Transcripts

text | pdf |

---

RACHEL REABE: MPR's Main Street radio coverage of rural issues is supported by the Blandin Foundation, committed to strengthening communities through grant making, leadership training, and convening.

Welcome to our special Main Street broadcast from the Minnesota Public Radio studios of KZSC KLSC in Rochester. I'm Rachel Reabe.

Minnesota has 446 nursing homes. Clearly, our long term care system is nursing home dominated. But it's not the right choice for everyone. Main Street reporter, Brent Wolfe, looks at senior foster care, one of the options being developed in Southeastern Minnesota for the elderly.

BRENT WOLFE: After retiring from IBM, Barb and Dick Woodruff built their dream home on a rolling hillside surrounded by 230 acres of farmland in the eastern part of Olmsted County. They wanted a little extra income, and they wanted to work with people rather than machines. So they built the house to accommodate five seniors in an assisted living setting. That means no steps and several bathrooms big enough to turn a wheelchair around in.

The elderly they take in can still get around, but they can no longer do things like the housework and cooking necessary for living on their own. They often gather around the kitchen table to talk about old times and current events. Barb Woodruff says she makes the seniors part of her family and doesn't run a rigid schedule.

BARB WOODRUFF: It's not like that you have to get 50 people down to the dining room table to go and eat, so they have to get up at 6 o'clock or whatever. Yeah, you allow them to be home. And you do home things. And I don't have names on doors. Or even with their memory problems, I just assist them so that it helps them. But this is their home. It's not an institution.

BRENT WOLFE: This new version of a nursing home is catching on. About 50 families in Olmsted County provide senior foster care. There is training required and homes must meet specific safety guidelines.

Margie Hankin's 92-year-old father, has lived with the Woodruffs for nearly two years. She says when it became clear he couldn't take care of himself anymore, she began looking for a place to take care of him. The Stewartville Nursing Home was full, so someone referred her to the county's senior foster care program called Homes Plus. Hankin brought her dad out to the Woodruff's home to check it out.

MARGIE HANKIN: So we took him out there when on a Saturday. They talked back and forth. And then they said that they would be happy to have him. And so then I told dad, I said, well, let's go home and we'll get your clothes and so on and forth. And well, he said, no. He said, I want to stay. So he stayed right then. They made him feel so comfortable and so at ease in home. And it's always been like a family.

BRENT WOLFE: And like most families, they have their routines and special events. Every Friday morning, they head into town to go bowling. Hankin's father, Christian Perkowski, loves it, even though he's nearly blind and deaf.

CHRISTIAN PERKOWSKI: I can't see the alleys, but I know where all the pins are. I make it so they got to beat me. I don't let them beat me. They got to beat me. I know where the alleys are. I know where the pins are. And just because I can't see the pins, that's no sign I don't know where they are.

BRENT WOLFE: There is still some guilt involved for some people when they send their mother, father or grandparent to live with another family. But Margie Hankin says the Woodruffs are providing a service they get paid for. And she comes to visit her father often.

MARGIE HANKIN: I don't worry any more than when we're gone because I know he'll be taken care of and whatever. I mean, it's just wonderful. And like I said, it's a family.

BRENT WOLFE: Another reason Hankin likes the program is that it's less expensive than a nursing home would be. On average, senior foster care in Olmsted County costs $3 to $500 a month less than nursing home care.

Barb Woodruff says it's important to keep seniors active. And she doesn't face the same constraints as a nursing home. She can adapt to the unexpected, such as a former resident named Marie, who had her eye on her husband's Gold Wing motorcycle.

BARB WOODRUFF: My husband was just teasing her one day, and he had to go put gas in it. And he said, Marie, how would you like to go for a ride on this? And she said, sure. And I went and got her a helmet, and she crawled on that thing like she had rode it forever.

And so when she came up the driveway, Marie was waving and laughing. And she just had such a good time. And Marie said the only thing that she regretted is while she was taking the ride, that she didn't see anybody that she knew that would see her. She wanted somebody to know that she had been on that motorcycle.

BRENT WOLFE: Woodruff says some people clearly need a level of care that can only be provided in a nursing home. But she hopes as the older generation in America gets bigger and bigger, more people will offer foster care and make seniors part of families instead of institutions. I'm Brent Wolfe, Minnesota Public Radio.

RACHEL REABE: And I'm Rachel Reabe. You're listening to a Main Street Radio special on Minnesota's long term care system. My guests at the NPR studios in Rochester are Connie Bagley, director of the Southeastern Minnesota Area Agency on Aging, and Hal Freshley with the Minnesota Board on Aging. Dr. Ken Hepburn, director of the geriatrics program at the University of Minnesota's Family Practice Department is joining us from our studio in Saint Paul.

Good afternoon, and welcome to all of you. Our phone lines are open for your questions and comments. Listeners, you can call us this afternoon at 1-800-537-5252, 1-800-537-5252.

Dr. Hepburn, do you think that our nursing home infrastructure-- I know in Minnesota, we have 45,000 nursing home beds. Is that an obstacle to building alternatives for long term care?

KEN HEPBURN: I don't think it's an obstacle. I think it's the given of a system of the future that has to emerge. It seems to me that as our population doubles, the population of people over 65 doubles, what we're going to face is a situation of enormous chronic care need where the existing nursing home stock will likely be transformed into accommodating more specialized needs, such as the need for intensive rehabilitation, the need for care of people who are extremely difficult in their behaviors and certainly, hospice care. But the system, as it will emerge, I think, is one that is going to be much more community based using nursing homes and hospitals in more specialized ways.

RACHEL REABE: Mr. Freshley, would you respond to that?

HAL FRESHLEY: In fact, I wrote down the word build alternatives in long term care, particularly because I think a lot of people currently think of facility-based long term care. And as Ken Hepburn said, we are increasingly looking at the growth of looking at the growth of community-based options. And when we say community based options, we mean everything from someone who can come into your house and help you do some general things around the house, heavy chore helping you do shopping.

There are all kinds of new options. And perhaps, during this hour, we'll start talking about them. But there has been a tremendous growth, partly because of the market and then also partly because the public sector is responding to that desire for other kinds of alternatives that don't necessarily require a separate facility, a built environment for long term care.

RACHEL REABE: Ms. Bagley, how difficult was it to develop the adult foster care network down here in Southeastern Minnesota?

CONNIE BAGLEY: It takes a lot of work to encourage people to start to develop another alternative. It's new. Sometimes, it's risky. I know that the people that we worked with in the beginning to encourage them to get into foster care, of course, are taking a risk. It's starting a new business.

You aren't guaranteed that although you have a facility and you're opening it up to people, that people are going to use that service because for probably the prior 20 years before we began to develop foster care, it was a foreign concept as an alternative for seniors and had been used primarily for other segments of the population.

So it did take a lot of hard work and encouragement of the people who got into it, as well as education and encouragement of the service network to make referrals and encourage people to use that as an alternative. I think the piece that you had as we opened the hour demonstrated, though, the warmth and the nice home feeling that you have as a result of foster care.

RACHEL REABE: And when I'm 95, I'm really not going to be nervous to ride a motorcycle. At that point, I think I might even go without a helmet.

CONNIE BAGLEY: Well, I think you've got to remember that the population that we're talking about is us. If you're 35 years old and you're listening to the broadcast today, we're talking about you. And are you afraid to ride a motorcycle?

We're talking about a generation that's grown up, who's been a part of the baby boom, the '60s. And we have a lot of different attitudes and wants and desires. And we're going to be very demanding about what we want in the future.

RACHEL REABE: Our phone lines are open for your questions and comments this afternoon. The number, 1-800-537-5252. We go to Dr. George Johnson now, who is calling from Fargo. Good afternoon, Dr. Johnson.

GEORGE JOHNSON: I'm a pediatrician with the University of North Dakota School of Medicine. And I've long been intrigued by the similarities between pediatric medicine and geriatric medicine. As a physician involved in chronic disease of childhood, I've been highly impressed how important animals are to a child with chronic disease.

And I would like to ask the managers of adult foster care their opinion about animals for our wonderful seniors. And I would like to add, parenthetically, why not? Why not have animals in nursing homes throughout the state of Minnesota and for that matter, North Dakota?

RACHEL REABE: Who would like to respond to that.

KEN HEPBURN: Let me respond to that. I think that's a terrific idea. And we're seeing some experiments going on in the Twin Cities in some several nursing homes have instituted a process that's called edenization. In that process, numerous cats and dogs and cockatiels are being introduced into the environment as well as just tons and tons of plants-- people are being.

But it isn't just the implementation of add some animals. It's a restructuring of the environment. So the people are moved into more of a neighborhood, and they have-- they're given more responsibility. I think what the delight that a child takes in an animal, any person can take.

But in addition, now we're seeing that the residents in the nursing homes are being given responsibility. And responsibility is something that's often taken away when people are moved into nursing homes. So I think we're getting double benefit from these kinds of experiments.

RACHEL REABE: So we are changing the way that nursing homes are set up. Mr. Freshley?

HAL FRESHLEY: Yeah, nursing homes are changing. In fact, one of the things that-- the first half of the show talked a lot about the changes in nursing homes that are coming about partly because of labor changes and the labor force. But even within the nursing home industry and the ways that nursing homes are reimbursed, there are tremendous changes.

The percentage of people in Minnesota in nursing homes really reached a peak in the '80s and has been going down ever since. We have a reputation for having an awful lot of people in nursing homes. I think someone said that it's something that we spend huge amounts of money on. And nobody really wants to be in an institutionalized setting.

And as a consequence, they have actually changed tremendously. For people who do live in nursing homes, there are lots of new options. As Ken Hepburn mentioned, the Eden projects, where there's a lot more flexibility. But nursing homes themselves are becoming more of a post-hospital place where people just go to recover to get some therapy.

RACHEL REABE: Temporary stock.

HAL FRESHLEY: Temporary. Now, in fact, just this year, it was the very first time that more people were discharged from nursing homes to their own homes than to death. It used to be it was a place where people went and they lived out the rest of their lives. And they died in a nursing home. Now, actually, the majority of people who go into a nursing home subsequently go home.

RACHEL REABE: We go now to Lino Lakes, where Mary is on the phone. Good afternoon, Mary. Welcome to this Main Street special.

MARY: Hello. Hi. Well, my kind of question and just to put in my input, I'm a registered nurse. And I've been a registered nurse for going on 20 years. I've worked in both spectrums, a long term care and the hospital setting.

Probably about six, seven years ago, they started licensing foster care also to do adult day care at home. And that's what I've started in my home. And I'm just telling you about the fruits that I've seen. It has been just wonderful to be able to offer a home setting-- there's no more than five-- for people 60 and older to come into our home for the day and then to go home in the evening.

And then this allows their family members to work. This allows also respite stays. We can do a weekend to let them get away. It allows them to have some flexibility in the evenings for care. Really, what we do is buddy up with the family to provide the care.

And this program, I don't know of any others that have started. We've tried to encourage many others to start these kinds of homes to provide a family atmosphere during the day, putting up with the family so that they can have their individual needs met. And the fruits have been just beautiful. People are very happy here. The families are happy.

Anoka County has been wonderful promoting this program, which has helped. So I'm just saying that there are lots of little things that are happening. But I think one of the major problems is to get it out, that people can provide this kind of service in their homes to the elderly. And it works so much better than large institutions where I have come from.

RACHEL REABE: And Mary, so at the end of the day, then your five seniors would return mostly to their children's homes?

MARY: Their children. Some returned to their spouses.

RACHEL REABE: And was it hard to find the people to fill your slots? Or could you fill them many times over if you had the openings?

MARY: At first it was educating everybody about this program because it's under the elderly waiver and alternative cares. And it was kind of educating everybody about this. And so it was about six, seven months that we had a problem. But now, we're full and we usually have a waiting list.

So now that people have tried this, the public health nurses have seen it work. The social workers have seen it work. And just, wow, this is beautiful. A lot of people that come here may not have done as well in a large nursing home setting where they have some of these adult daycare centers. And they usually run approximately 30 people. So you can see there's quite a difference.

There's my husband and myself. And usually, we have someone else come help us for four hours. And so that's almost a ratio of three able-bodied adults to five clients.

RACHEL REABE: Thank you for calling us this afternoon. Connie, do these seem like-- are these ideas that are spreading?

CONNIE BAGLEY: Well, certainly they're ideas that are spreading. And I think that this hour, one of the things that we really want to emphasize is that this is just the tip of the iceberg and that I would like to also focus or bring our discussion more into the arena of alternatives that are available to seniors in the community. And certainly, expanding foster care to provide respite is one of them.

But we also have a lot of other kinds of programs in the community that make it possible for seniors to remain in the community. And that's certainly the focus and the target of what we're trying to work on between now and 2030. We also offer volunteer respite programs in the community so people can remain in their home so that the individual who is the primary caregiver can have some relief by having a volunteer come to their home and provide four hours, six hours, eight hours of relief.

And that enables that person to be able to have some personal life and personal time and be able to continue to be a caregiver and keep that person at home much longer. There are a lot of other kinds of services that help support that like home delivered meals, congregate dining, transportation programs. There are peer support groups for caregivers.

And so I think it's important that we emphasize this hour that certainly, we began by talking about the importance in crisis that we're facing in nursing homes, that we have alternatives like foster care. We haven't talked about assisted living yet this morning. But we need to really get across the point that there are really dozens and dozens of alternatives that are being developed and that we want to continue to work on in the coming years in order to prepare for this growing population.

KEN HEPBURN: Well, Rachel, can I add to that?

RACHEL REABE: Yes.

KEN HEPBURN: I'm glad that you broke the ice, Connie, on primary caregivers, family caregivers because when we talk about alternative care systems, I think we really ought to acknowledge, before we start that conversation, that the primary care system is the family. 80% to 85% of care provided to chronically ill people is provided by family members. And I think when we look at the system, we ought to look at ways of strengthening and further empowering that group.

We really do not have reimbursement systems that provide ways for health care organizations, for instance, to train family members in the work that they do. And the family members will often spend four or five six years. And I'm working with a person right now who's in her 18th year of caregiving.

People who do that work need to be trained. We don't pay for that. Respite can be found sometimes through volunteers. But it's hard to arrange for it through insurance. But most, I think, importantly, the family caregiver remains an outsider to the health care system.

We don't integrate her-- because 71% of the caregivers are women. We don't integrate her into the health care system except in anecdotally individual cases. So I think we have some systems issues to deal with regard to what I think is the primary care system for older persons.

RACHEL REABE: And for those family members that are providing care, answer this question for us. If I was caring for an elderly parent in my home and it was my parent, would I be able to get reimbursement or would that only happen when I place that person someplace else?

HAL FRESHLEY: You may not get reimbursement for the care that you provide. But you can certainly get a couple of things that-- one that Ken mentioned was training to do a better job. If you're caring for some loved one, it's probably because you really them. And you really want to do the very best job that you can.

And all kinds of research shows that people who have gotten some training, who have learned how to do it better, have learned how to do it more easily, don't burn out. They actually can feel better about the work that they're doing and can do it and want to do it a longer period of time. So first of all, you can, in some instances, actually-- and we'd like to increase the number of options for people to get some training.

But there are a lot of other services that currently can be brought in. Respite services, as the earlier caller mentioned, if you're caring for someone and you're also trying to work, there are daycare programs that you can pay for or that your loved one may be eligible for that are paid for with private money.

I also want to mention that because there is a lot of interest in this, not only is there public money now going into supports for people in the community but the private foundations are starting to look at this. It's growing near. The market is growing lots and lots of new options.

RACHEL REABE: We go to the phones now. Carol is standing by in Cloquet. Good afternoon, Carol. Welcome to the program.

CAROL: Hi. My phone is probably running out of juice, but could you please speak to the issue of long term care insurance? It's extremely expensive. And is it actually worth it? And I'll hang up and listen because I'm out of power. Thank you.

RACHEL REABE: Mr. Freshley.

HAL FRESHLEY: There-- currently, there is a lot of interest in trying to increase the pool of people in long term care insurance. Insurance is based on the risk. And currently, long term care insurance is only attractive to people who probably think they're going to need it.

And that means that they're probably people who are going to use it. And therefore, it's expensive because the insurance companies base the rates on how expensive the people are that are insured. If we are able to increase the risk pool-- this is getting into some insurance talk here. But if we can increase the risk pool of people who purchase long term care, we can drive the price down and therefore, actually make it more affordable.

There are very interesting experiments in California right now. There have been some-- there's been legislation proposed here in Minnesota to try to increase the risk pool for private long term care insurance. But currently, it is pretty expensive because it only appeals to people who think that they're going to need it.

CONNIE BAGLEY: Well, it really-- what it amounts to is that we need more education and convincing of younger people to invest in long term care insurance because presently, the people who think that they need to buy long term care insurance, generally, are over 60. And that is why this is a costly insurance plan and why it is not growing as quickly.

The proposed legislation in the session-- in our current legislative session is trying to make this available to state employees and would set an example, I think, in the state of Minnesota to encourage more employers and more people who are of the baby boom age to see this as an investment that they make long term so that when they do reach that age, they will have this kind of coverage. But right now, people are hesitant to buy it when they're 40 years old.

RACHEL REABE: We're talking today about long term care options for the elderly with our guest, Dr. Ken Hepburn, Hal Freshley, and Connie Bagley. I'm Rachel Reabe, and our phone lines are open for your questions and comments at 1-800-537-5252. We'll be back with more of Main Street and your phone calls after a look at news.

IRA FLATOW: I'm Ira Flatow. In 1914, Ernest Shackleton and the crew of the Endurance set sail for Antarctica. His plan was to be the first person ever to walk across the frozen continent. That voyage turned into a harrowing 20-month ordeal as Shackleton's ship became trapped and eventually crushed by pack ice. Join me on the next Science Friday for a look back at this legendary tale of survival in a frozen world. That's on Talk of the Nation from NPR News.

GRETA CUNNINGHAM: Good afternoon. It's 12:30 with news from Minnesota Public Radio. I'm Greta Cunningham. NATO officials in Belgium today refused to provide more details of this week's accidental attack on a refugee convoy. They also did not show pictures or video of the attack.

NATO officials admitted yesterday that an American F-16 hit a civilian vehicle. A NATO spokesman says military Commanders are already reviewing tactics to see if there are ways for pilots to better identify their targets.

NHL officials say Wayne Gretzky is announcing his retirement this afternoon. Gretzky is a center for the New York Rangers. He's scheduled to make an official announcement at 4 o'clock this afternoon at New York's Madison Square Garden.

There are still no answers about the cause of a Korean Air crash yesterday in China. The cargo plane went down just after taking off from Shanghai's airport. The crash killed nine people and injured 35 others. Investigators are searching for the plane's flight data recorders. The South Korean airline is suggesting terrorism may have been involved in the crash.

In regional news, the Minnesota Senate today passed an early childhood funding bill with money for subsidized child care and services for the homeless. The bill includes $90 million for the subsidized child care. That's $20 million more than the house is likely to approve.

Carver County officials say the rising Minnesota River is forcing them to close part of County Road 45 in San Francisco Township. The affected road is near the border of Carver and Scott counties. Officials say motorists will have to use other routes to cross the river. The road is expected to be closed for one to two weeks.

Looking at the forecast for the state of Minnesota today, blustery and cold statewide. There's a possibility of some snow mixed with rain in Western and Southern Minnesota. High temperatures today ranging from 35 to 45 degrees.

At this hour, Duluth reports cloudy skies and 45. It's cloudy in Rochester at 42, cloudy in Saint Cloud and 35. And in the Twin cities, cloudy skies, a temperature of 44. That's a news update. I'm Greta Cunningham.

RACHEL REABE: You're listening to a special Main Street report on the coming wave of senior baby boomers. 30 years from now, 1 in 4 Minnesotans will be over 65 years old-- double today's number. I'm Rachel Reabe. My guests are Hal Freshley with the Minnesota Board on Aging, Dr. Ken Hepburn, director of the geriatrics program at the University of Minnesota's Family Practice Department, and Connie Bagley, director of the Southeastern Minnesota Area Agency on Aging.

Our phone number is 1-800-537-5252 if you would like to join the conversation this afternoon. We go now to Minneapolis. Good afternoon, Kay.

KAY: Thanks for having me on. I'm a geriatric nurse practitioner and have spent much of the last 25 years caring for patients who live in nursing homes. But the most exciting thing that I do is work in our Southeast Seniors block nurse program. I wanted to talk about block nurse programs, since I haven't heard that mentioned until now.

We've been operating about 10 years in the Twin Cities. The St. Anthony village was the first program that began. Our goal is to keep people out of nursing homes and to improve their quality of life.

We have a primary care nurse who lives in the neighborhood. We have home health aides who live in the neighborhood. And a big part of our program is the volunteer aspect of it who do things like take people for appointments and do friendly visiting.

We've got a volunteer board. And although we do get some Medicare funding from when our patients meet those requirements, we do have some patients on medical assistance, some private pay. But we're engaged in fundraising so that we can keep going in the light of the loss of some of our funds.

RACHEL REABE: And so, Kay, who would your employer be then?

KAY: I'm not employed. I'm on the board. I am, in my professional life, a geriatric nurse practitioner. But my volunteer years have been on the Southeast Seniors board. And so--

RACHEL REABE: But for the paid staffers, for instance, the paid block nurse?

KAY: We have two employed staff. Our program director and our volunteer director are employees of Southeast seniors. And our nurse is employed by an agency of home health care agency. But she does only our patients. And our home health aide is an employee of the same agency, but she only works in our neighborhood. So it really is a neighbor caring for neighbor program.

RACHEL REABE: What a great plan. Connie, is this going on other places around the state? Is this a viable option?

CONNIE BAGLEY: It has been an option that has been growing over the past years and as an example of a combination of paid and volunteer kinds of work where we're using people to provide more volunteer nursing services within the community.

Another program that has really blossomed in the last couple of years is the parish nurse program as well. And parish nursing is where we have really gone to work with the churches in the communities and encouraged leaders within those churches-- very often, nurses in most cases-- to take a leadership role in organizing outreaches to their parishioners and to identify people who are isolated, have health problems, and provide information and referral to community-based services.

But it is a volunteer-based program and is something that really is an example of what we're trying to do more and more of in the communities throughout the state of Minnesota in putting the communities in touch with the needs of the seniors in their community and finding low cost and no cost ways of providing services and identifying needs and connecting seniors with services, all of which mean that they are able to stay in the community longer.

KAY: That's right. I was going to tell you about two fun experiences of referrals that came from within our community. One was from a local garage person who determined that a lady who was about to get in her car and drive home was unable to tell him what those little letters, PRMD, meant on her drive shift.

And so he took her home and referred her to our program. Our local pharmacist will refer patients to us. And so we've got a wonderful referral system right within the neighborhood.

RACHEL REABE: Thank you so much for your call. We go now to Joseph in Minneapolis, who's standing by to join our conversation. Good afternoon, Joseph.

JOSEPH: Hello. I'm calling to say that, in a time when these programs are increasing, Ramsey County, unfortunately, has cut back on their services, their home making-- in-home making services to the elderly. First, they tightened eligibility and then they stopped taking referrals. And then they pretty much eliminated the program altogether. And I think it's important that people know that.

RACHEL REABE: Dr. Hepburn, are we going two steps forward, three steps back?

KEN HEPBURN: In general, Minnesota has the self-image that it's a very progressive state. But when you look at its spending patterns, our major investment continues to be in spending for institutionally based long term care. And we're kind of in the bottom fifth of the states in terms of spending for community based long term care or what I think we're talking about here is alternatives for long term care.

A program like the block nurse program that Kay was talking about before has come into existence on the backs of a couple of very, very creative nurses who are also very effective lobbyists and fundraisers. And programs like that shine. And we take great pride appropriately in them, but they are not the norm. So to answer your question, I think that we're probably not doing as much as we believe as a people that we are.

RACHEL REABE: Let's talk about--

KEN HEPBURN: I'd like to hear Hal, if Hal thinks the same thing.

RACHEL REABE: And Hal wants to address you.

HAL FRESHLEY: I had my finger up here. In fact, there was a program just before this talking about Minnesotans and our attitude about paying taxes. And the caller who called in to mention that we're making eligibility stricter and stricter is part of not just Minnesota, but all across the country.

We are trying to figure out how we can actually use less public money to support long term care and to try to increase private responsibility. In fact, Senator Kiscaden also mentioned that phrase, and that is what are ways in which we can increase private responsibility. And that is really the focus right now of a lot of policy and a lot of legislative debate.

And we're less interested in continuing to fund and to make more generous the public kinds of programs. But I just want to tell every person in our radio audience that this is us, as we said earlier. Wake up and smell the coffee.

If we are expecting private individuals. Walls to be more responsible for our own long term care, our own future, there are certain kinds of things, as Connie said earlier, people really should start knowing about. Knowing about long term care insurance for themselves as well as for their parents, thinking about their own health habits and what kinds of chronicity they're are going to be having when they're older.

Thinking about family. You mentioned that 80, 85% of care is provided by family members. The baby boom, as a generation, is doing a pretty abysmal job of staying married and being in good relationships with our children.

And one of the highest-- one of the things that makes people most at risk of needing long term care is living alone. So to the extent that we can't figure out how to live with each other and we're continuing to live alone, we are putting ourselves at risk. So I think this is a great topic for people to think about. But it's not just the elderly out there, someone else. It is us, too.

RACHEL REABE: The alternative to institutionalized care, nursing homes, often people are talking well, assisted living. That's where we need to go. We will move into this two or three bedroom, beautiful, brand new apartment. And that's where we will live out our golden years.

We heard Senator Kiscaden say an hour ago, though, that what it's really doing is developing into a two-tier system, that we have the wealthy elderly who can afford, for instance, in Rochester Carrington Cottages. We're talking about 2,800 to $4,000 a month to have one of those cottages. Or if you don't have money, you're winding up in a nursing home.

Let's talk about assisted living. Is it viable? And is it going to be for the middle class at some point?

CONNIE BAGLEY: Well, it's certainly an alternative. And there is a very rapidly growing market of assisted living. And everything you've just said is correct about assisted living. And it is another alternative.

But I think the thing we want to stress today is that it is going to take many, many alternatives and options in order to address our aging population. There's no one answer. It isn't going to be nursing homes and assisted living. It's going to be lots of different options.

If you ask anyone if they want to be in a facility or if they want to continue to remain in their own homes for as long as possible, I guarantee you that 98% of the answer is going to be I want to stay in my own home. I don't want to move into a nursing home. I don't want to move into assisted living. I purchased this home. I've made an investment, and this is where I want to live out the majority of my life.

And that's why it's so important for us to focus on the answers to the aging population and its growth as multiple approaches and multiple alternatives. That's why we need to continue to educate and work with communities and do community development in order for all of us to be aware and understand what it is that we need to do in order to address this baby boom.

KEN HEPBURN: Well, we're also going to have to make some real policy choices here. And Oregon has successfully moved away from nursing homes as the principal option for long term care and into something that looks more like assisted living. And that was done by conscious decision on the part of the legislature.

We don't take as many-- and that let me put it another. That involves allowing a lot of risk. You're going to put people who are vulnerable, who are chronically ill in situations where they're less watched, if you will.

We're not as comfortable, I think, with risk. And one of the things that I think has to change in the next 30 years is the development of a much greater comfort for risk and allowing people to make and take their own risks.

RACHEL REABE: So talk more about quality of life issues. If I could live five years in setting A or if I could live three years in setting B and ride a Gold Wing motorcycle, maybe I'd pick B.

CONNIE BAGLEY: Exactly. And I think that the other thing-- and I'm going back to this whole risk issue. And it's certainly an important point. The good and the bad about Minnesota is that we are so orientated towards licensing, supervising, managing, and making sure that the absolute best quality of care is provided, that we have developed a system that really can't accept risk.

And we have not been able to make changes in the legislature that gives people the authority to do the kinds of things in the home setting, using people who are trained volunteers, trained family members or neighbors who can supervise medications and make sure someone takes their medication or helps with things that we now view as skilled and having to be supervised and licensed so heavily.

If you go to other countries and look at how they care for their elderly, you will find a much more relaxed, much more higher accepted level of risk in caring for individuals in very home-like situations with much more emphasis on community, home and family, and less emphasis on treating everything as though it's a health care issue.

RACHEL REABE: We go now to Janice, who is standing by in Mendota Heights. Good afternoon, Janice. Welcome to our show.

JANICE: Yes, Hello. I have waited a long time. But believe me, you people are worth it because I think you're an excellent program. And I'm 50, so I'm part of this baby boom generation. And my mother is 82 who just fell actually riding a bike and was in an accident, who was kind of a health freak person, anyway.

But now, between my three brothers and myself, we have been having to take care of her, which is fine because our family is very close. And we're used to doing that. But I want to put a bid in, I guess, for people to be able to do, like you just mentioned, like in, say, in Europe where they take care of their elderly and really respect the elderly.

And I kind of have the feeling-- I know it is difficult. I mean, it's hard to take care of her. And we are having help also, but we are all taking turns with her. So it's within our family. We're all helping each other to help her, which we feel we want to do, too.

But I would like to encourage people to be able to do that, like you said, from your home type of thing or her home type of thing as long as we can and get help. We need to be kind of trained now because she needs physical therapy. We didn't know what to do. So we have been working with the hospital to know how to do physical therapy with her or to do assist her.

And so anyway, it's a collaborative job is what I'm trying to say. And I think they want to encourage people to take care of your own at home. Like you said, do the private thing. And she likes open windows and this and that.

And she got in this place and said, oh, my gosh. I can't get any fresh air. They won't open a window in the hospital. They don't have a window to open. And she just started getting claustrophobic and just going crazy in there.

But I mean, little things like that you're used to in your own home that I think, like you just said, we can do more than sort of institutionalize all these things and make it more comfortable for people and natural for people. And I think that will help solve the problem.

I hope it's going to be going that direction because I'm coming out there and I want to be in my own setting. And I want to stay healthy and have those alternatives and options. And the creative thinking process is beginning now is what it needs to do. Thank you.

RACHEL REABE: Thank you, Janice. Mr. Freshley?

HAL FRESHLEY: I noticed that several people have said we want to do what we want to do. We just did a huge project over the last year and a half. Connie mentioned it, the 2030 Project. And we had over 1,800 people statewide kind of talking about the future and a lot of baby boomers.

And one of the things that's really very characteristic perhaps of this cohort and that's different is that baby boomers really want what they want. And they're not going to be satisfied with what other people think they want. And so as we've talked about policy change, I think it will actually happen because as baby boomers start to realize that these are issues that are now affecting us, our legislators will also hear these issues and these concerns.

The market will hear these concerns. I don't think we can't overestimate the fact that the market is sensitive. If people are willing to buy in-home services, they will be available. And so as we-- as the baby boomers start to have parents and our own issues and start to influence what's available, it will inevitably change.

CONNIE BAGLEY: I wanted also to add another piece of information about the growing need for home care services and how people go about accessing those because we really haven't talked very much yet today about how people go about finding information about the kinds of services that we're talking and what's available in their own community.

Throughout the state of Minnesota, we have a telephone Information and referral system that is designed to make it very easy to access. You only have to dial one number, and you're connected directly to the region that you're calling for information about. It's called the Senior Linkage Line.

The senior linkage line is a 1-800-333-2433 number. And by dialing that number, people can find out about all kinds of community based services that are available to them in their own community. This is a service through the Board on Aging and the Area Agencies on Aging.

And I want to make sure that people know today, before we finish that, we have a lot of answers that maybe won't be provided today, but that would be one of the fastest ways that they could connect with the system.

RACHEL REABE: Let's hear the number again, Connie.

CONNIE BAGLEY: It's 1-800-333-2433. And it's a direct connect system. And once you access that system, we provide you with information. We connect you to another provider if that's what's needed. And we don't drop you from the system. We don't just say, well, call this number or call that number. We really spend time with people and explain services to them and make the connection that's needed.

RACHEL REABE: Connie, are the people in rural Minnesota-- which we know, statistically, are older than the people in the Metropolitan area and, in many cases, have not as big of a support system. In many cases, the young people who might have helped them have moved on for employment purposes. Do we have the systems in place in rural Minnesota to take care of the aging population, or is there a big problem there?

CONNIE BAGLEY: It varies widely throughout the state of Minnesota. And again, that's based on population. The more densely populated the area, rural area, the more likely it is that we will have services. Here in Southeastern Minnesota, we're very fortunate. And we do have a lot of services, although it won't meet the need if we don't continue to develop community supports. And that's a large part of it.

In other parts of the state, it continues to be a significant problem. There aren't as many agencies or organizations. There isn't the availability of resources that we would like to see. And it could become a very large problem in the future.

HAL FRESHLEY: As a matter of fact, when we think of aging populations and we think of the future-- and you mentioned, Rachel, that in the future, the population of older people in Minnesota is going to be so big. Well, we already have 20, 30 in a lot of Western Minnesota. And many of our listeners who come from Western, Southwestern Minnesota are already living in communities that may have 20, 30% or more of their population who are already older.

And in looking at these communities as a laboratory, it's actually been a positive experience for me to see how creatively the older people in those communities are working in their communities as volunteers. They're creating all new kinds of ways to help each other. So there are, in fact, ways to think about an older population as not just a source of new need but as a source of resources. Because if you're retired and you've got a lot of time on your hands and you can find a kind of neat role in your community, you can actually help other people in your community.

RACHEL REABE: And Dr. Hepburn, isn't this increasing our focus on chronic care situations? You told me earlier this week that we've spent so much time on acute care, that chronic care has really been the area that suffered.

KEN HEPBURN: I think that's exactly right. I think that what I've been thinking is we really have to significantly invest in the kinds of training that we provide to our health professionals so that they can really adapt, adopt this as a paradigm of care. I work particularly with people who care for relatives with dementing disorders, so they're going to be involved with the health care system for 10, 15 years.

What they look for is some kind of partnership with health care providers that's going to be a faithful partnership and one that really understands the evolving emerging situation. We have some specialists that do that. But the general-- I'd say the general health care profession has not been exposed to that kind of training and is only learning it now. They're learning it, in fact, from the consumers themselves.

RACHEL REABE: We go to Carol in Minneapolis who is standing by. Good afternoon, Carol.

CAROL: I'm glad to join this discussion. I'm a public health nurse, and I work for Hennepin County Coordinated Home Services. And that's a county administered program that's statewide for low income elderly people to help them remain in their home.

And I haven't-- I missed a little bit of the program, but I haven't heard that mentioned And also that there are some-- in some of the high rises in Minneapolis-Saint Paul, there are some subsidized assisted livings that work with these waiver, elderly waiver and alternative care programs. And of course, the county has a central intake, which is 348-4500 if anyone has questions about services for the elderly in Hennepin County.

RACHEL REABE: Excellent. Thank you for your call. Today we go to St. Louis Park now where Mary is standing by. Good afternoon, Mary.

MARY: Hello.

RACHEL REABE: Hello.

MARY: This is Mary in St. Louis Park, and I have two questions.

RACHEL REABE: Yes, go ahead.

MARY: Can you hear me? One is what would the speakers suggest as a first step for a citizen to begin the process of informing or indicating that they want a community based services? The second question is when they refer to training for primary caregivers as home caregivers, where do you get that training? Thank you.

RACHEL REABE: Good. Let's address those questions. First of all, how do you start with communities, making them friendly, making them orient themselves to taking care of their own? Connie, how do you get started.

CONNIE BAGLEY: Well, certainly the agency that I represent today is one of the organizations that is primarily responsible for working with citizens such as our caller and their communities to talk about the need in a particular community. And I would urge her to get in touch with her local Area Agency on Aging to talk about a specific need. I'm sure she's connecting with an issue that she has.

Community awareness is raised through your county boards of commissioners. They're another planning entity that needs to stay abreast and aware of the kinds of services that are needed in the community. And in some parts of the state-- not all parts-- there is also a group called a SAIL team, which is Senior Agenda for Independent Living.

These are all groups that work with members of the community to help identify need and identify ways that addressing those needs. But again, she can contact the Area Agency on Aging anywhere in the state of Minnesota to begin that discussion.

RACHEL REABE: One of the other issues that has been brought up for baby boomers is plan for your retirement. Stay healthy. These are all pieces of the puzzle when we start talking about our long term care system. In other words, don't expect somebody to come in and help you do what you could have done for yourself.

HAL FRESHLEY: In fact, the idea of trying to have as few people in the future-- if we're going to have a huge increase in the percentage of older people, we are really better serving ourselves as individuals and ourselves, as a state, if the fewest of those people actually need public support. So the ways that we can keep from or keep the future need from totally just breaking the bank is for each of us as individuals-- and this is kind of you can talk about it, but it's kind of hard to figure out what it really means for yourself.

But it really is to figure out how you can be as prepared as possible for your own older age and your family. I don't want to make it sound that this is just an absolutely an individual thing. And we've been talking about how important it is for families to understand the aging of the family. But it's an intergenerational thing. And we need to increase the numbers of people who are able to purchase long term care insurance.

We have to have good long term care insurance. That's a good buy. We have to take care of our own health. We have to think about what kinds of relationships we have with our families. So they'll want to take care of us. And we need friends. We need to make sure that our friends would be willing to help us, too.

RACHEL REABE: Connie Bagley, Ken Hepburn, Hal Freshley, thank you for being with us today. I'm sorry. We're out of time.

This special Main Street Radio broadcast is a production of Minnesota Public Radio. Our engineers are Cliff Bentley in Rochester, Steve Griffith in Saint Paul. Our producer is Sara Meyer. Executive Producer, Mel Sommer. Site producer, Brent Wolfe.

We'd like to thank the staff at KZSC, KLSC in Rochester for making this broadcast possible. We invite you to visit the Main Street website. Go to www.mpr.org. You'll be able to hear this broadcast as well as other Main Street reports. The address, again, is www.mpr.org.

MPR's Main Street Radio coverage of rural issues is supported by the Blandin Foundation, committed to strengthening communities through grant making, leadership, and convening. Minnesota Public Radio's Main Street team consists of 12 reporters at MPR bureaus across Minnesota. I'm Rachel Reabe.

LORNA BENSON: I'm Lorna Benson. Jesse Ventura, the marriage counselor? It's true. In his new film, included in this week's Word of Mouth Roundup of the Arts. It's All Things Considered, beginning at 3:00 on Minnesota Public Radio.

RACHEL REABE: The Public Radio. It's 44 degrees at KNOW FM 91.1 Minneapolis, Saint Paul. Twin Cities weather for today calls for windy and cold conditions under cloudy skies, high of 44 degrees. Temperature dropping to 26 degrees tonight. For Saturday, the skies should clear up. We're looking for partly sunny skies, 45 degrees.