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St. Anthony Park’s Block Nurse Program: A Study in Community Activism
By: the Park Bugle
Publish Date: 7/5/2001
2001 is a time of celebration for the St. Anthony Park Block Nurse Program, a neighborhood program to help seniors live at home independently. This year marks the 20th anniversary of this community-generated, community-run, community-serving organization.
The story of its founding is the story of a group of women who recognized a need in society and responded with action. Their inspiration, their values, their hard work resulted in the SAP Block Nurse Program.
In 1981, professor of nursing and local resident Ida Martinson, who was serving on the National Institute on Aging Advisory Board, sought to apply her background in hospice and in-home care of very sick children to needs of the elderly. At the time, only medical services provided in institutional settings were covered under governmental and insurance regulations. Many seniors were independently, but unsuccessfully, trying to meet their medical and home care needs by themselves.
Martinson believed that communities should come together to aid elderly residents in need of basic physical and emotional assistance. Help would come from paid public health/geriatric nurses and home health aides as well as neighborhood volunteers. By receiving in-home health care, clients could stay in their homes for extended periods of time, preserving their quality of life and remaining a part of their community network while at the same time avoiding expensive nursing home costs.
In December of 1981, JoAnne Rohricht, a member of the Human Services Committee of the District 12 Community Council, wrote an article for the Bugle reporting on Martinson’s participation in the White House Conference on Aging. She included a description of the “block nurse program” idea, as Martinson had described it.
Martinson’s vision recognized the value of the trust that exists within a neighborhood network. Her hope was to use nurses and aides living in the neighborhood who might not be working full time, as well as neighborhood volunteers. As Ann Copeland, then District 12 Community Organizer, remembers, “Immediately, Ida received calls from nurses and seniors asking, ‘When is it starting? I want to be a part of it!”
Rohricht then hosted an organizational meeting to explore the idea further. Martinson, Rohricht, Copeland, and Ann Wynia (then St. Anthony Park’s State Representative) attended. They began to grapple with issues of structure and funding. Funding continues to be an issue. Says Copeland today, “We were so naïve, thinking the concept made so much sense that it would surely be within the reimbursement system within 3-5 years.”
Later, Martinson happened to describe the idea to a businessman seated next to her during a plane trip. He suggested that she talk with Elmer Andersen of H.B. Fuller for possible help with start-up funding. The next Sunday Martinson saw Andersen at church and broached the idea. Within a week the new organization had submitted a proposal requesting assistance, and by April 1982 they received a grant from Fuller and assistance from Medtronic Corporation, which completed what was needed to begin the project.
The founding group expanded to include Marjorie Jamieson, who had been present at the nurse’s conference when Martinson initially described her idea, and Barbara O’Grady, director of the Ramsey County Nursing Service. Jamieson became the program director, and O’Grady worked closely with the program as they developed a way to pay block nurses.
According to Copeland, the new model did not fit with the county’s existing system. “If not for Barb’s willingness to be flexible within the government structure, the Program never would have gotten off the ground,” she said.
In June of 1982 the program opened, with neighborhood resident Jane Prest-Berg as the first block nurse. Prest-Berg soon recognized the need for home health aides or, in the terminology of that time, “block companions.” Meg Shaefer became the first home health aide in April, 1983.
Nurses also recognized that some seniors needed social contact, so Rohricht, as the initial volunteer coordinator, incorporated other residents as volunteers to provide supportive visits to seniors. She enlisted seven residents, from ages 68 to 85, to take a 10-week training course in peer counseling. This became the first group of volunteer visitors. The Community Service Committee of the Community Council then helped design a system to use teens, college students, scouts, churches and service clubs in providing aid to seniors.
Malcolm Mitchell is the director of Elderberry Institute, a replication and advocacy group for block nurse programs. He describes the founding as the story of a group of women who recognized the value of neighborliness and of trusting relationships and who had a strong sense of community and a deep respect for the elderly. “They were never stopped by hearing the words ‘We don’t do things that way.’”
By 1983 the St. Anthony Park Block Nurse Program was attracting interest from beyond the local community. A Japanese film crew documented the program and showed it in Japan. Twenty representatives of the Japanese Nurses Association visited the Program in 1984. That year the St. Paul Foundation funded a professional evaluation of program results, which showed that 85% of clients served would have been in nursing homes without block nurse program care.
Validation and recognition of the value of the program grew. A neighborhood in Oregon sought guidance in developing a similar program. Then-Governor Rudy Perpich issued a proclamation applauding the SAP/BNP. The “Main Agency Achievement Award” was given by the Midwest Alliance in Nursing, and the program received an “Innovations in Government” award from the Ford Foundation, which included money for assisting in replicating the model elsewhere.
In 1987 a “Spirit of Service” award and a proclamation by the Ramsey County commissioners acknowledged the role the Block Nurse Program had played with the County Public Health Nursing Service, the District 12 Council, St. Anthony Park and St. Paul in organizing cost-effective medical care and supportive services to help seniors remain in their homes as long as possible.
Over the years the program has made several changes. In 1991 it merged with Living At Home, an outreach program to healthy elders the “intermediate frail.” The Living at Home/Block Nurse Program has now been replicated in 31 communities in Minnesota and 5 in Texas.
Replication assistance is provided through Elderberry Institute in St. Paul, which also attempts to influence public policy regarding elder care. According to Institute director Mitchell, “Our role is to respond to a neighborhood call. Every program began with an individual who said, ‘I want to see this happen in my community.’”
The values and principles of the original founders are thus carried on in each new program. Rohricht, one of the founders, sees the ongoing mission as “citizens reclaiming a sense of commonwealth wherein the common good of the community is the responsibility of the citizenry.”
Currently, the St. Anthony Park Block Nurse Program has 17 nursing clients, 32 foot care clients, 40 Living at Home clients, 26 volunteers and some occasional group volunteer efforts. Resource coordinator Judy Probst acknowledges that it’s more difficult to get volunteers these days but stresses that there are many ways to help. Some needs are short term, and there are many one-time volunteer tasks.
“The Block Nurse Program has changed since its founding, and needs to continue to change in response to current realities,” says Patricia James, current board chair. Those realities include managed care limitations on services, the fact that some companies will provide services until they can no longer bill Medicare and then will refer patients to BNP, the fact that Medicare pays for less than it used to, and the fact that assisted living facilities now sometimes operate in conjunction with nursing homes.
“Pressure is always on the program to do less and to spend less time with clients,” said James. Nevertheless, she affirms, the program is still committed neighbors helping neighbors and to nurses being able to maintain good relationships with their clients.
The board today is made up of up to 18 people, all neighbors, who meet monthly to formulate policy and guide the organization. As always, they invite participation from the community. They will also be inviting the neighborhood to a 20th anniversary celebration some time this year.
The Park Bugle, June 2001. Reprinted by permission.
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