic versus acute social needs.

Our assessment. Call frequency was self-selected rather than assigned, baseline need differed sharply, the sample was small, and there was no non-caller comparison. Satisfaction and perceived support are important user evidence but do not establish reduced loneliness, avoided emergency visits, suicide prevention, or cost-effectiveness.

11,860 community-dwelling adults aged 65 or older living with frailty in high-income countries

2023 Cochrane review of 20 randomized trials. Compared with usual care, case management may make little or no difference to mortality, nursing-home residence, quality of life, serious adverse effects, or physical function and probably makes little or no difference to hospital admission or costs; certainty was low to moderate.

Our assessment. This is transferable evidence for a broad intervention class, not IOA's Community Living Fund or other programs. Included models, teams, eligibility rules, usual care, and outcomes varied, and the review cannot supply IOA's local counterfactual effect or marginal cost.

470 adults aged 60 or older, mostly in small six- to twelve-week face-to-face volunteer visiting programs

2023 Campbell systematic review of nine randomized and four non-randomized studies. The review found very low-certainty evidence and could not determine whether volunteer friendly visiting reduces loneliness, social isolation, or related wellbeing outcomes in the short or intermediate term; no study reported long-term loneliness.

Our assessment. Face-to-face friendly visiting is not the same as IOA's multilingual 24/7 warm line, crisis support, or scheduled outbound calls. The review clarifies the weakness of the broader befriending evidence base but does not estimate the Friendship Line's effect.

3. Qualitative assessment

Proactive, repeated human contact directly targets loneliness and removes access barriers.

Key reservations

IOA is a large multi-program organization; a portfolio total cannot be divided by calls, participants, or favorable outcomes to create a causal unit cost.
The 67,000-person reach figure does not publish counting rules, program mix, repeat-contact treatment, geography, or outcome follow-up.
Friendship Line call volume is not a unique-caller denominator, completed intervention, reduced-loneliness outcome, resolved crisis, or life saved.
The 121-person proactive-call study has no concurrent control group, so favorable within-participant changes cannot be assigned to the program alone.
The 63-caller observational study shows high need and perceived support but cannot compare calling more often with an assigned alternative.
Broader case-management and friendly-visiting evidence is heterogeneous and does not establish IOA's organization-specific effect.
FY2025 finances and ten multiyear city contracts do not identify private-gift additionality, payer displacement, program-level costs, or current capacity.
Without one bounded marginal plan, unrestricted support may be valuable but cannot receive a defensible outcome forecast or donor allocation.

Benefits not included in our estimate

Suicides averted, because no program-specific counterfactual suicide effect was located
Emergency visits or healthcare spending averted, because participant anecdotes are not utilization estimates
Mortality, QALY, WELLBY, or life-substantially-bettered conversions
Benefits from inbound crisis calls, grief groups, referrals, or other IOA programs
Caregiver and family spillovers
Suicides averted, emergency visits, healthcare spending, mortality, and crisis resolutions not causally measured for Friendship Line
Depression, anxiety, unhealthy-day, referral, safety, and social-connection benefits not captured by the loneliness utility transfer
Caregiver, family, clinician, volunteer, and community spillovers
Benefits from inbound calls, grief groups, or other Institute on Aging programs

4. What do you get for your dollar?

Our current model: roughly $15,000 per six-month loneliness remission.

We start with the observed fall in loneliness from 46% to 28%, then heavily discount it because the study had no control group. We separately build a bottom-up participant cost because IOA does not publish Friendship Line program accounts. Every number below should be replaced when IOA provides better data.

A better life is our comparison unit of 10 additional quality-adjusted life years (QALYs), potentially spread across people. These are uncertain estimates, not measured returns or verified donation offers.

How we calculate the estimate

MODELED COST PER ADDITIONAL REMISSION: $1,040 ÷ 7%
= $14,857

Model inputs and assumptions

Proactive calls over six months: 52 calls (range: 26 calls–78 calls). MFI operating assumption of two calls per week; IOA does not publish a common dose for the pilot or current participants very low.
Staff or volunteer time per call including notes: 20 minutes (range: 15 minutes–30 minutes). MFI operating assumption; no IOA time-and-motion study located very low.
Loaded program resource cost: 60 USD per hour (range: 40 USD per hour–75 USD per hour). MFI blended assumption for supervision, paid staff, volunteer management, technology, training, and overhead—not an IOA reported wage very low.
Six-month marginal cost per proactive participant: 1,040 USD (range: 600 USD–1,560 USD). Bottom-up synthesis of call dose, time, loaded resource cost, and a modest non-call allowance; not reconciled to program accounts very low.
Observed decline in participants reporting loneliness: 18% (range: 18%–18%). 46% at baseline to 28% at six months in the 121-person single-group pilot moderate for the enrolled sample; not causal.
MFI estimate of causal six-month remission per participant: 7% (range: 2%–12%). Judgmental 39% attribution of the observed 18-point within-participant decline, with a 2–12 point range for regression to the mean, secular change, selection, and missing counterfactual very low.

What would $100,000 buy?

Optimistic: 20 additional remissions. 166.7 participants · $5,000 each
Best guess: 6.7 additional remissions. 96.2 participants · $14,857 each
Pessimistic: 1.3 additional remissions. 64.1 participants · $78,000 each

Our current best estimate: about $14.9 million per better life (10 QALYs).

Publish an explicit, very-low-confidence decision estimate of approximately $14.9 million per 10 QALYs. This participant-level model is separate from the native six-month remission calculation. It starts with the native model's judgmental $1,040 cost per participant and 7% causal remission probability, then assigns each causal remission 50% of a systematic review's 0.04 annual lonely-versus-not-lonely health-utility gap for 0.5 effective year. That yields 0.0007 QALY per participant and approximately $14.9 million per better life. The conditional positive-effect range is approximately $1.25 million to $624 million; a true null, harm, or funding displacement remains plausible. This is a best-effort donor estimate, not a measured IOA effect, verified marginal price, rank, or funding recommendation.

EXPLORATORY COST PER 10 QALYS · ONE BETTER LIFE: $1,040 ÷ 0.0007 QALY × 10
= $14.86M

QALY conversion assumptions

Modeled donor cost per participant: $1,040 (range: $600–$1,560). Bottom-up MFI synthesis of call dose, time, loaded resource cost, supervision, volunteer management, technology, training, and overhead. IOA does not publish Friendship Line program accounts or a current marginal price. very low as a marginal price.
Causal six-month loneliness remission: 7% (range: 2%–12%). The midpoint attributes 7 percentage points of the uncontrolled 18-point decline to Friendship Line. The positive range is judgmental and reflects regression to the mean, secular change, selection, 45% six-month retention, and incomplete scheduled calls; null or harm remains outside the finite range. very low.
Observed annual lonely-versus-not-lonely utility gap: 0.04 (range: Published contrast used as point anchor). Two cross-sectional chronic-condition studies reported a 0.04 utility difference between lonely and not-lonely groups using HUI2 or EQ-5D-3L. The review could not pool estimates because of population, instrument, tariff, condition, and loneliness-measure heterogeneity. very low as a causal transfer.
Share of observational utility gap retained: 50% (range: 25%–100%). The midpoint retains half of the cross-sectional 0.04 utility gap to reflect confounding, population transfer, instrument differences, and the absence of a validated 3-item UCLA threshold mapping. This is a judgment range, not a confidence interval. judgmental transfer.
Effective utility duration: 0.5 year (range: 0.125–1 year). The midpoint combines gradual onset during the six-month program with limited persistence after the endpoint. The cautious case approximates a short-lived late gain; the optimistic case allows a full year. IOA measured neither onset nor post-program persistence. judgmental.

Optimistic positive transfer: $1.25M. $600 per participant · 0.0048 QALY each
Central transfer-discounted estimate: $14.86M. $1,040 per participant · 0.0007 QALY each
Cautious positive transfer: $624M. $1,560 per participant · 0.000025 QALY each

The numeric range is conditional on a positive Friendship Line effect, a positive remission-to-utility relationship, and donor additionality. The pilot has no control group and only 78 of 175 baseline participants completed six months; the utility gap is observational; related telephone and befriending evidence does not identify IOA's effect; and IOA publishes no current marginal plan. If proactive calls have no causal loneliness effect, cause no health-utility gain, produce only transient change outside the assumed duration, harm some participants, or a private gift displaces health-plan or public funding, the impact price has no finite positive upper bound. No source maps IOA's 3-item UCLA threshold directly to health utility. The 0.04 gap is observational, binary, and confounded; the causal remission probability, transfer retention, and duration are MFI decision assumptions rather than study estimates.

5. Funding and previous grants

IOA has not published program accounts, a marginal capacity plan, or evidence that a private gift adds calls rather than replacing public funding.

The $100,000 gift is an illustrative denominator, not a claim that IOA can productively absorb it for incremental proactive calls. A recommendation requires a dated marginal plan, program accounts, staffing and volunteer capacity, payer restrictions, and evidence that a private gift would add rather than displace calls.

This review does not establish a verified marginal funding offer or a complete history of grants.

Donate

Opens the organization’s giving page. A general donation may not fund the specific activity modeled here; confirm allocation with the recipient.

6. Sources

An Evening That Brings People Together: Join Institute on Aging's 2026 Gala. Institute on Aging. organization-reported annual portfolio reach and program description. Published: 2026; exact publication date not stated in extracted page; retrieved: 2026-08-31.
Friendship Line. Institute on Aging. organization program model, audience, geography, languages, and call volume. Published: publication date not stated; current page retrieved 2026-08-31; retrieved: 2026-08-31.
Community Living Fund. Institute on Aging. organization program eligibility, services, geography, and public-funding disclosure. Published: publication date not stated; current page retrieved 2026-08-31; retrieved: 2026-08-31.
Fiscal Year Ending June 2025 Financial Statement. Institute on Aging. organization financial summary. Published: covers fiscal year ending 2025-06; file publication date not stated; retrieved: 2026-08-31.
A proactive phone intervention for older adults to address loneliness identified by a health plan. Hough et al., Annals of the New York Academy of Sciences. peer-reviewed mixed-methods single-group pilot of Friendship Line outbound calls. Published: 2024-09-24 online; 2024-10 issue; retrieved: 2026-08-31.
The Role of Daily Calls to Telephone Companionship Lines for Older Adults Experiencing Chronic Loneliness. Eubanks et al., Journal of Applied Gerontology. peer-reviewed mixed-methods observational study of Friendship Line callers. Published: 2025-11 issue; retrieved: 2026-08-31.
Case management programmes for older people living with frailty in the community. Cochrane. systematic review of randomized trials. Published: 2023-05; retrieved: 2026-08-31.
Friendly visiting by a volunteer for reducing loneliness or social isolation in older adults: A systematic review. Laermans et al., Campbell Systematic Reviews. systematic review of randomized and non-randomized studies. Published: 2023-11-30; retrieved: 2026-08-31.
Exempt Organizations Business Master File Extract (California). Internal Revenue Service. legal identity and source-native financial fields. Published: 2026-08 source snapshot; tax period 2025-06; retrieved: 2026-08-24.
Supplier Contracts. DataSF. city prime-contract accounting context. Published: data as of 2026-08-20T08:40:53; retrieved: 2026-08-24.
Support Institute on Aging. Institute on Aging. legal entity, EIN, and donation route. Published: publication date not stated; current page retrieved 2026-08-31; retrieved: 2026-08-31.
A proactive phone intervention for older adults to address loneliness identified by a health plan. Annals of the New York Academy of Sciences. peer-reviewed uncontrolled mixed-methods pilot. Published: 2024-09-24; retrieved: 2026-09-01.
The impact of loneliness and social isolation on health state utility values: a systematic literature review. Quality of Life Research. peer-reviewed systematic literature review. Published: 2022-01-24; retrieved: 2026-09-01.
Layperson-Delivered Telephone-Based Behavioral Activation Among Low-Income Older Adults During the COVID-19 Pandemic. JAMA Network Open. randomized clinical trial of related telephone interventions. Published: 2024-06-18; retrieved: 2026-09-01.

Annual expenses: years and sources

Average annual expenses (three consecutive fiscal years): $87,823,470. Organization size is separate from the modeled cost-effectiveness of a donation.

Institute On Aging

Whole legal entity Form 990 Part IX total functional expenses; latest original reconstructed filings checked, fiscal-end year from printed reporting dates. Older fallback rows from IRS extracted API.

Latest original filings checked; ProPublica extracted API lags these original returns.