Lorraine Anderson's hip hurt so badly that the 82-year-old couldn't get out of a chair in her southeast Minneapolis house. But she didn't want to go to the doctor.
"She was afraid they'd make her move out of her home," said Jean Gotfredson, a volunteer from Nokomis Healthy Seniors.
Healthy Seniors promised Anderson that if she sought medical care, they would do whatever they could to keep her living independently. And they did. Today, three months after a hip transplant, Anderson remains in the house where she has lived for 49 years.
To stay in her home, Anderson depends on Nokomis Healthy Seniors, one of 43 local programs in Minnesota's Living at Home Network. Using thousands of volunteers to do simple household tasks, the network kept 1,222 elderly Minnesotans out of nursing homes in 2008-09, its leaders say, and provided them healthy, safe living options.
Caring for those same clients in nursing homes would have cost an additional $20 million -- much of it borne by taxpayers -- the network's leaders say. Multiply that by the thousands of other frail, elderly Minnesotans -- a number that will skyrocket with the graying of Minnesota in the next two decades -- and the sums grow large.
"The need [for long-term care] is growing," said Dale Gandrud, a member of the board of Steele County Healthy Seniors in southern Minnesota. "Funding is going down. This is a way to multiply the dollars we have."
Some experts question the network's savings estimate -- and its adaptability. "For a program to be an alternative to nursing home care, it has to be systematic," said Dr. Robert Kane, a long-term care specialist at the University of Minnesota. In the Living at Home Network, he said, "people aren't chosen on the basis of need, but on the basis of geography."
As that debate continues, everyone agrees that Minnesota must do something to keep its exploding elderly population out of nursing homes for as long as possible to curtail the crushing costs of extended institutional care.
Tax dollars spent on seniors' long-term care are projected to grow from roughly $1 billion in 2010 to $5 billion in 2035. In fiscal 2010, Minnesota spent $720 million on nursing home care for the elderly, compared with $333 million on non-institutional care. By 2035, the state hopes to reverse the ratio, spending $3.5 billion on non-institutional care and $1.5 billion on nursing homes.
Count Anderson as a true believer in the strategy.
"I got something going every day," Anderson said of her arrangement with Nokomis Healthy Seniors. Some days it's a volunteer to give her a bath. Some days it's someone to pick up her prescription drugs. Some days it's a person doing laundry or cutting grass.
"I never want to be without these girls," she said of the middle-aged volunteers who help her. "I doubt I could stay here without them."
Living at home is almost always cheaper and more comfortable than living in an institutional setting, said Kristen Whittenbaugh. She directs Nokomis Healthy Seniors, which serves 502 senior citizens on an annual budget of $165,000.
By comparison, in 2009 the average cost of a private room in a Minnesota nursing home was $54,750 a year, according to MetLife insurance company. In the Twin Cities, the annual average was $62,780.
The Living at Home Network, once called the Block Nurse Program and the Elderberry Institute, dates to 1981. Recently renamed, the loosely organized network just changed its budgeting and management to reaffirm its original mission, which allows localities to develop unique programs that all push the common goal of keeping the elderly out of nursing homes.
What it takes to keep senior citizens in their homes can be beguilingly simple and inexpensive. And whether most seniors would prefer to live independently is a no-brainer.
Dolores Aldous likes the Minneapolis home she has occupied for 46 years for the same reasons most seniors like their homes. Aldous' house is familiar and private. Living on a fixed income, she rarely must dip into savings to pay for housing.
At 81, Aldous recognizes what most seniors do: "Everybody isn't real fond of a nursing home situation," she said. "They know it's kind of the wind down" to life's end.
In Owatonna, Minn., the network has helped Francie Drake keep her Alzheimer's-afflicted mom and physically delicate dad, both 84, out of institutional care.
"I quit my job to take care of my parents," said Drake, who has stayed home nearly four years with her parents. Volunteers from Healthy Seniors of Steele County "give me the sanity time that makes me able to do this."
Drake needs a few simple sources of help: a volunteer to shop for groceries, another to accompany her parents to mass, and sometimes, a volunteer to stay with her parents when other family issues require her attention. Drake can't afford to pay for those services. She bets others can't either.
"Right now, the state is spending huge amounts to keep people in institutions," she said. By expanding the Living at Home Network, "the state could save money."
It remains to be seen if the network can provide a viable statewide alternative to nursing homes. But it does seem to meet many of the criteria set by skeptics such as Kane. First, it offers relief to family members, who make up perhaps 90 percent of long-term caregivers. Second, it focuses on community-based services that delay or avert the move to institutional care, which Kane calls crucial. Third, it recognizes that services needed to keep seniors at home are neither exclusively medical nor terribly sophisticated.
Key to the network's economical philosophy is its ability to recruit volunteers.
Edna Ringhofer, executive director of Healthy Seniors of Steele County, has overseen an increase from 85 clients to 1,100 since she took over in 2007. Her annual budget is $163,000. The bulk of the work is done for free by 340 volunteers.
"It's kind of like 'It takes a village to keep a senior citizen out of a nursing home,'" Ringhofer said.
Added state board member Bryce Wahl: "It's neighbors looking after neighbors.''
Jim Spencer • 612-673-4029