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At 4 a.m. on a winter morning last year, Claire Harmon woke up in her New York co-op with heart palpitations and anxiety. She was recently widowed and living alone and knew she needed medical attention.

"I didn't know what to do — my daughter lives four blocks away and has three girls and I didn't want to disturb her. I live two blocks from a hospital and I decided I would walk over to the ER by myself." But first she took her dog for a walk because she didn't know when she'd be back.

When she told people in her building about her experience, she said the universal reaction was, "Why didn't you call me?" She said she never thought to do that. She also found from talking with others that she was hardly alone in her hesitancy to ask for help.

Now she is part of a new health network for women over 50 in the New York City area called the Caring Collaborative. The group is made up of highly independent women, most of whom are working or have worked most of their lives. Though it doesn't cover emergency situations, the collaborative can arrange help by providing an escort home from a medical appointment, taking care of a pet, or bringing groceries to someone temporarily disabled, or finding someone to share information about a medical condition. The idea is to help women "age in place" or live independently in their own homes for as long as possible.

At the heart of the program is a time bank: Members register the kind of help they can give and when a member needs help, she calls the program manager, Laura Traynor, who logs the request, finds a volunteer to help, and keeps track of the transactions.

"We found from focus groups that this is a group of women who are very independent, and they want to remain independent," Traynor said. "Yet it's very difficult for them to ask for help. The feeling was that if you had accrued points for having helped others — you wouldn't be so reluctant to ask for help when you needed it."

The collaborative grew out of The Transition Network (TTN), which was cofounded in 2000 by Charlotte Frank and Christine Millen to help women with changes in their careers and personal lives.

TTN has since grown to about 3,500 members in 44 states and several countries. The Caring Collaborative was a natural offshoot, designed to have a healthcare focus. Organizers drew up a grant proposal and received funding from the New York State Health Foundation. With the help of partners, including the home healthcare provider, Visiting Nurse Service of New York, and information gathered from focus groups and grass-roots organizers, the Caring Collaborative was launched, and a handful of women had made exchanges by late last year. Organizers expect that number to swell as members become more familiar with the opportunities.

One of the members helping to get the message out is Hila Richardson, RN, DrPH, FAAN, associate dean for the New York University College of Nursing. She is now on the steering committee for the collaborative. She said she got involved for two reasons.

"The first was personal," she said. "It was recommended to me that I join The Transition Network when I was going through a difficult personal transition — to get to know a network of very accomplished women who were [making a transition] for one reason or the other...The other comes after working as a public health nurse. I was concerned about health policy and the gaps in health services. This just resonated with me."

According to Richardson, the collaborative also helps when a person needs a level of care that can be accomplished without formalized healthcare. "Sometimes, you just don't want to have to deal with the health system. You don't want to go and sign a contract if you don't need that level of help," she says. "It fills the gap without having to be interviewed, be invoiced, or take complicated steps. You can call up the network."

Richardson stressed that no medical advice or assistance is provided. She has helped the collaborative make sure it can provide privacy in compliance with the Health Insurance Portability and Accountability Act (HIPAA). She consults on issues like ensuring members' confidentiality and on determining what requests are acceptable. Part of the training for group members is to teach people the boundaries — that you would not administer someone's medication, for instance, or lift them into a chair.

She emphasized that this program is not to replace formalized healthcare, but to complement it. Say you are afraid to get a colonoscopy, she says. If you can tap into a network where someone says, "I've had three of those; I'll pick you up afterwards and we can have lunch," you are more likely to make and keep that appointment.

That hesitation was familiar to collaborative member Frieda Marshall, who had been putting off a colonoscopy. She made a request through the network and Claire Harmon answered the call. Harmon walked Marshall home from the hospital and got more than a credit in the time bank for her efforts.

Both women had been among the original planners of the collaborative. They quickly found they had much more in common — they both speak Yiddish and share a love of piano, for starters — and a friendship is growing as well as a commitment to help others. When it was Claire's turn to need help recently after a carcinoma was removed from her face, she asked whether Frieda could be the one to help.

"I don't usually like to ask for help for two reasons," Marshall says. "I like to think I can do it myself. My attitude is I can just put myself in a cab. Also, everyone's so busy — I don't want to bother anybody. When we did the exchange, it felt magical, almost. We had been planning and planning for the collaborative and now we were actually doing it."

So far, one area the collaborative is not able to cover is emergency care. Services are performed during regular work hours. But Harmon was inspired to set up an emergency network in her own high-rise. She approached her neighbors, many of whom agreed to an informal system of trading help for each other any time of the day or night.

Though the collaborative is for New York women, the goal of the group, and a requirement of the grant that funds it, is to make sure the model can be copied and used for all kinds of service groups nationwide.

Its simple concept and minimal cost make it highly adaptable. The New York program taps into the membership of TTN, where members pay a $125 annual fee, but there is no separate fee for joining the collaborative. Costs for the program include the salary of a manager and minimal costs for leasing the time bank software. With the time bank, services take on a measurable value.

"So many times I see people being thanked for doing a favor and they say 'Oh, it was nothing,'" Marshall says. "This assigns a palpable, tangible value to helping someone."

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Marcia Frellick is a freelance writer.

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