It’s noon on Thursday and Margaret Marvin’s friend has just dropped off a load of groceries. Potatoes, gingerbread cookies, milk and eggs rest in plastic bags on the dining room table.

Using a walker, Marvin shuffles 15 feet between her dining room and the kitchen, carrying one item at a time. She shrugs off help.

“The problem with helping too much, if you don’t keep going then you are stuck,” she said.

The 93-year-old woman clutches to her independence just as tightly as she does the egg carton destined for the refrigerator.

While Marvin lives alone in her duplex on the outskirts of Kansas University’s campus, she is backed by a network of family, friends and organizations whose goal is to keep seniors in their homes for as long as possible.

More seniors in Douglas County, as well as the state and nation, are choosing to wait longer before heading to nursing homes or assisted living facilities.

It is a decision made easier by businesses, nonprofits and government agencies catering to seniors who still live at home but need some help to do so.

From around-the-clock care to getting a hot meal every weekday, Douglas County seniors have some options. Depending on what they can afford, seniors can hire a caregiver to help do laundry and remind them to take their medicine. Or they can go to adult day care, where the options could include a hot lunch, yoga class and arts and crafts.

Staying at home longer

Douglas County health workers say the trend to shy away from retirement homes has been occurring for decades.

From 1990 to 2000, the population of seniors – those 65 or older – living in Douglas County increased by almost 20 percent. During the same time period, the number of people living in nursing homes dropped by 22 percent, according to the U.S. Census Bureau.

Sandra Kelly-Allen, coordinator for the senior-focused Project Lively out of the Lawrence-Douglas County Health Department, said the trend is spurred from two directions.

First, it usually costs less to have help come into the house for a few hours a week compared with living in a nursing home.

Second, the quality of life is better for the senior.

“Your home is where you’re the most comfortable. You know where everything is,” Kelly-Allen said.

In the past few years, the demand in Lawrence for home care – especially medical or housekeeping assistance – has continued to increase.

Trinity In-Home Care was formed 30 years ago to give respite care to children. It’s serving a far different population now, said Kelly Evans, executive director of the nonprofit. Today, people 60 and older make up 61 percent of its roughly 500 clients.

“It seems like in the past, it was more expected (for seniors) to move into a nursing home at a certain age, whereas now there are more options, more supportive services to stay at home longer,” Evans said.

Another nonprofit, Douglas County Visiting Nurses Association, is looking to extend its services beyond simply providing medical care at home for those who are recovering from a hospital stay or are acutely ill.

The VNA plans next month to launch a service where seniors could pay for help, from a few hours of household chores to 24-hour assistance, including bathing and assisting with medications. Executive Director Judy Bellome said the agency had been receiving 20 calls a month asking for the in-home care service.

The going rate for in-home care in Lawrence runs from $15 to $25 an hour, with many agencies requiring that workers be in the home for at least two hours, Bellome said.

Trinity, which is funded partially through grants and the United Way, offers a sliding scale of $8 to $16 an hour, depending on the client’s income.

Finding the workers

Evans said staffing is a constant challenge. Often there could be a two- to three-week wait for clients to get service.

In the past three and a half years, Trinity has gone from 80 to 130 employees, many of whom are part-time, Evans said. Salaries for Trinity caregivers start at $8 an hour.

The hardest-to-find caregivers are those willing to work around the clock and spend the night at a client’s home, said Linda Lubensky, executive director of the Kansas Home Care Association, a trade group for home care agencies.

Wilma Wake, who owns the local company Professional Sitters Unlimited Inc., said she has trouble staffing caregivers for hospice patients. The job can be physically and mentally draining.

“You don’t want to burn anybody out,” Wake said.

A slip away

But independent living has its risk. Seniors can be a fall away from having to move into a nursing home, said Kelly-Allen of Project Lively.

“There can be complete independence, you fall down and it’s a slippery slope into a nursing home,” she said.

Project Lively, which at $110,000 makes up 4 percent of the health department’s budget, connects seniors to services. The agency also evaluates seniors’ homes to make sure they are safe.

For Marvin, who uses a walker, that meant padding the corners of her kitchen counters, moving food off high shelves and putting a bench in the bathroom. She also wears a black box around her neck, which when pressed alerts 911.

“The only reason I wear it is so the children can sleep easier,” she said.

Marvin relies on a housekeeper recommended by her son-in-law, a friend from her reading circle and a woman she met through an in-home care agency that no longer operates in Lawrence. She also has visits from physical therapists, Kelly-Allen and her children and grandchildren who live in town.

It’s an arrangement that works for Marvin, and she has spread the word, passing along her helpers’ names to others.

Kelly-Allen said she has heard good and bad stories about people using care providers that are outside licensed agencies.

Others in Lawrence take a more cautious tone.

Under state law, no training or licenses are required to become a care provider. While private care providers that work alone can be cheaper and have references from a friend or family member, they don’t come with the background checks or supervision that licensed agencies provide, Lawrence attorney Molly Wood said.

Wood helps families plan for long-term care and seniors who have been financially exploited. She can rattle off the names of cases she has worked on or heard about in Lawrence where a caregiver was placed in a position of trust and took thousands of dollars.

“The combination of wealth and frailty can attract the wrong kind of people,” Wood said.

Impact on baby boomers

With baby boomers just pushing past 60, most don’t need long-term care yet. But many have had to navigate the system with their parents.

“They are a very informed consumer group, who will cause changes in our health continuum because of what they demand,” Lubensky said. “No doubt new kinds of services will pop up to meet the need.”

And, she said, the different options will be spurred by a demographic that has more of a disposable income than its parents did.

Health professionals say long-term care insurance, which covers the cost of a care provider and nursing home stay, is becoming more common.

Wood, who is in her 50s, said she plans on signing up for long-term care insurance in the next few years. It would prevent the situation that she sees played out in her office, where clients are reacting to, not planning for, the prospect of long-term care.

“Half the time, I’m sitting with the family, one is the marriage partner, I’ve got two kids and one of the kid’s spouses all figuring out how we are going to pay for and accommodate the needs for the elderly parent,” Wood said. “And the baby boomer is sitting there saying, ‘What is up with this?'”