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What will become of our elders?

“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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Comments (5)

  1. Submitted by evelyn blum on 07/28/2008 - 06:03 pm.

    What the heck does the school topic and issues of welcoming schools have to do with What will become of our elders??

    Except for actually using any forum what so ever to try and promote someones special interest group? Do you go around and use anyplace you can possibly post something? to gain some recognition on this subject?

    I am shocked and dismayed at the tactics here.

    This is huge proof that you indeed need to promote your special interest, “moral standard”

    Please can we stick to the subject that is at hand here which is What will become of our elders?

  2. Submitted by Richard Schafer on 07/28/2008 - 11:45 am.

    We all want more Home Community Based Servies (HCBS) and less institutional care. But these findings reflect no comprehension of why America has a system biased toward nursing home care in the first place. Government made that care venue virtually free with Medicaid and Medicare in 1965. Costs exploded as the country was paved in nursing homes. A privately financed home and community based services infrastructure and a private insurance market to pay for it were both crowded out. Now government is trying to “rebalance” toward HCBS but can’t afford to pay for quality care in the community or in a nursing home.

    What characteristic distinguishes each of these two kinds of insurance? If you die, or your house burns down, or you get sick and you are uninsured, it is bad news. You are out of luck and out of pocket! On the other hand, if your property floods or your home quakes or your crop fails or you need long-term care, the government is there to help you with loans, subsidies, grants, and public assistance. In a nutshell, people buy insurance when they face a real financial risk; but when they don’t, they don’t.

    The main purpose of private insurance is to replace a small risk of catastrophic loss with the certainty of an affordable premium. In a free market, private insurance also performs another vital function; it prices risk. Voluntary exchanges between willing sellers (insurers) and willing buyers (insureds) determine actuarially sound premium levels. Premiums tell the public as accurately as humanly possible what the precise danger is of living on a flood plain or ‘going bare’ for long-term care. Given this information, rational people who are free to choose can make intelligent decisions in their own best interests.

    Ironically, for all its good intentions and altruistic justifications, government distorts this risk calculation and dangerously misleads the public by providing tax-financed grants or subsidies to indemnify the uninsured. By reducing or disguising actual risks, the government discourages responsible people from buying private insurance and rewards the irresponsible for failing to do so. This is the real reason why so few people have flood, crop, earthquake or long-term care insurance, self-serving evasions (‘it won’t happen to me’ or ‘insurance costs too much’) to the contrary notwithstanding. When insurance truly costs too much, it means the risk is too great to take, by definition! If the government rebuilt every home that burned down, no one would buy fire insurance either.

    Government has paid for most expensive LTC, such as it is, for 43 years. That put the public to sleep about the risk. The only people waking up and buying LTCI have been through a wrenching experience with a loved one. Wait for all the parents of baby boomers to require LTC and the market will finally improve.

    But the waiting game is for suckers. The better strategy is proactive. Advocate public policy to target government financed LTC to people truly in need. Use the savings to incentivize LTCI and reverse mortgages for people with wealth to protect or use. Everyone wins because the more private money in long-term care, the better the access, quality and diversity of care for everyone, rich and poor alike.

    America’s messed up long-term care service delivery and financing system is self-inflicted by perversely counterproductive public policy. The good news is we can fix it over night. Just stop doing what we’ve always done and we’ll get a different result. Albert Einstein called that the definition of sanity.

    To wit: stop giving away most home care and nursing home care through inadequate public programs. Make middle class and affluent people pay their own way, either up front or later through estate recovery. Stop using Medicaid as free inheritance insurance for the baby boom generation. Use the savings to pay for tax incentives for LTC insurance, LTC education programs and to promote the use of home equity to fund LTC.

    You can do that through responsible public policy. Or you can stay on the same course we’re on, let the long-term care system collapse altogether, hurt poor people most, and end up with the middle class and affluent having to use their home equity to get decent care in the long run anyway. Long-term the outcome will be the same.

  3. Submitted by Steve Rose on 07/29/2008 - 10:40 am.


    My mistake. I have not previous submitted a letter to, and I did not intend to associate it with this article regarding our elders. Sorry to both shock and dismay. No “huge proof”; no “moral standard”.

    My interest was in commenting on something that I had observed in my community. My only special interest is that of a parent. As I noted in my letter, I am not trying to work my agenda into the classroom. I want the classroom to focus on core academic fundamentals. I am not the one introducing a change.

    This is an interesting piece on elder care. What are your thoughts?


    Steve Rose

  4. Submitted by Eric Schubert on 07/31/2008 - 06:08 pm.

    The financing of aging services and long-term care has to be transformed. Neither the private sector (long-term care insurance) or public sector (government) is doing the job so that people have the dollars they need to live fully and as independently as possible. This is an issue that Minnesota and America should absolutely be able to find a solution on. If we don’t that $1.5 billion we spend on long-term care in the state budget now will have many more digits behind it, crowding out spending for many other things we desire.

    This is a health care issue, a business issue, a quality of life issue, a community development issue . . . not simply a long-term care issue.

  5. Submitted by Steve Rose on 07/28/2008 - 08:41 am.

    School’s Out

    School is out for the summer, but our neighborhood elementary school is still trying to parent. The marquis in front of Hale School on East 54th Street carries the message, “Have a Great Summer, Don’t Forget to Wear Your Bike Helmet”. Perhaps good advice, but it points to the school’s emphasis on parenting, rather than educating. Messages I would expect from the school to children include, “Have a Great Summer, Master the Multiplication Table”, or “Have a Great Summer, Read At Least 30 Minutes Each Day”.

    Minnesota has no bicycle helmet law; bicycle helmets are the prerogative of the parents. I keep the brakes and tires on my children’s bikes in good working condition. That’s what I do; I’m the dad. Minnesota MCA test scores for Hale School don’t indicate that the job of education is getting done. Of course, these scores can be debated and explained away, but even the most creative brush stokes don’t paint a pretty picture of reading and math learning at Hale.

    Hale’s latest foray into parenting is the Welcoming Schools curriculum, which is backed by the Human Rights Campaign. The HRC has learned that the public schools are willing to carry their water, and the HRC is more than willing to top off the tank.

    The HRC’s GLBT curriculum teaches family values that are not held by all Hale families. The curriculum and supporting films portray family structures that not all parents want to teach to their children, age five to ten. The curriculum neglects to teach the fact that same sex marriage is not legal in MN.

    I have values that are not held by all Hale families. Were it important, I would tell you what they are. They are not important, because I am not trying to force them into the classroom.

    Having grown up in the Minneapolis schools, I remember when the school’s mission was academic education, and parents handled the rest. I liked that.

    Steve Rose

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