By Marty Rosen
American News Service
The federal grants have helped. So have plugs from Sen. Paul Wellstone (D-Minn.) and the Ford Foundation. But the homegrown program to keep the elderly out of nursing homes gets its biggest boost from neighbors watching out for each other.
Locals call it "Minnesota Nice."
"Sometimes they say it jokingly and sometimes they say it gratefully,'' said Lynn Thibodeau, 72, a retired St. Paul journalist who recovered at home from a double bypass operation last year with assistance from the Living at Home/Block Nurse Program. "It probably saved my sanity. To be put into some other care facility would have washed me down the drain."
Started in the 1980s by residents of a St. Paul neighborhood alarmed by the unmet needs of elderly neighbors, the Living at Home program has grown into a net of home health care services. Elderly participants get fed, comforted, read to and nursed, regardless of income.
In St. Paul, volunteers canvass participating neighborhoods for those who need help as well as for more volunteers: someone to iron shirts, play cards, offer a ride to the doctor's office.
Allan Forman, 91, said he started getting help through his church when his eyesight began to fail. "They wanted to know if I'd be interested in having someone come and visit."
He let the volunteer into his home. "We've had a great time," he said, adding that he wouldn't have given a government worker the same access.
"It's because there's trust," said Marjorie Jamieson, executive director of the private, non-profit program. "It's because the home health aide lives down the block or the nurse goes to their church. Depression-era people are terrified the government will provide services and take away their homes."
Wellstone (D-Minn.) touts it as a health care success. The federal Health Care Financing Administration has run with a spin-off of the Living at Home program, the Healthy Seniors Project, as part of a national effort to control Medicare spending.
In Minnesota, organizers see the program - now spreading to other states - as a model for reducing these costs. So far, it appears the nurse-managed program is about one-third less expensive than typical fee-for-service home health programs, according to Jamieson. There are shorter stays in the hospital, fewer ambulance trips, fewer emergency room visits.
"Instead of a client going to an outpatient clinic, the nurse says, I'll stop by and see you.' It's called appropriate care,'' Jamieson said.
The Living at Home program began in 1981, when a local nursing professor recognized that the acute care system wasn't serving the elderly. Another nurse, reading her comments in a community newspaper, volunteered to help.
"You're exactly right," she said.
Too many of Minnesota's elderly were in nursing homes: about 8 percent of the elderly population. Nationally, the number is closer to 5 percent. Legislators, recognizing the problem in 1985, capped the number of licensed beds at about 44,000 and forced communities to seek solutions.
The program grew through a patchwork of county support, federal funding, private grants from St. Paul's H.B. Fuller Foundation, and donations to cover about 20 percent of the unfunded nursing and home health aide costs. They had bake sales and candy drives. Neighborhood-run District Councils, publicly supported citizen planning bodies, unique to St. Paul, were among the original sponsors.
Even as the program grew, encompassing 15 Minneapolis and St. Paul neighborhoods, each community kept its autonomy. Each appoints its own board of directors and hires a program manager and staff. Each program finds its own financing, although they have begun to collaborate as funding has become more competitive, said Alice Seuntjens, the program's assistant director.
Referrals come from friends, someone in church, someone in the neighborhood. No one is turned away for lack of money, and the services are as specific as the needs.
Lynn Thibodeau, the retired writer, was hospitalized three months with complications following her bypass surgery. She refused transitional care, she wouldn't live with her adult children, and she fought against having a stranger in her four-story St. Paul home.
"To have someone invade my home? I wasn't mentally receptive to that. But it didn't take more than one day to convince me," she said. The nurse assigned to change her dressings each day became a close friend. "It became a social thing I looked forward to each day.''
Despite a childhood handicap that forces him to use a cane, Allan Forman is spry for 91. Someone at his Lutheran church brought him into the program. While a college student makes social visits, he also looks for signs of decline. Is Forman eating right? Does he need help with housework? Should a nurse intervene?
JoAnne Rohricht, a founder of the program who still advises it today, has recruited many volunteers to pair with elderly clients.
"My pattern has been to think of people I know who are sort of naturals relating to other people," she said. She's always looked for good listeners, people who can handle a confidence. "That's important in small neighborhoods.''
Similar living-at-home programs have developed in Columbia, S.C., and Birmingham, Ala. Some supporters of the Minnesota program say it can't work outside a close-knit community.
"I think it can work wherever people have some sense of concern for the common good. Wherever there is some value for community. It takes that," Rohricht said.
Copyright ©1997 American News Service
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