For older people, it often seems that life in a nursing home is inevitable.

But many organizations, including county and state agencies, offer programs that allow the elderly to remain at home as long as possible.Shauna O'Neill, director of Salt Lake County Aging Services, believes the elderly have several options, but many are not aware of them.

Transportation programs are one way the elderly can get help. Vans and mini-buses are available to help older people get around the community for doctor and dental appointments and even to go to he grocery store.

Another important program is Meals on Wheels - especially since poor nutrition is a common problem for older people who live alone, O'Neill said. Meals on Wheels allows certain people to get a hot lunch six days a week, providing one-third of their nutritional needs.

O'Neill said malnutrition is responsible for 15 percent of senility cases in nursing homes. Early on, adequate diets can reverse the senility, she said. "That meal becomes very important."

To qualify for Meals on Wheels, a person must be homebound and unable to prepare meals, with no viable alternatives, such as nearby family. No fee is assessed for the program, although a small donation is suggested.

The county can also provide case management if a physician says a patient is within 90 days of nursing home placement. Under this program, the county makes an assessment of what resources are available to the aged person and then makes a master plan of which groups can provide particular services.

The case manager may determine that the family is capable of providing certain services, a local church group can provide others, and county programs can fill in the gaps.

The county has a limited amount of money available to help people who qualify. For example, the county may be able to remodel a bathroom doorway for a person who has recently had to start using a wheelchair. All elderly people in the county are eligible to have a case assessment made, O'Neill said.

A particularly popular option is the Senior Companion Program. It is designed to give the family members a break from their responsibilities, O'Neill said. Low-income senior citizens are paid $2.20 an hour by the county to visit a particular residence once or twice weekly and care for an elderly homebound person, while the family members go shopping, pay bills or just get out of the house.

"If you've got somebody at home whose situation is fragile, you really can't get away to go grocery shopping," O'Neill said.

That small break often relieves stress. A 65-year-old woman caring for her 90-year-old mother, could be on the verge of having a heart attack from all the stress. A brief respite can help her health, O'Neill said.

Dorothy Young was a nurse at LDS Hospital until she retired two years ago. Now she is a senior companion.

"I thought I was ready for retirement and then when I got into it I realized my money wasn't going as far as I thought it would." She also wanted to contribute something and felt the senior companion program would be just the ticket. She now puts in about 20 hours a week visiting five different clients. She visits a different person each weekday and spends about 31/2 hours with each one.

Young helps prepare meals, does grocery shopping and sometimes takes the client to run errands. She does not, however, provide any nursing services.

Senior companions have monthly in-service meetings to discuss problems and learn how to provide better care for their patients. In one session, Young said, senior companions learned simple exercises they could teach to stroke victims suffering from paralysis.

Besides helping the family care providers, senior companions are able to supplement their incomes and have a sense of belonging, O'Neill said. "The sense that you're making a difference in someone's life is a nice gift," she said.

Homemaking services are yet another option for the aged wanting to remain home, unable to handle routine chores. Such services can help people with light housekeeping, laundry, yard work and sidewalk snow removal.

For people without a family member available 24 hours a day to take care of an older person, adult day care services are available. They work much the same as child day care. An advantage of such programs is the socialization it provides the elderly, O'Neill said.

The Neighborhood House Senior Day Center, 423 S. 11th West, is one such program. It is a private, non-profit organization, supported in part by funding from the United Way.

The center can handle up to 52 people a day, and averages 45. Some clients visit the center every day, while others participate one or two days per week. The cost of the program is on a sliding-fee scale, based on client resources.

Clients at the center participate in arts and crafts projects. Kathie Williams, an employee at the center, says ceramics and clay-working are some of the most popular projects. Another favorite activity is the weekly visit with children from the nearby Neighborhood House.

Besides the arts and crafts projects, Williams said, the center offers aerobic workouts specially designed for older people, as well as bend and stretch exercises. Physical, speech and occupational therapists are also available at the center.

Similar programs are available at Sandy Regional Center and Mapleridge Adult Day Care in Bountiful. Both facilities charge $18 a day and have nurses on staff.

Finally, in cases where the county can't help, several private firms offer home health care services - ranging from nursing care to chore services - on a contractual basis.

Nursing homes are often a good solution to the problems of the elderly. But they are not necessarily the only solution. Group homes, retirement homes and support groups each have important contributions to make to the quality of life of the elderly.