1986 Winner
City of St. Paul, Minnesota
Innovations in American Government Awards
Innovations in American Government Awards

In 1984, less than 12 percent of the U. S. population was over 65. As the "baby boom" generation ages, this percentage is expected to increase, almost doubling by the year 2030. Further, healthier lifestyles and modern medical breakthroughs have insured that, in the future, more people will reach the age of 65 and survive long after. These citizens will require health care. Traditionally, elderly parents were cared for in the home, but as the modern economy increasingly requires two incomes, there is no adult in the family home to care for an aging parent, causing an even greater need for alternatives in elderly care.

In 1979, the General Accounting Office estimated that only 60 percent of nursing home residents needed full-time care. On the average, elderly persons in nursing homes run out of financial savings in two years and then become dependent on Medicaid. In the state of Minnesota alone, the total expended for Medicaid in 1970 was $83 million and is projected to top $3 billion by the year 2000. In the nursing home setting, residents lose their independence and privacy while the state loses millions of dollars in overpriced and unnecessary care. This is a current problem that is developing into a social, economic, and cultural emergency.

In St. Anthony Park, a neighborhood in St. Paul, Minnesota, local nurses have created a program to address this problem. The Block Nurse Program (BNP) is a neighborhood-based system of home care designed to meet the needs of the elderly, in their homes, irrespective of their ability to pay. Local nurses, trained in gerontological nursing and employed by the local unit of the State Public Health Department, manage the program.

In BNP, there are two providers of service: the nurses and the Block Companions. Block Companions are trained to provide home health aid and homemaker services in order to assist the elderly in maintaining their independence. The nurses are provided to elderly persons in need of frequent medical assistance for health care. Both nurses and Block Companions live nearby, so that the elderly client will be more likely to welcome them into their home. Further, the fact that they live close by ensures that the nurses will be available even in inclement weather. In St. Paul, nurses have been known to use cross-country skis to visit their clients during snowstorms.

The program is efficient and inexpensive. BNP makes use of volunteers and family participation to lower costs. The Board of Directors are also volunteers. Other support, such as financing, publicity, and volunteers, comes from local corporations, foundations, churches, and civic organizations. The District 12 Community Council serves a fiscal agent and provides training for home visits. The Block Nurses are hired by Ramsey County, and the county monitors their care to insure that it is of high quality. In all, the BNP represents an innovative partnership among local government, private corporations, foundations, and community organizations.

The BNP has served approximately 80 clients since its founding in 1982. This represents 10 percent of people aged 65 and older in St. Anthony Park. Of those clients, approximately 85 percent would require nursing home placement in the absence of home care services. Also, the BNP has stimulated increased family involvement in the care of clients as well as increased community awareness of the needs of the homebound elderly. The number of volunteers for the BNP and other programs serving the elderly has increased. For example, the number of drivers for the Meals-on-Wheels Program in St. Anthony Park has grown from 3 to 36.

The program's replicability is high. The neighboring community of Highland, Minnesota, is currently implementing its own Block Nurse Program. It is also being adapted in Portland, Oregon and as far away as Japan. The idea that a neighbor should care for a neighbor is not particularly new or innovative. But with the Block Nurse Program, citizens in St. Anthony Park have created a way to address a growing national problem.


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