(00:00:00) NPR'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 stood. He's of KZ SE que él se in Rochester. I'm Rachel riebe. 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 wolf looks at senior foster care, one of the options being developed in Southeastern, Minnesota for the elderly. After retiring from IBM barban dick, but drift built their dream home on a rolling hillsides 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 wheel chair 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. Barbra drift says she makes the seniors part of her family and doesn't run a rigid schedule. 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, we 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. Sunday at it helps them but this is their home. It's not an institution this new version of a nursing home is catching on about 50 families in Olmsted County provides senior foster care. There is training required in homes must meet specific safety guidelines, Margie Hankins 92 year old father has lived with the Butcher of us 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 Senior foster care program called homes plus tank and brought her dad out to the butcher's home to check it out. So we took him out there when on a Saturday, they talk back and forth and then they 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 fourth down he said no, he said I want to stay so he stayed right then they made him feel so comfortable and so at ease and home and it's always been like a family and like most families they have there. Teens and special events every Friday morning. They hit into town to go bowling Hankins father Christian broke a skeet loves it, even though he's nearly blind and deaf. 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 him beat me. They got to beat me. I know I know where the hell is our know where the pins are and just because I can't see the princess. No Sinai. I don't know where they are. There is still some guilt involved for some people when they send their mother father or grandparent to live with another family. But Margie hanken says the butcher shops are providing a service they get paid for and she comes to visit her father often. I don't don't worry anymore. Then when we're gone because I know you'll be taken care of and whatever. I mean it's just wonderful and like a like I said, it's a family another reason hanken likes the program is that it's less expensive than a nursing home would be on average senior foster care and Olmsted County cost three to five hundred dollars a month less than Nursing Home Care Bar Butcher of 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 Goldwing motorcycle. My husband was just teasing. 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 helmet and she crawled on that thing like she had wrote it forever. And so when she came with the driveway Maria is a wave and and laugh and then she just had such a good time and memory said the only thing that she regretted as 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 butcher 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 wolf, Minnesota Public Radio. And I'm Rachel re be listening to a Main Street radio special on Minnesota's long-term care system. My guests at the MPR studios in Rochester are Connie Bagley director of the Southeastern Minnesota Area Agency on Aging and how freshly 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 one eight hundred five hundred seven fifty to fifty to one eight hundred five three 75252 doctor Heparin. 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? I don't think it's an obstacle. I think it's it's the given of a of a system of the True that has to emerge. It seems to me that as our population doubles the population of people over 65 doubles. 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 and 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 and more specialized ways. Mr. Freshly. Would you respond to that? 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 can Heparin said we are increasingly look 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 have each or helping you do shopping. There are all kinds of new options and perhaps it during this hour we'll start talking about them, but there has been a tremendous growth but 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. Mrs. Bagley how difficult was it to develop? The Adult Foster Care Network down here in Southeastern Minnesota. 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 and 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 in your 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 what 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 and make referrals and encourage people to use that as an alternative. I think the the piece that you had is we opened the hour. Demonstrated though the warmth and the nice home feeling that you have as a result of foster care 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. Well, I think you've got to remember that the population that we're talking about is us if you're 35 years old when you're listening to the broadcast today, we're talking about you. Are you afraid to ride a motorcycle? We're talking about a generation that's grown up who's been, you know part of the baby boom the 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. Our phone lines are open for your questions and comments this afternoon. The number one eight hundred five three 75252 we go to dr. George Johnson now who is calling from Fargo? Good afternoon. Dr. (00:09:30) Johnson. I'm a pediatrician with University of North Dakota school of medicine and I've long been interested. By the similarities between pediatric medicine and geriatric medicine as a physician involved in chronic disease of childhood. I've been highly impressed 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. (00:10:10) I would like to respond to that. 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 Eden ization 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 the implementation of you know, add some animals. It's a restructuring of the environment so that people are moved into more of a neighborhood and they have their given more responsibility. I think what what the Delight that a child takes in an animal any person can take but in addition now we're seeing that the the residents in the nursing homes are given being given responsibilities and responsibilities is something that's often taken away when people are moved into nursing homes. So I think we're getting double benefit from from these kinds of experiments. So we are changing the way that nursing homes are set up. Mr. Presley and nursing homes are changing. In fact, one of the things that the cut those the first half of the show talked a lot about the 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 you know, we have a reputation for having an awful lot of people in nursing homes. I think someone said that you know, it's something that the we spend huge amounts of money on and nobody really wants. Nobody really wants to be in an institutionalized setting and it's a consequence they have actually changed tremendously for people who do live in nursing homes. There are lots of new options as can have burned mentioned the the Eden Project. Where there's a lot more flexibility, but nursing homes themselves are becoming more of an post-hospital place where people just go to recover to get some therapy ferreri stomper Airy now, in fact just this year. It was the very first time that more people were discharged from nursing homes to their own homes, then 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 the nursing home now, actually the majority of people who go into a nursing home subsequently go home. We go now to Lino Lakes where Mary is on the phone. Good afternoon, Mary. Welcome to this Main Street special. (00:12:55) Hello. Hi. Well my kind of question and just to kind of put in my input. I'm a registered nurse and I've been a registered nurse for 0 going on 20 years. I've worked in both spectrums the 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 5 to 4 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 like a weekend to let them get away. Hey and 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 butting 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 (00:14:44) from in Mary. So at the end of the day then your 5c Years would return mostly to their children's (00:14:52) homes their children some return to their spouses (00:14:57) and was it hard to find the people to fill your slots or could you feel the many times over if you had the (00:15:02) only birthday it was educating everybody about this program because it's under the elderly waiver and alternative cares. It was kind of educating everybody about this. And so there's 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 at seen it work the social workers have seen at work and just wow, you know, this is beautiful. A lot of people that come here may not have done as well in eight large nursing home setting where they have some of these Adult Day Care 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 That's almost a ratio of three able-bodied adults 25 clients. (00:15:55) Thank you for calling us this afternoon. Connie do these seem like these ideas that are spreading. Well, certainly their ideas that are spreading and I think that this our 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 as 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 certainly the focus and the target of what we're trying to work on now 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. (00:16:49) Eight (00:16:49) 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 our 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 in that we want to continue to work on in the coming years in order to prepare for this growing population where Rachel can I add to that? I am glad that you broke the ice Connie on the primary caregivers family caregivers because when we talk about Alternative Care Systems, I think we really ought to Knowledge before we start that conversation that the primary care system is the family 80 to 85 percent of care provided a 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 healthcare organizations for instance to train family members in the work that they do and the family members will often spend four 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 through insurance. But most I 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 Healthcare System except in anecdotally individual cases. So I think we have some systems issues to deal with with regard to what I think is the primary care system for older persons. 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 may not get reimbursement for the care that you provide but you can certainly get a couple of things that one that can mention was training to do a better job most if you are caring for some loved one, it's probably because you really love them. And you really want to do the very best job that you can and we've 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 give that currently can be brought in a respite services as the earlier color mentioned if you're caring for someone in your also trying to work there are Day Care 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 there is a lot of interest in this not only is there public money now going into support. Supports for people in the community, but the the private foundations are starting to look at this. It's growing there. The market is growing lots and lots of new options we go to the phones now. Carol is standing by in Cloak a good afternoon, Carol. Welcome to the program. (00:21:09) 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. (00:21:23) Mr. Freshly. They're currently there is a lot of interest in trying to increase the pool of people in long-term care insurance, you know 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 based the rates. And you know how expensive the the people are that are insured if we are able to increase the risk pool 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. They're very interesting experiments in California. Right now. We have where 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. 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 that is why this is a costly insurance plan and why does not growing as quickly The Proposal Distillation in the session in our current legislative session is 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 they 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. We're talking today about long-term care options for the Elderly with our guest. Dr. Ken Hepburn how freshly and Connie Bagley. I'm Rachael Ray be in. Our phone lines are open for your questions and comments at one eight hundred five hundred 75252. We'll be back with more of Main Street in your phone calls after a look at news. (00:23:36) 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 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 and a frozen world that's on top of the nation from NPR news. (00:24:05) 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 four 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 planes flight data recorders. The South Korean Airline is suggesting terrorism may have been involved in the crash in Regional news. The sort of Senate today pass in early childhood funding bill with money for subsidized child care and services for the homeless. The bill includes 90 million dollars for the subsidized childcare. That's 20 million dollars 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 Motors 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 and Rochester and 42 cloudy and st. Cloud and 35 and in the Twin Cities Cloudy Skies a temperature of 44. That's a news update. I'm Greta Cunningham. You're listening to a special Main Street report on the coming wave of senior Baby Boomers 30 years from now one in for minnesotans will be over 65 years old double today's number. I'm Rachel re be my guests are how freshly 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 1-800-555-9408 like to join the conversation this afternoon we go now to Minneapolis. Good afternoon (00:26:40) 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. Wanted to talk about black Nurse Program 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 ball Pierre board and although we do medic 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. (00:28:07) It's okay. Who would your employer B, then? (00:28:11) I'm not employed. I'm on the board and I am in my professional life geriatric nurse practitioner, but my volunteer years have been on the Southeast seniors board and (00:28:24) so on for the paid staffers for instance. The people (00:28:27) are loners. We have to employed staff our program director and our volunteer director our employees of Southeast seniors, and our nurse is employed by an Agency 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. (00:28:59) Which what a great plan Connie's is going on other places around the state. Is this a viable option it's it has been an option that has been growing over the past years and is an example of a combination of paid in cash 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 and most cases to take a leadership role in organizing outreaches to Their parishioners and who 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 and throughout the state of Minnesota in putting the communities in touch with the needs of the 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 (00:30:20) right? I was going to tell you about to 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. P R and D mint 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, you know, we've got a wonderful referral system right within the neighborhood. (00:31:04) Thank you so much for your call we go now to Joseph in Minneapolis who standing by to join our conversation. Good afternoon (00:31:11) Joseph. Hello. I'm calling to to say that you know in a time when when these programs are increasing Ramsey County. Unfortunately his cut back on their services their honk making serve in home homemaking services to the elderly first, they tightened eligibility and then they stop taking referrals and then they pretty much eliminated the program altogether. And I think I'm quitting the people know that. Dr. Hepburn are we (00:31:45) going two steps forward three steps back in general? Um, Minnesota has the self-image that it's a very Progressive state, but when you look at it spending patterns where our major investment is 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 would I think we're talking about here is alternatives for long-term care program, like the block Nurse Program that K was talking about before has, you know, come into existence on the backs of a couple of very very creative nurses and who are also very effective lobbyists and and fundraisers and programs like that shine and we take great pride. In them, but they are not the norm so it to answer your question. I think that we're we're probably not doing as much as we believe as a people that we are. Let's I like to hear Hal if Al thinks that the same thing that's the address right? I had my finger up here. In fact, there was a program just before this talking about minnesotans in 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 Cascade and 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'm just want to tell every person in our radio audience that This is us as we said earlier, you know, wake up and smell the coffee. If we are expecting private individuals 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 start 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 there are going to be having when they're older thinking about family. You mentioned that 80 85 % of care is provided by family members Baby Boom as a generation is doing a pretty abysmal job of staying married and I've had 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 you know, we can't figure out how to live with each other and we're continuing to live a long we are putting ourselves at risk. So I think it was a great topic. People to think about but it's not just the elderly out there someone else it is us to the alternative to institutionalize Care nursing homes often people talk 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 that's where we will live out our golden years. We heard Senator kiss Cadence a an hour ago though that it's 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 were talking about 2800 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? 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 assistive living and it is another alternative but I think the thing we want to stress today is that it's 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 there 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. Element 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. We're also gonna have to make some real policy choices here and you know, Aragon has successfully moved away from 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 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 for risk and allowing people to make and take their own risks. So so talk more about Add quality of life issues if I could live 5 years in setting a or if I could live three years and setting B and write a Goldwing motorcycle. Maybe I'd pick be right exactly and I think that you know, the other thing in going back to this whole risk issue. 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 and 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 there. Occasion or helps with things that we now view a skilled and having to be supervised and license 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 healthcare issue we go now to Janice who is standing by in Mendota Heights. Good afternoon, Janice Welcome to our (00:39:31) show. Hello. I have waited a long time, but I believe me, huh. You people are worth it because I think you've 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 an accident who's kind of a health freak person anyway, but now between my three brothers and myself we have been having to take Cara for which is fine because our family is very close and we're used to doing that. But I'm I want to put a bid in I guess for people to be able to do like you just mentioned it like in say in Europe where they take care of their elderly and really respect the elderly and I kind of have the feeling, you know, I know it is difficult. I mean it's hard to take care of her and and we are having helped also, but we are all taking turns with her. So it's within our family were 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 there your home type of thing or her home type of thing as long as we can and and get help we need to be kind of train now because she needs Physical Therapy. We didn't know what to do, you know, so we have been working with the hospital to know how to do physical therapy with her or you know to do a sister. 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 It was saying 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. You know, they don't have a window to open, you know, and she just started getting crushed a phobic and just going crazy in there. But I mean, you know little things like that that you're used to in your own home and that I think like you just said we can do more than stead of institutionalize all these things and and, you know, make it more, you know comfortable for people and then natural for people and I think you know that will help solve the problem. I hope it gets going to be going that direction because I'm 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 which it needs to do. Thank you. (00:41:39) Thank you Janice. Mr. Freshly. Um, I noticed that several people have said, you know, we want to do what we want to do. We just did a huge project over the last year and a half Connie mentioned is a 2030 project and we had 18 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 it'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 we as Baby Boomers start to realize that these are issues that are now affecting us. Our legislators will also hear these these issues and these concerns the market will hear these concerns. I can't I don't think we can 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. 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 were 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 1-800 333 243 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 in the area agencies on aging and I want to make sure that people know today before Are 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. Let's hear the number again Connie. It's one eight hundred three three three 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. 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? 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 as a matter of fact when we think of Aging populations and we think of the future and you mentioned Rachel that you know in the future of 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. Are already living in communities that may have 20 30 or more percent of their population who are already older and in kind of looking at these communities as a laboratory. It's actually been a positive experience for me to see how creatively the the older people in those communities are working in their communities as volunteers. There are 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 and Doctor 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 Has really been the area that suffered. And I think that's exactly right. I think that what I've been thinking is we really have to significantly invest in the kind of training that we provide to our health 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 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 Healthcare 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 we go to Carol in Minneapolis who is standing by good afternoon. (00:47:55) Well, 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 ministered program that Statewide for low-income. Elderly people to help them remain in their home. And I haven't missed a little bit of the program, but I haven't heard that mentioned and also that there are some and some of the high-rises Minneapolis st. Paul. There are some subsidized assisted livings that work with these waiver elderly waiver and Alternative Care programs, and of course the county is a central intake which is 348 4500 if anyone has questions about services for the elderly in Hennepin County. (00:48:37) Excellent. Thank you for your call. Today we go to St. Louis Park. Now where Mary is standing by. Good afternoon, Mary. Hello. (00:48:45) Hello, this is Mary in St. Louis Park. And I have two questions. Yes. Go ahead. You hear me? Okay one is what would what would the speaker's suggest as a first step for a citizen to begin the process of informing or indicating that they want them to Community Based Services. The second question is when they referred to training for primary caregivers as home caregivers. Where do you get that training? (00:49:19) Thank you. 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? Well, certainly the agency that I represented a is one of the organizations that is primarily responsible for working with citizens such as our collar and their 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 Board of Commissioners it they are 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 on that all parts. There's also a group called a sale 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 of addressing those needs. But again, she can contact the Area Agency on Aging anywhere in the state of Minnesota to begin that discussion. 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. 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 remember 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 kind of families to understand the Aging of the family, but it's an A generational thing and we need to increase the numbers of people who are able to purchase long-term care insurance. You have to have good long-term 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 family. So they'll want to take care of us and we need friends, you know, we need to make sure that our friends would be willing to help us to Connie Bagley. Can Hepburn how freshly 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 st. Paul. Our producer is Sarah Mayer executive producer Mel summer site producer Brent wolf. We'd like to thank the staff at K Zs e que él se in Rochester for making this broadcast possible. We invite you to visit the Main Street website go to www.mptv.org. You'll be able to hear this broadcast as well as other Main Street reports. The address again is You w dot npr.org 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 Minnesota public. Radio's Main Street team consists of twelve reporters at MPR bureaus across Minnesota. I'm Rachel rebe. 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 on Minnesota Public Radio. Republic radio it's 44 degrees at knoo wfm 91.1 Minneapolis st. 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 sky should clear up. We're looking for partly sunny skies 45 degrees.