“What’s going to happen to our elders?” That was my first thought when I learned that some grants that helped fund Minnesota’s 43 Living-at-Home/Block Nurse Programs (LAH/BNP) were not renewed during the most recent round of Department of Human Services Community Service/Services Development (CS/SD) grants.
Throughout Minnesota, LAH/BNP staff and volunteers provide assistance to elders to help them remain healthy and safe in their own homes. According to a 2008 survey conducted by the U.S. Department of Health and Human Services Administration on Aging, most seniors prefer to remain in their homes, which represent independence and security. Most services are offered on a sliding scale basis, and no one is turned away because of inability to pay for services.
Keeping elders out of nursing homes makes financial sense as well. According to the 2006-2007 Cost and Services report by Elderberry Institute, every dollar invested in LAH/BNPs saves taxpayers $3.50. Elderberry Institute is the umbrella organization for LAH/BNPs.
In the same report, 40 Minnesota metro and rural LAH/BNPs were shown to have kept 1,138 people out of nursing homes for 8,238 months and saved more than $35 million, which would have been the cost of nursing home care if they had been admitted. During the 2008 legislative session Gov. Tim Pawlenty and legislators expressed concern over the increasing percentage of the state budget expended for nursing home care costs.
Annual program budgets for the metro area LAH/BNPs average $110,000. Each program uses a combination of funding sources that includes grants from the state (CS/SD and other Department of Human Services funding), foundation grants, donations and fees for some services provided.
The St. Paul Payne-Phalen Living-at-Home/Block Nurse program is larger than most programs. In fiscal year 2006-2007, when our program kept 89 East Side elders at home and saved more than $4 million dollars, our budget was $257,000. Two CS/SD grants that provided a majority of the funding in recent years were not renewed for the coming year. The impact of the loss will mean changes to Payne-Phalen’s program, including staffing and service cuts.
Many local, state and national elected representatives do appreciate the value of having LAH/BNPs available to seniors in their districts. Two newer LAH/BNPs on the East Side, North East Neighborhoods in District 2, and Dayton’s Bluff Seniors in District 4, were among 12 new Block Nurse Programs throughout Minnesota to receive $20,000 in base funding as part of a bill passed during the recent legislative session. Payne-Phalen and other established programs also receive this base funding.
Worried about Teri, Norm, Helen and Cal
The Payne-Phalen Program is seeking new grants, donors and other sources to fill the gap so we can continue our work. But since we didn’t have a lot of notice about the grants that weren’t renewed, we’re concerned about how we’ll be able to provide for the elders who rely on us. I’m particularly worried about some of the East Side elders I’ve come to know — people like Teri, Norm, Helen and Cal.
Teri, 56, was introduced to the BNP by friends. The program typically serves persons 65 and older, but the age limit may be lowered when individuals have disabilities. Four years ago Teri had surgery for a brain tumor. The effects of the tumor left her paralyzed on the left side. After spending six months at Courage Center getting rehabilitation, Teri and her husband moved from their home in Forest Lake to an accessible apartment in a senior building near Lake Phalen. Teri attends monthly social gatherings and has helped as a volunteer in the Block Nurse office.
Norm is an 85-year-old widower. His two adult children live in other states. Since the first of this year Payne-Phalen staff and volunteers have visited Norm 29 times. He has received help with medical forms, nursing assessments, wound care and rides to medical appointments. We also found someone to assist him with cooking, housekeeping and lawn services. When he has questions about a health issue, is concerned about his ability to drive due the weather, or needs help with a situation at home, he calls us.
Helen is an 82-year-old widow who has no children. She has macular degeneration and is legally blind but has been able to stay in her home with the help of rides to the doctor and bank from staff and a volunteer who takes her shopping every other week. At a monthly blood pressure clinic the block nurse noticed that Helen’s blood pressure was dangerously low which put her at risk of a heart attack or a fall. Our nurse called her clinic to obtain a change in her medications which stabilized her pulse and prevented medical complications. Helen also enjoys visits from nursing students and attends the Payne-Phalen program’s monthly social gatherings.
Cal is 80 and has outlived three wives. He is a Korean War veteran and has health issues including diabetes, hypertension, and vision problems that require regular visits to the VA Medical Center. A block nurse staff person picks him up and accompanies him to visits and helps him navigate the halls of the clinic. After each visit he says, “I don’t know what I’d do without you.” Our staff also helps educate Cal about his diabetes. He has his blood pressure checked at a free monthly blood pressure clinic that the block nurse program conducts in his building.
Repercussions could be noticeable soon
Lack of funding to sustain LAH/BNPs should be of grave concern for any elder, their caregivers, relatives, neighbors, and anyone in the community who hopes to be an elder one day. The repercussions of cuts to our program could be noticeable soon, and in some cases they might be serious, not to mention costly in the long term. Pawlenty and the Legislature have expressed increased share that nursing homes have taken up in recent state budgets.
Employers could see a rise in absenteeism as adult children need time off work to care for elderly relatives, since block nurse staff and volunteers won’t be available to provide visits and rides to doctor appointments. If we have to discontinue blood pressure clinics and are unavailable to notice elders whose symptoms indicate health conditions so we can refer them to their primary clinics to get treatment, there may be an increase in the number who suffer falls, strokes, or heart attacks.
What’s going to happen to our elders? I’m afraid of finding out what the answer will be.
Mary Gallagher is manager of elder/volunteer services for the Payne-Phalen Living-at-Home/Block Nurse Program in St. Paul. This article is reprinted with permission from Access Press, where it first appeared.
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