Despite the challenges the elderly face in rural towns across America, there is no overlooking the value of neighbor helping neighbor.
Seniors are relying more on each other to keep living at home, and they are getting help to tap into a wide range of programs for the day-to-day assistance they need to avoid moving to a nursing home.
In Robinson, that includes taking turns as a chauffeur to get friends to the senior center for meals or gathering them for a bus trip to Bismarck, about an hour away, for a doctor's appointment.
"We've had people that have had cancer and the whole town offers to drive them around," said Mary Lou Hanson, the center's manager. "It's a pretty close-knit community."
In Traverse County, Minn., a clutch of rural farm communities where more than a quarter of the 4,100 or so residents are older than 65, a "phone mate" program pairs the elderly or disabled to check on each other at a prescribed time each day. Volunteers home-deliver meals or drive older people to see a medical specialist.
Across the country, the need for such community safety nets is expected to climb significantly in coming years. By 2050, census figures show, 5 percent of U.S. residents will be 85 or older, compared with 1.5 percent now.
North Dakota has the country's highest proportion of residents age 85 and older, and that population is growing. By 2020, state officials predict, the number may jump to more than 24,000, nearly 4 percent of the population.
Robinson, a community of about 70, sits amid miles of farmland in central North Dakota.
Many residents, such as widow Emilia Randall, 93, would not live anywhere else. She has lived in Robinson since 1968, when she moved off the family farm.
"I call this God's country," she said. "The great, wide-open spaces -- it's beautiful."
But to stay here, Randall and her friends need help, particularly if they no longer have a spouse.
More than 30,000 women in North Dakota are widows. In Kidder County, where Randall lives, about 42 percent of the people older than 65 have outlived their husband or wife.
A low-income, eight-unit apartment building owned by Elsie Whitman, 82, is home to her and four other single women. They look after each other, get together for regular card games and move in a pack from home to the senior center for meals.
Without that community of neighbors to rely on, "they'd have to be in nursing homes," Hanson said.
Even Randall drives other seniors to do errands at the grocery store, the post office and elsewhere around town, or to the mall or movie theater in Bismarck, although recent eye surgery grounded her temporarily.
Networks of family and friends lend so much unpaid help to the elderly or disabled that losing their services "would break the Medicaid and Medicare system very quickly," said Cherry Schmidt, a regional administrator for the state's aging services program.
A recent study by the National Family Caregivers Association said more than 27 million people -- usually family members -- act as caregivers for others. The group said the market value of those unpaid services is about $257 billion each year.
In rural areas, where the population often is older, residents sometimes are separated from relatives living in the city. That presents an extra challenge for caregivers.
"A great many people who are caregivers are people who might need the services of a caregiver themselves," said Andrew Zovko, a director at the caregivers association. "Certainly, an elderly person caring for another elderly person is a common situation."
It is a situation that presents its own problems.
"Our volunteers are getting older and more frail," said Evie Rinke, a coordinator of aging programs for Traverse County, Minn. "When it's ice and snow we wonder, 'Oh, my, should we even send them out?' "
With elderly people and younger children making up a large portion of the county's population, "it doesn't leave a whole lot of us in that middle area to provide a lot of care for the elderly," Rinke said.
Pat Randall, Emilia's daughter-in-law and the director of Senior Services for Emmons and Kidder counties in North Dakota, said volunteers at the three senior centers in her territory logged more than 1,030 hours in January and February. She said the federal Older Americans Act, which has paid for buses and meal programs, has been a lifesaver, although state funding has lagged.
"It's like our state legislators are having a hard time understanding that we need to increase the funding to match the needs of the people," Randall said. "If there's more elderly and there's less money, what are you going to do?"
State officials say a relatively new federal program gives them some flexibility in offering help to those taking care of an elderly or disabled person at home. The National Family Caregiver Support Program allows states to tailor assistance to the needs of caregivers, said Judy Tschider, a regional coordinator.
In one case, a woman needed driving lessons because her husband, who had always handled the transportation, was in poor health and under her care.
"That can help her in taking care of him as well," Tschider said.
It also helps both of them stay in their community as long as possible. That's a familiar refrain for those who work with seniors, Randall said.
As she ate lunch with a group of other women at the senior center in Tuttle, Rachel Wolff, 78, recalled that a doctor was puzzled by her decision to move to the small town when she left the family farm.
"He said, 'How come you moved to Tuttle? Why didn't you move to Bismarck?' " Wolff recalled.
Anita Wagner, 71, answered for her: "You feel more at home here."