If not for Bretos, Rafaela Diaz would have been sent to a nursing home. Instead, Rafaela, who's 102 years old, still has her own apartment in a public housing complex for seniors in downtown Tampa.

So does 90-year old Wilma High.

"Who would want to go to a nursing home if you're as able as I am?" High says.

"They don't need a doctor. They don't need a nurse," Bretos explains. "They just need to be supervised."

Bretos' big idea began with a question: How come so many senior citizens being cared for at taxpayer expense were being put into nursing homes when they didn't need nursing home care?

It turns out that under Medicaid, the only kind of state-funded care seniors are entitled to is in a nursing home. That costs Medicaid $47 billion a year, a cost Bretos calls wasteful.

"There is a place for nursing homes, but it has become the dump yard for every low-income senior in this country," Bretos says.

Her idea was to let low-income seniors, who often live in public housing, stay in their apartments. She gets exemptions from Medicaid to bring assisted-living services to them. These services include three meals a day, housekeeping, transport to the doctor and help with medications.

For High, service at home is perfect.

"You don't need a nursing home, but you need extra care," High says.

And taxpayers get extra savings.

A nursing home in Florida costs $48,000 per person, every year. Bretos' assisted living costs $18,000, including housing. That's a yearly savings of $30,000 for every senior.

Back in Washington, the former chief of Medicaid, Mark McClellan says pioneers like Bretos are forcing change.

"It's a good example of how people working around the country at the grass-roots level can change the way a whole big bureaucratic program works," says Dr. Mark McClellan, former chief of Medicaid.

"It's a crisis. It's no longer a need," Bretos says.

That's why the federal government is paying attention to her big idea. In fact it's becoming the model for long-term care: Don't move seniors to care they don't need; figure out what they need and bring it to them.

She did just that. Bretos, now 60, launched Mia Senior Living Solutions in Miami Beach with her own money. Her for-profit company has helped 40 public-housing projects in 12 states bring assisted-living services to their residents. She obtains waivers that allow Medicaid funds to be used to keep people in their homes. Her pièce de résistance is a pending agreement between the U.S. Housing & Urban Development Dept. and the Health & Human Services Dept. to work together to provide these services nationwide. "It is one of the highest achievements of my life," Bretos says. She is far from slowing down. "I hope to do it until the day I die, because I don't see it as work," she says.

Instead of just retiring from their primary working lives at 50-plus, Bretos and so-called social entrepreneurs like her are starting companies and nonprofits that apply new business solutions to intractable social problems in the fields of housing, education, health care, and the environment, among others. "There is a groundswell of baby boomers who are on fire about making a difference in their community and the world," says Sally Osberg, CEO of the Skoll Foundation, founded by Jeff Skoll, first president of eBay, to invest in social entrepreneurs worldwide.

Starting nonprofits or working for the greater good is no easy or inexpensive task. Still, it has become a little less difficult in the past few years. Since 2000, a handful of organizations flush with cash have sprung up to help these social entrepreneurs get off the ground with both funding and guidance. With the exception of Civic Ventures, most of the groups are backed by extremely successful people in the hedge fund and venture capital worlds.

LATE-ONSET IDEALISM

Known as venture philanthropists, these individuals and their organizations have adopted the rigorous due diligence used in for-profit venture capital investments to find and support those who can create significant social change. These foundations also incubate social entrepreneurs' organizations and provide the kind of networking and strategic direction given to for-profit investments. Each year, new grantees, or fellows as they're called, are chosen and financed.

Civic Ventures is different in another respect: It is the only group that focuses solely on the aging baby boomer. Last year a Civic Venture survey of 1,000 people aged 50 to 70 found that nearly three in five participants in their 50s said they wanted to use the next chapter of their lives to improve the quality of life in their communities. To further encourage that altruism, Civic Ventures created the Purpose Prize, five $100,000 and ten $10,000 cash gifts given to 15 social entrepreneurs aged 60 or older (Atlantic Philanthropies and the John Templeton Foundation have donated $9 million to fund the first three years of the award). Last month, the first winners were announced. Bretos, who competed with 1,200 other applicants, was one of the five who won a $100,000 award. Hers was the only profit-making venture on the list. Starting Oct. 15, Civic Ventures will taking applications for its 2007 Purpose Prize Fellows.

While the other groups do not have an age requirement for their applicants, they are seeing increasing numbers of older social entrepreneurs applying for grants. For example, Ashoka, the oldest and largest program that supports social entrepreneurs with 1,800 fellows worldwide, backs 15 to 20 new fellows per year. This year, Ashoka (named for an Indian emperor who devoted his life to helping humanity) elected 13 fellows, of whom a record number of five were over 50 years old. Charlotte Frank of New York, 70, is one of them. She co-founded The Transition Network, a national organization for women over 50 that helps them channel their skills and experience into volunteer projects that address social issues. For example, members have mentored disadvantagedwomen in job training, equipped a library at a school for disabled children, and helped seniors navigate the Medicare drug program. Depending on financial need, Ashoka gives individuals an average of $50,000 each year, for three years.

Blue Ridge Foundation New York is more generous in its grants, but it restricts them to organizations based in the Big Apple. So far, Herb Sturz has received $100,000 from Blue Ridge to launch ReServe, a not-for-profit organization that places skilled retirees in part-time positions with New York City social service and government organizations that need, but can't afford, qualified help. Since its launch a year ago, ReServe has placed 83 retirees in various jobs at places such as the American Museum of Natural History and the city government. Retirees receive $10 an hour and work 15 hours a week.

"These seniors have so much to offer, and these jobs bring meaning to their lives," says Sturz, who has had a long career working on social issues as New York's deputy mayor for criminal justice and the chairman of the New York City Planning Commission, among other positions. ReServe follows on the heels of another program Sturz started called the After School Corporation, which involves 250 afterschool enrichment programs serving 40,000 kids. Its goal is to keep them off the streets and engaged in stimulating, worthwhile activities. At 75, Sturz still has a lot to offer, himself. With the aging baby boomers right behind him, it looks as if he'll be in good company.

D.light, a company cofounded by Sam Goldman, who spent four years in the Peace Corps in Benin before earning a master's degree in business from Stanford University, is an example. Mr. Goldman started D.light with the mission of replacing millions of kerosene lamps now used in poor, rural parts of the world with solar-powered lamps.

Having used kerosene lamps himself while living in Benin, Mr. Goldman learned firsthand of kerosene's problems — it is expensive, it provides poor light and it is extremely dangerous. When the son of his West African neighbor nearly died after suffering severe burns from spilled kerosene, Mr. Goldman said he realized he wanted to create a venture to solve both the social and economic problems caused by these lamps. His time in Benin also convinced him, he said, that only as a business could a project become large enough to reach the great number of people who use these lamps as their primary source of light.

"We could have done it as a nonprofit over a hundred years, but if we wanted to do it in five or 10 years, then we believed it needed to be fueled by profit," he said. "That's the way to grow."

Since the company incorporated in May 2007, it has raised $6.5 million from a combination of investors who, Mr. Goldman said, are able to push the company on both its social mission and its profitability.

What to call these innovative businesspeople is the subject of some debate. The terms "social entrepreneur" and "social businesses" are generally used to characterize people and businesses that bring entrepreneurship to ventures that have a social mission. Yet there are those who would limit the social entrepreneur label only to those without any profit motive. A separate, but related, category are companies referred to as "socially responsible." These are generally companies whose core business does not necessarily have a social mission, but who display socially responsible characteristics, like environmental sensitivity.

Because of the difficulty of defining these social ventures, it is hard to gauge the exact number of them, but there are indications that there is increasing interest in the idea of using business to tackle the world's big problems. Last year, 630 people attended a new conference, Social Capital Markets, on social venture investing. According to Kevin Jones, the creator of the conference and a principal in Good Capital, an investment firm focusing on social business, two-thirds of the participants signed up after the collapse of Lehman Brothers, which he called a sign that people are flocking to what he calls a "new asset class."

Experts concede that not all social problems respond well to the for-profit model. One example could be early childhood education. "If you set it up as a business, you might be able to raise money more quickly and grow more quickly," said David Bornstein, the author of "How to Change the World" (Oxford University Press, 2004), an often-cited book on social entrepreneurship. "But if you want to be profitable, you might find that you have to make choices that diminish the quality of your program and then children won't learn to read as quickly. While Stanley Kaplan can make a fortune selling education to well-heeled people, providing the same services to low-income kids would probably not provide a very good income."

Mr. Bornstein said it came down to one crucial question: "As you grow, will the economics of your business work in favor of your mission or will they work against it? In the case of providing access to solar energy for people in villages, the bigger you get, the cheaper your product will be, so the economies of scale make sense."

Conchy Bretos, too, chose a for-profit model for her venture. While working as Florida's secretary for aging and adult services, Ms. Bretos learned of the difficulties that force older people to leave their homes and move into nursing homes for lack of proper care.

With a partner, Ms. Bretos started the Mia Senior Living Solutions, a business that advises governments as well as private housing developers on how to bring assisted living services cost-effectively to low-income housing communities so that older people can be cared for in their own homes.

Ms. Bretos said that a business was the natural model for their venture. "We came from a strong business background and we developed a business plan," Ms. Bretos said. "By doing that, we discovered that we were offering something that no one else was offering. We got our first client even before we incorporated and within a few hours we had to form a company to be able to put together a contract. It was just easy to form an S corporation."

Ms. Bretos said she also had to make a living. "In this nation, we equate success with profit," she said. "We wanted to be profitable while also doing something that was right and giving back to the community."

Advisers who work with these kinds of companies say the rise in social business reflects the times. "Historically, social and legal norms tended to recognize and treat for-profit and progressive social or environmental motivations and activities separately," said Jonathan S. Storper, a partner at the law firm Hanson Bridgett who specializes in sustainable and socially responsible business. "These lines have blurred and converged as the business world attempts to respond to the modern culture's demand that businesses be good stewards of the environment and society."

Still, there are legal issues to consider. The basic analysis, Mr. Storper said, is whether the organization's primary goal is to maximize shareholder profit or to benefit the public. "If the primary goal is to benefit the shareholders, then the legal structure should maximize the ability to create wealth," he said. "While nonprofits have advantages, such as an exemption from paying taxes and the tax deductibility of donations, nonprofit activities are restricted to its charitable purpose."

He noted that the government and the public "generally are less able to scrutinize the operations and finances of for-profit businesses." But, he added, "The mission of an organization may benefit from the broad public involvement and support inherent in nonprofit organizations."

Selected from among 1,200 applicants, the winners of the Purpose Prize — three individuals and two pairs — are leading projects to help low-income older adults, disabled teenagers, black women with health problems, and children of incarcerated parents, and to promote reconciliation between Muslims and Jews.

The Purpose Prize was created by Civic Ventures, a charity in San Francisco that promotes projects to tap into the expertise of people in their later years — and that dash the stereotype of older people as burdens on society. It calls the Purpose Prize cash awards "the first significant investment in this undiscovered force for the greater good," given at a time when the oldest of the baby boomers are reaching their retirement years.

"It's conventional wisdom that young people drive entrepreneurialism and innovation, but the Purpose Prize winners turn that outdated notion on its head," Marc Freedman, president of Civic Ventures, said in a statement.

The winners were selected by a committee of 21 business, political, arts, and nonprofit leaders headed by Sherry Lansing, chief executive of the Sherry Lansing Foundation and former chair of Paramount Pictures' Motion Picture Group.

In addition to the $100,000 prize, the winners — along with 10 finalists — will be able to apply for grants from a $1-million Fund for Innovation.

Money for the awards and the innovation fund was provided by two foundations: the Atlantic Philanthropies, in New York, and the John Templeton Foundation, in West Conshohocken, Pa. The winners are: Conchy Bretos, 61, of Miami Beach, Fla. Ms. Bretos was honored for her pioneering work to bring assisted-living services to older adults in public housing. Born in Cuba, Ms. Bretos served from 1994 to 1996 as Florida's Secretary for Aging and Adult Services, where she observed that many low-income older adults were forced into nursing homes prematurely because they could not afford the help they needed to stay in their homes.

After leaving office, she became head of Mia Senior Living Solutions, which created and managed the nation's first public-housing assisted-living program, in Miami. The group has since helped 40 public-housing projects in a dozen states offer assisted-living services to older residents.

Charles Dey, 75, of Lyme, Conn. Mr. Dey was honored for creating a program to provide job training to high-school students with physical, mental, or emotional disabilities. He worked as a college dean and boarding-school head before he was recruited to create the jobs program, Start on Success, by the late Alan Reich, a friend of Mr. Dey's who founded the National Organization on Disability, in Washington.

Since 1995, the program has provided mentors and internships at hospitals, universities, and businesses to more than 1,500 high-school students in five states, most of them minority students in urban schools. Eighty-five percent have gone on to full-time jobs or further education.

Marilyn Hughes Gaston, 67, and Gayle K. Porter, 61, of Potomac, Md. Dr. Gaston, a physician and leading expert on sickle-cell disease, and Ms. Porter, a psychologist, were honored for starting Prime Time Sister Circles, a program that sets up 14-week support groups to help African-American women aged 40 to 70 lead healthier lives through exercise, stress management, and good nutrition.

The pair operate the Gaston & Porter Health Improvement Center and are authors of Prime Time: The African American Woman's Complete Guide to Midlife Health and Wellness. They created Sister Circles in 2003 out of concern that black women suffer disproportionately from life-threatening diseases. Almost 140 women in Maryland, Washington, Illinois,and Florida have participated in the circles. Dr. Gaston and Ms. Porter are now developing a training program for group leaders and considering expanding the circles to other ethnic and age groups.

W. Wilson Goode Sr., 68, of Philadelphia. Mr. Goode was honored for his work as director of Amachi, a program that provides mentors to children of incarcerated parents.

Mayor of Philadelphia from 1984 to 1992, he earned a Doctor of Ministry degree and became director of Amachi in 2000. When Mr. Goode was 14, his own father went to jail. Today, he recruits mentors for children in similar situations by working with African-American churches. More than 240 programs in 48 states are now affiliated with or inspired by Amachi; their mentors have helped 30,000 children.

Judea Pearl, 70, of Los Angeles, and Akbar Ahmed, 63, of Washington. The pair were honored for speaking and leading discussions across the country and abroad as part of the "Daniel Pearl Dialogue for Muslim-Jewish Understanding."

Mr. Pearl is president of the Daniel Pearl Foundation, created to honor the memory of his son, a Wall Street Journal reporter who was killed by terrorists in Pakistan in 2002. Mr. Ahmed, a former Pakistani government official, is a professor of Islamic studies at American University. The two men teamed up to promote reconciliation between Muslims and Jews and to provide a forum for moderate Muslims.

Judea Pearl, 70, of Los Angeles, won one of the five Purposes Prizes in partnership with Akbar Ahmed, 63, of Washington. The two professors, from UCLA and American University, teamed up after Wall Street Journal reporter Daniel Pearl was killed by terrorists and have traveled nationwide to lead discussions on religious tolerance and Jewish-Muslim understanding.

Goode, 68, has served since 2000 as director of Amachi, a nonprofit helping children with parents in jail or on parole. He rallied pastors in black communities to encourage their congregants to be mentors; more than 240 programs in 48 states are now affiliated with or inspired by Amachi, and mentors have helped 30,000 children.

The Purposes Prizes were initiated this year by Civic Ventures, a California-based think tank, and drew 1,200 applicants.

"It's conventional wisdom that young people drive entrepreneurialism and innovation, but the Purpose Prize winners turn that outdated notion on its head," said Marc Freedman, founder and president of Civic Ventures. "Today's boomers and older Americans are an extraordinary pool of social and human capital that _ with the right investment _ could yield unprecedented returns for society."

The other winners, selected by 21 jurors from business, politics, journalism, the arts and the nonprofit sector, are:

_Conchy Bretos, 61, of Miami. Born in Cuba and sent to America when Fidel Castro came to power, Bretos lived in a Nebraska orphanage for three years before reuniting with her parents. While serving as Florida's secretary for aging, she was struck by the yearning of many poor, older adults to avoid nursing homes. She became the force behind the nation's first public housing project _ the Helen Sawyer building in Miami _ to bring assisted-living services to low-income adults who need help to stay in their homes. She now runs a consulting company that has helped 40 public housing projects in a dozen states bring assisted-living services to residents.

_Charles Dey, 75, of Lyme, Conn. At 64, after a career in education, Dey created Start on Success, a National Organization on Disability program providing paid internships and workplace mentors to predominantly minority high school students with physical, mental and emotional disabilities. More than 1,500 students have had internships at universities, hospitals and businesses in five cities; 85 percent have gone on to full-time jobs or further education.

_Marilyn Gaston, 67 and Gayle Porter, 60, of Bethesda, Md. With African-American women suffering disproportionately from serious health problems, Gaston, a doctor, and Porter, a psychologist, dedicated themselves to lowering the rate of preventable deaths. They created Prime Time Sister Circles, part support group and part health course on exercise, nutrition and stress.

The top 70 prize applicants were invited to participate in a three-day Innovation Summit starting Thursday at Stanford University, where they will be able to confer with venture philanthropists.

The five prize winners and 10 finalists also can apply for financial support from Civic Ventures' new million-dollar Fund for Innovation. Two foundations, The Atlantic Philanthropies and The John Templeton Foundation, provided money for this new fund and for the prizes.

The inaugural Purpose Prize awards provide $100,000 each to five individuals and teams who were selected as role models for the huge cohort of baby boomers about to plunge into their seventh decade -- as both President Bush and former President Clinton recently did, with some joking and bemoaning.

While some post-60ish people are devoting their time to golf or bridge, the Purpose Prize winners are part of "a growing cadre of individuals who are harvesting their midlife experience and using it in creative and innovative ways," said Marc Freedman, president of the Civic Ventures think tank, which sponsors the prize.

Among the winners are UCLA computer science professor and Encino resident Judea Pearl and American University professor Akbar Ahmed, who are partners in promoting Muslim-Jewish understanding in the wake of the 2002 murder of Pearl's son, journalist Daniel Pearl. The two men speak around the country at colleges and other public forums, tackling such issues as how to encourage peace between Israelis and Palestinians.

The prize "reminds me of something that I tend to forget: that I am over 60," Pearl said in an interview before the award was publicly announced.

Pearl, who turned 70 on Monday, said he would devote his $50,000 to the Daniel Pearl Foundation, which the family founded in honor of the late Wall Street Journal reporter who was kidnapped and killed by Islamic militants in Pakistan. The organization sponsors such activities as fellowships for international journalists and a world music festival.

Ahmed, 63, a former Pakistani diplomat who now is the department chairman of Islamic Studies at American University in Washington, D.C., said the award is a good counterbalance to American secular culture's obsession with youth.

"Muslim culture is somewhat different," he said in a telephone interview. "The older you are, the wiser you are considered, the more status and more authority you have. There is no conflict with people doing remarkable things at this age."

The prize also reflects "American generosity and friendship in reaching out to Muslims" at a time of tension between the U.S. and the Muslim world, Ahmed said.

He said he expects to use the stipend to defray research travel costs and to try to launch younger speakers on more forums of the Daniel Pearl Dialogues for Muslim-Jewish Understanding.

The other Purpose Prize winners are:

* Conchy Bretos, 61, a former Florida official who now helps bring assisted-living services to senior citizens.

* Charles Dey, 75, a Connecticut activist who created a program of workplace internships for disabled high school students.

* Marilyn Gaston, 67, and Gayle Porter, 60, of Maryland, who started a group to promote better health for African American women.

* W. Wilson Goode Sr., 68, the former mayor of Philadelphia who now heads a nonprofit that aids children whose parents are in prison.

The recipients all share "an overarching sense of optimism, idealism and purpose," said Freedman, 48. "They have a tremendous desire to have a sense of direction in their lives and reasons for getting up in the morning."

Freedman, who wrote the 1999 book "Prime Time: How Baby Boomers Will Revolutionize Retirement and Transform America," said he founded Civic Ventures in 1998 in anticipation of such changes. "Our whole focus is on the aging of American society and how to best use the talent of aging boomers, particularly in ways that benefit the wider community," he said.

The organization also sponsors the Experience Corps, which sends tutors over age 55 to volunteer in urban schools.

Purpose Prize judges selected 15 finalists from about 1,200 nominations. A separate jury headed by Sherry Lansing, the former chairwoman of Paramount Pictures, chose the five big winners. The John Templeton Foundation and Atlantic Philanthropies funded the prizes.

The 10 finalists who did not make the final cut will each receive $10,000 and can apply for additional grants. They include two Californians: Bernard Flynn, 71, a former Sacramento-area almond grower who founded River Partners, a group that works on flood control and restoring wildlife habitat; and W. June Simmons, 64, who heads the San Fernando-based healthcare and policy group Partners in Care, which, among other things, helps uninsured people obtain medical treatment and screens elderly patients for possibly dangerous prescription medicine conflicts and overdoses.

"Traditional retirement is sort of outmoded in my mind," Simmons said. "I think it's really better to go on to new adventures."

The 15 finalists and about 55 more Purpose Prize nominees are expected to attend a three-day conference starting Thursday at Stanford University, hosted by the Center for Social Innovation at the university's Graduate School of Business.

The Helen Sawyer Plaza, a sparkling but inexpensive Miami facility built in 1998 from a run-down housing project, was a huge success, and she's since brought her model to about 40 projects in 23 states. "We have nursing assistants who can get people out of bed, get them dressed and supervise medication, and we provide meals and exercise," she says. "With this program, the state Medicaid program saves about $48,000 per year per resident. Because of that, we get funding from [federal and state government programs], so the seniors pay little to nothing." And that's real progress. –F.C.

Sure, he needed some help, the longtime traveling trophy salesman thought. But there was plenty he could do solo.

"I went just berserk over it," said Moore, 83. "I had a nurse there convinced if I wasn't out (soon) I was going to crawl across the street and over to the 7-Eleven and call my ex-wife to get me out of here."

He didn't need to escape; the nursing home released him soon after. But Moore, like a growing number of elderly Americans, couldn't live alone at home or afford a private room in an assisted living facility, which can cost more than $36,000 a year.

Friends helped him land in a program offered within Tampa's Palm Avenue Baptist Towers. It's part of an emerging segment of affordable housing: assisted living facilities that allow low-income seniors to remain partly independent in an approved housing complex. Residents get help with daily living activities such as preparing meals, bathing, dressing, housekeeping, and managing daily medications and doctor appointments. What doesn't take place is full-time medical care, something mandated at nursing homes.

Though assisted living facilities are popular in the private sector, up to a third of the people needing this help can't afford it, national surveys show. So those who rely on government Medicaid support often are stuck, attempting to remain independent or being prematurely placed in an expensive and emotionally debilitating nursing home environment, affordable-housing advocates maintain. "It's very easy to get lost in the shuffle," said Conchy Bretos, chief executive of the for-profit MIA Consulting, which manages affordable assisted living programs in 24 states, including the one at Palm Avenue Towers.

Elderly people qualify for this program by applying for Medicaid waivers designed to support full-service nursing home care. This fiscal year, Florida has $33 million set aside to assist, said Mark Benson, with the Pinellas/Pasco Area Agency on Aging.

Popularity is rising

Today, there are 2,723 Floridians and 282 Hillsborough County residents receiving Medicaid waivers for programs such as Palm Avenue Towers, said Katie Parkinson, program manager for the West Central Florida Area Agency on Aging. The agency has money to add 120 more Hillsborough residents to the program, she said.

"This is a viable option for them if they are no longer able to care for themselves," she said.

The concept of diverting elderly adults from nursing homes is increasingly popular. In September, AARP settled a class-action lawsuit when the state agreed to spend up to $23 million next year shifting qualifying low-income seniors from nursing homes to assisted living facilities.

Locally, there are several programs operating in subsidized housing complexes in cities including Tampa and Pinellas Park. The state recently agreed to increase the number of Palm Avenue Towers apartments for assisted living services to 60 from 48. The rest of the 199 units are for low-income seniors living independently.

"They need assistance, but we want to encourage and foster their independence, not to just stick them in kind of a warehouse setting," said Michelle Capurso, administrator of the Towers program, which provides a first-floor dining hall for meals and activities such as crafts and bingo.

Moore, who has trouble remembering his age, said he is far healthier now that he has someone cooking for him and keeping him busy. He is motivated to stay active and is excited that physical therapy has him nearly able to move without his walker.

"Right now, due to the work of these people right here ... I'm almost ready to walk without any help," Moore said. Not everyone qualifies for the program, which requires residents to get a state Medicaid waiver to help cover long-term health care costs. Residents must be at least 65, make less than $23,000 a year - about $1,900 a month, in pay, pension or other support - and cannot own a home. More importantly, they must show a clear need for help in at least three daily activities, such as bathing.

At Palm Avenue Towers, 30 percent to 40 percent of the assisted living residents rely only on a monthly Social Security check for $674; the rest get no more than $1,000 a month, Bretos said. The program receives all but a small portion of each resident's monthly support in exchange for the housing, food and other services.

This type of long-term care saves significant money for government agencies accustomed to paying for nursing home care, said Bretos, who served as Florida secretary for aging in the 1980s. She estimates that nursing home care costs Medicaid $120 a day, on the average. She said her program costs Medicaid $28 a day.

Private sector comparisons

Assisted living is far less expensive than nursing home care, even in the private sector. The National Center for Assisted Living estimates that a private unit at an assisted living facility costs $3,022 a month on the average, or about $101 a day. By comparison, a private room at a nursing home's average cost is $6,390 a month, or $213 a day.

Although there may be savings to be had by shifting people out of nursing homes, it is not a cure-all for every elderly person needing help with their daily routine, said Kristen Knapp, spokeswoman for the Florida Health Care Association, which represents private facility providers.

She said it's critical that each person be properly assessed for care, and that many may best be served in a medically staffed nursing care facility.

It's also a concern that legislators are not increasing the financial support for long-term health care for the elderly. Instead, money is being diverted to take care of what is a growing population of seniors needing some level of care.

"You should not take money away from one sector and give to another," she said. "That affects the level of quality care."

That concern is magnified as lawmakers in Washington debate health care reform. Two weeks ago, a Senate revenue estimate conference predicted that Medicaid expenses would rise 17.4 percent next year. The potential budget shortfall in that same period: $1.6 billion, Knapp said.

The issue, however, is about far more than money to people such as retired Tampa beautician Mary Herttell, 93. She thrives on the activities at Palm Avenue Towers, where she has lived for almost four years and still cooks eggs or pasta occasionally in her tiny, tidy kitchen.

She loved living on her own, but her mobile home grew lonely, the widow said. Although family in town still visit and help her with trips to the doctor, she knows she needs someone coming by every morning, without fail.

"I love when they come in and say, 'How are you? Are you OK?'" Herttell said. "It makes me feel good because maybe they find me gone or something."

The Purpose Prize winners are using their experience and entrepreneurial skills to help solve long-standing problems, including intolerance, racial disparities in preventable deaths, job opportunities for the disabled, housing needs of the elderly poor, and the disrupted lives of millions of children who have a parent in jail.

"It's conventional wisdom that young people drive entrepreneurialism and innovation, but the Purpose Prize winners turn that outdated notion on its head," said Marc Freedman, founder and President of Civic Ventures. "These inspiring men and women illustrate an emerging trend in our society, as millions of aging Americans turn their experience and passion for change into meaningful work in the second half of life."

Seventy older social innovators -- the top five percent of the 1,200 Purpose Prize applicants -- have been invited to participate in a "Purpose Prize Innovation Summit," September 7-9, at Stanford University in Palo Alto, California. The event is cosponsored by Civic Ventures and the Stanford Graduate School of Business' Center on Social Innovation, one of the world's leading academic centers focused on social entrepreneurship.

At the Summit, social innovators can learn from presenters and one another, build a network that will link and support innovators working in the second half of life, discuss ideas with funders and venture philanthropists, and explore how individual efforts can create a wave of social innovation that could transform America.

The five Purpose Prize winners and 10 finalists can also apply for support of their work from Civic Ventures' new million-dollar Fund for Innovation. Two foundations, The Atlantic Philanthropies and The John Templeton Foundation, provided funding to Civic Ventures for the Prize program and the new Fund.

"Today's boomers and older Americans are an extraordinary pool of social and human capital that -- with the right investment -- could yield unprecedented returns for society," said Freedman. "Instead of being a lifetime achievement award, the Purpose Prize is an investment in what these amazing individuals will do next to solve important problems."

The winners -- selected by a jury comprised of 21 leaders in business, politics, journalism, the arts, and the nonprofit sector -- include:

Conchy Bretos (age 61, Miami, FL)

Bringing assisted living services to public housing Born in Cuba and sent to America when Castro came to power, Bretos lived in a Nebraska orphanage for three years before reuniting with her parents. As an adult, she worked university and public sector jobs, then became Florida's Assistant Secretary for Aging and Adult Services. Appalled to see what poor, older adults endured to avoid nursing homes, she became the force behind the nation's first public housing project -- the Helen Sawyer building in Miami -- to bring assisted-living services to low-income adults who need help to stay in their homes. Today she runs a consulting company that has helped 40 public housing projects in a dozen states bring assisted-living services to their residents.

Charles Dey (age 75, Lyme, CT)

Engaging high school youth with disabilities in the world of work At 64, Dey had a long career in education and a record of starting programs to ensure equal educational opportunity. Alan Reich, a friend who founded the National Organization on Disability after an accident left him a quadriplegic, told Dey to "do for young people with disabilities what you did for minorities in the '60s." Dey created Start on Success, a National Organization on Disability program providing paid internships and workplace mentors to predominantly minority high school students with physical, mental and emotional disabilities. Over 1,500 students have had internships at universities, hospitals and businesses in five cities, and 85 percent have gone on to full-time jobs or further education. Dey is working to expand Start on Success, while also building the National Organization on Disability's efforts to help disabled adults, including returning veterans, find jobs.

Marilyn Gaston and Gayle Porter (ages 67 and 60, Bethesda, MD)

Empowering midlife African-American women to improve their health With African-American women dying at rates greater than any other group of U.S. women, Gaston and Porter were inspired to stop many of these preventable deaths. Accomplished health professionals, they created Prime Time Sister Circles - part support group and part health course on exercise, nutrition and stress. The meetings, taking place in convenient locations like churches and community centers, encourage goal-setting, peer support and empowerment to change how African-American women approach their health and the health of their families and communities. Research in four cities shows that 68 percent of participants maintain improved health.

W. Wilson Goode, Sr. (age 68, Philadelphia, PA)

Mentoring children of incarcerated parents In 2000, former Philadelphia Mayor (1984-1992) Wilson Goode earned a Doctorate of Ministry and became the director of Amachi, a nonprofit helping the 7 million children who have one or both parents in jail, on parole or under supervision. Goode, whose own father went to jail for assaulting his mother when Goode was 14, paired mentoring with faith-based recruiting. He rallied pastors in African-American communities to encourage their congregants to be mentors. Today more than 240 programs in 48 states are affiliated or inspired by Amachi, and mentors have helped 30,000 children. Without intervention, experts predict that as many as 70 percent of children with incarcerated parents would end up in jail.

Judea Pearl and Akbar Ahmed (ages 70 and 63, Los Angeles and Washington, D.C.)

Fighting intolerance, conflict and terrorism through dialogue and exchange After terrorists murdered his son, Wall Street Journal reporter Daniel Pearl, Judea Pearl, a computer science professor at UCLA, teamed up with Akbar Ahmed, a professor of Islamic Studies and envoy to Muslims in the U.S. and abroad. The two travel the country to speak and lead dialogues on religious tolerance, linking their stories to a call for reconciliation and providing a rare forum for moderate Muslims in the U.S. Dialogue is central to the work of the Daniel Pearl Foundation, which sponsors fellowships for journalists and an Internet news service for high school journalists, advocates press freedom, and organizes world music days to bring diverse people together.

Allen Sells, 61, once a financial services CEO, moved to Miami last year to become pastor of a church and is overseeing 15 youth programs for The Children's Trust.

At 51, Patricia Kodish, a former math and science teacher in Coral Springs, has just finished a master's program in public health and is hoping for a fellowship that could take her to China or Indonesia.

And former teacher Linda Bach, 59, has a medical practice in Miami Shores, having graduated from medical school at 50.

According to author Marc Freedman, these four South Floridians are part of a revolution that may change the nature of work and retirement in the United States — people who, instead of fading from the workforce in midlife, are embarking on second careers.

'Instead of the freedom from work, they are searching for the freedom to work; instead of saving for a `secure retirement,' they are underwriting an encore career," Freedman writes in his new book, Encore: Finding Work That Matters in the Second Half of Life (Public Affairs, $24.95).

He will be in South Florida Tuesday to speak at the Florida Conference on Aging and to the public at 7 p.m. at Books & Books in Coral Gables.

Many Baby Boomers are looking for more than a paycheck, Freedman say. Forty years after coming of age in the tumultuous '60s, they want meaningful work.

"We have to rethink this Baby Boomer generation," said Miamian Conchy Bretos, who reinvented herself after years in government and a bruising, unsuccessful campaign for the county commission in 1993. "They have a lot of juice in them."

At 50, Bretos started Mia Senior Living Solutions, which brings assisted living services to seniors in public housing so they won't have to go to nursing homes.

Last year, she was one of five winners of the $100,000 Purpose Prize from Civic Ventures, a think tank led by Freedman, 49, aimed at "redefining the second half of life as a source of social and individual renewal."

With her daughter Pilar Bretos Carvajal, Bretos has embarked on projects in 18 states and is on the verge of forging a historic agreement between the U.S. Department of Housing and Urban Development and the Department of Health and Human Services.

"I cannot imagine simply bowing out and staying home and doing crochet," said Bretos, now 62. "I feel at this time in my life I have too much knowledge and I want to give it away somewhere."

The notion that 50-plus Americans are an untapped resource is gaining attention. The Community Foundation of Broward has just completed a study of how their talents can be tapped for community projects, both paid and volunteer.

"Boomers want to be engaged," said Sheri Brown, vice president of grants and initiatives for the foundation, who organized the study, which will be released next month. "They have a strong desire to be engaged and make a difference in the community."

But, she notes, both corporations and nonprofits will have to change if they want to benefit from Boomers' talents.

"There is a line they don't want to cross," said Linda Carter, president of the foundation. "They don't want the hassle of certain things," like having to drive through rush-hour traffic to engage in volunteer work.

While Freedman's book envisions a world in which employers accommodate older workers' desire for flexibility, he acknowledges that such jobs are unusual. And, for many, opening a business is the best way to get the flexibility and control they want. While they pay more for health insurance than they did as employees, most people can buy policies for individuals or small businesses.

Back to Her Roots

Karen Doyle had had a long and successful career in public relations, advertising and marketing, but was dissatisfied with the "dog-eat-dog" nature of the business. She also wanted to tap into her creative side.

She had studied architecture and engineering as well as advertising at the University of Florida, and had once run the Urban Land Institute's South Florida office. An avid home gardener, she had long noticed a lack of good landscaping in commercial and residential developments.

Gradually, those experiences coalesced into a business plan: upgrading the outdoors for home and business owners who wanted more than a lawn service and less than a landscape architect. Last year, she made the leap and opened Gardening Angels.

Doyle is reveling in the freedom she finds as an entrepreneur and the pleasure she takes in working outdoors.

"The thing that you spend the most time doing, it has to make you happy," she said.

Spiritual Rewards

Allen Sells was a businessman for more than 30 years, starting companies and working with venture capitalists during the dot-com era. "I enjoyed the business of business," he said. "I had the opportunity to work with many of the top people in their fields."

But as the dot-com boom was winding down, he saw an opportunity to follow another passion: spirituality.

He took a job running a Unity church in Marathon — at one-tenth of his former salary plus housing. A longtime believer in the "laws of attraction" popularized in The Secret, he ended up in a 5,400-square-foot oceanfront home, first while it was for sale and then as a house sitter.

Last year, he became the leader of the Miami Center for Spiritual Living. His work with at-risk children in the Keys led to his second job at The Children's Trust.

"This is highly rewarding," he said. "I can directly apply many of the things I learned in the private sector."

Back to School

For Patricia Kodish and Linda Bach, pursuing their passions meant going back to school in their 40s. Both had been pre-med students, Kodish at Emory University in Atlanta and Bach at Ohio State.

Kodish gave up her dream of being a doctor when she got married and had two children. She got a teaching degree, taught math and science and did 25 years of volunteer work, earning Florida Volunteer of the Year honors in 1998 for her work on a hunger project.

After a stint as director of an interfaith project on protecting children from environmental toxins, she decided that health advocacy and education were her true calling, and set out to earn a master's degree in public health at FIU.

Attending classes meant a 90-minute drive each way from her Coral Springs home. The hardest part was not the academic work, she said, but giving up nearly all her personal time. Divorced at the time, "I did not go out in two years," she said.

Kodish is a finalist for a fellowship with the federal Centers for Disease Control and Prevention that could take her to Asia or some other far-flung part of the world to work on AIDS initiatives.

In college the first time around, she had studied Russian and wanted to travel and experience other cultures. "My life took a different path than I'd envisioned," she said. "Now I'm trying to recap that dream."

A Bitter Pill

Bach, too, pursued the road not taken in her second career.

Her drive to become a doctor — born of her father's death when she was 10 and her desire to spare other children that heartbreak — hit a brick wall in 1968 at Ohio State University, which admitted only five women, with 150 men, to the next year's medical-school class.

"When I didn't get in, I was devastated," she said.

Bach went to work as microbiologist, got married, had a daughter and taught algebra and computer science.

When she was 43, she heard about a medical student who was 35, and began investigating whether it perhaps wasn't too late for her.

The University of Miami agreed to consider her application if she repeated all her pre-med classes and scored well on the medical school admissions test. She jumped through those hoops and went on to graduate from medical school at 50 and do a three-year residency at Jackson Memorial Hospital. She bought a family practice in Miami Shores and has never looked back.

"I'm so excited to come to work," Bach said. "All my life I wanted to be a doctor, and when I didn't get into medical school, I felt something was wrong. . . . For me to be able to actually be a doctor, it's a dream come true."

Knock on Wood

Les Cizek has advice for restless Boomers hesitant to make a change. At 78, he is more than 20 years into his second career.

In his mid-50s, Cizek gave up a lucrative career in aviation insurance to follow his real passion: woodworking and making furniture. He now spends half the year at his studio near Mendocino, Calif., and the other half in a Brickell condo.

During the two years he studied furniture making in California, his wife, Norma Watkins, had to take an unpaid leave from her teaching job at Miami Dade College. He went from custom-made suits and first-class airfare to an allowance of $10 per week.

"We just didn't need any of that stuff we needed before. It just really didn't matter," he said.

"The deciding factor doesn't have to be money. If you have a passion and you're sure that it is a passion make the jump. Just do it."

The older population in America will increase dramatically as baby boomers hit retirement age. By 2030, one out of every five Americans will be a senior. That's about 70 million elderly persons, more than twice what it was in 2000.

Barely half of the public housing's senior-headed households live in buildings designed for their use, said Nancy Bednar, project director at the nonprofit Housing Research Foundation. About 47% of the elderly households are scattered throughout conventional family developments, according to the foundation's recent report "Public Housing for Seniors: Past, Present and Future."

The study reports that about two-thirds of elderly public housing residents live in buildings constructed at least 30 years ago. As a result, the existing backlog of modernization costs is estimated by the Department of Housing and Urban Development (HUD) at a whopping $4.8 billion, or $11,603 per unit. In addition, it estimates an accrual of modernization costs in public housing for seniors of $1,076 per unit each year.

The estimates regarding accrued modernization needs are largely regarded as inadequate and underestimate the actual costs involved in modernizing public housing for seniors. HUD's estimates do not take into account the obsolescence of the housing as well as the need to bring seniors housing, such as Sec. 202 units, said the study. As a result, the actual costs of accrued modernization needs may approach $2,000 per unit each year.

The need goes beyond accommodating a growing number of elderly citizens.

Seniors in public housing are more likely than other seniors to be disabled or frail, according to the foundation. They may need prepared meals as well as assistance with bathing, medication and other tasks of daily living.

"I see all public housing authorities, in five to 10 years, having at least a component of assisted living within their public housing facilities," said Conchy Bretos, chief executive officer of Mia Senior Living Solutions. Her firm is currently working with 30 housing authorities across the nation in creating assisted-living facilities (ALFs).

ALFs, which provide residents with a combination of housing and personalized support services, allow residents to age in place. In many cases, the resident is not ready to move from a house or apartment into a nursing home, which often costs four times as much as an ALF.

The Miami-Dade Housing Authority (MDHA), one of the nation's leaders in providing public housing for seniors, has two ALFs with 200 units under development. They are coming on the heels of the agency's groundbreaking 104-unit Helen Sawyer Plaza project, a public housing development that lined low-income housing subsidies with Medicaid waiver funding.

The state's large concentration of retirees makes senior housing a critical need. Florida has the highest percentage, 17.6% of residents 65 years and older, of all the states, according to Census 2000 data. "We're ahead of the curve," said MDHA Deputy Director Al Brewster, referring to a surge in the elderly population that will hit the rest of the nation in the next 20 years.

With the elderly population already cresting in Florida, the Miami-Dade agency will be looked at for leadership in the creation of ALFs.

The nation's sixth largest public housing authority, MDHA is building a 100-unit assisted-living facility that will include an Alzheimer's unit and an extended congregate care program. Ward Towers will be the agency's first newly constructed ALF.

The agency has pooled several funding sources to build the $15 million project, including about $4 million in HOPE VI funds, $8 million in tax-exempt bond revenues, $3 million in low-income housing tax credits and local resources.

The project is in the early construction stages and is scheduled to be completed in 2003, according to Rudy Perez, director of public housing operations.

At the same time, MDHA is planning the 100-unit Smathers Plaza assisted living facility at an existing seniors housing project in Miami's Little Havana district. The project is estimated to cost $10 million to $12 million. Florida Housing Finance Corp. is providing a $3 million loan, said MDHA officials.

Both projects follow the success of Helen Sawyer Plaza. The project is considered one of MDHA's greatest achievements.

Originally built to house the frail elderly and disabled, the development opened in 1976 under the name Highland Park. In case after case, MDHA leaders began seeing residents grow more frail, Brewster said. The project had to evolve to meet their changing needs. After a conversation and remodel, the project became an ALF in 1998 and was officially inaugurated in 2000.

Three funding streams – HUD subsides, optional state supplementary funds and Medicaid waivers – are combined to support the 104-unit facility, according to housing agency leaders.

The housing authority and Mia Senior Living Solutions, which implemented the conversion and continues to manage Helen Sawyer Plaza, lobbied for a bill to create a project-based Medicaid waiver demonstration project, Bretos said.

A pilot project was then created in 1999 by Florida lawmakers with the original funding covering personal care and management costs for Helen Sawyer residents. A subsequent bill in 2000 provided "priority funding" for all Florida housing authorities to receive Medicaid waiver funding. Six housing authorities in the state are operating ALFs or in the process of building one, Bretos said.

Medicaid waivers reimburse local housing agencies for services provided to elderly residents. The waiver reimbursements vary by state. In Florida, the waiver reimbursements provide $28 a day per resident and $100 per resident per month for case management. Currently, 36 states have Medicaid waiver programs that cover assisted-living facilities, Bretos said. A leading authority in the field, she serves as Florida's secretary for aging and adult services.

A typical Helen Sawyer resident is a woman in her 80s who stays an average of 35 months. About 60 of the current residents are former nursing home residents or were about to be institutionalized.

The Housing Research Foundation's report, "Public Housing for Seniors: Past, Present and Future," can be found at www.housingreserach.org.

With $1.2 million in state Medicaid funds, the project, known as Helen Sawyer Plaza, became a national model promoted by federal housing and health authorities. Seniors, most below the poverty line, combine Social Security income with other subsidies to pay for the assisted-living services, such as cooking, cleaning, and oversight taking medication.

Mia Consulting has been involved in creating or managing 40 such communities and currently runs two in central Florida. The company also consults with housing agencies that want to adopt the model. Last year Mia raised $25 million to buy struggling private assisted-living homes and remake them for low-income seniors. "It's a neglected market," says Bretos, because most private operators don't want to deal with the paperwork needed to help low-income residents. "Our mission is to produce as many affordable assisted-living beds as we can." Bretos, 65, was named an Ashoka fellow last year.