Aging Americans are finding more ways to stay independent. At 99, Ruth Hilsee is a success story.

ONE MORNING last spring, Ruth Hilsee, age 99, took a stroll to inspect a new apartment.

As she clung to her favorite blue walker, the one with four wheels and hand brakes, this 93-pound puff of a woman, bent but ever bubbly, just couldn't imagine moving, even though the staff in her retirement community wanted her to consider it.

She had been living happily in a one-bedroom apartment at Kearsley, in West Philadelphia, for 15 years.

The Rev. Judith Beck, an Episcopal priest, gives Ruth Hilsee communion in her hospital room. Mrs. Hilsee was recovering from falls and afterward moved to the nursing-home wing of her retirement community. At 99, she is adjusting to the loss of her independence.

She shopped at the Acme, made her bed with more precision than a Marine in boot camp, and kept a checking account, writing $10 checks to charities of every stripe.

Kearsley was opening 60 "personal care" apartments, the trend in elderly living.

They were smaller than Mrs. Hilsee's, but offered one crucial advantage: an aide tohelp daily with dressing, bathing and taking medication -- things that Mrs. Hilsee had so far managed quite well on her own.

Mrs. Hilsee toured the cheerful apartment with Alice Evans, a Kearsley staffer. Evans told Mrs. Hilsee she would have space for one lamp, one table, one chair.

Mrs. Hilsee returned to her apartment. The afternoon sun filled her windows, their sills covered with African violets and many other plants. Mrs. Hilsee graduated from horticultural school in 1918 (she had recently pledged the usual $10!), and when a Kearsley staffer dropped by to ask the Latin name for baby's breath, she replied without hesitation: "Gypsophila."

Looking around her apartment, Mrs. Hilsee counted six tables. She thought about the ordeal of moving. What would she have to leave behind? Her books? The oil portrait of her son at age 6? The bedspread crocheted by her mother? Her love seat?

The next day, Mrs. Hilsee wrote Evans a note. She thanked her warmly, but she couldn't possibly move.

The day after that, Mrs. Hilsee wrote another note: "Perhaps I should reconsider."

RUTH HILSEE is a success story of modern medicine and social progress: She has lived nearly a century in excellent health, living independently, staying mentally active, finding joy and fulfillment in each day.

Throughout most of human history, half of people have died before their 18th birthday.

Today, four of five Americans live to 65. Those who do can expect to live 18 more years.

In just 30 years, America will have more people over 65 than under 18. In 50 years, nearly 90 million Americans will be over 65, and one million to five million could be as old as Ruth Hilsee.

Although Mrs. Hilsee is approaching the end of her life and is content to die, she still has choices to make, and she intends to make them.

What she and her generation want most is as much independence as their health will allow.

And America is rushing to comply with those wishes, building personal-care apartments -- often known as assisted living -- at a rapid pace, to help people like Mrs. Hilsee live in residential settings.

To allow them the freedom they want.

AFTER VISITING the personal-care apartment, Mrs. Hilsee spent several weeks discussing the pros and cons of moving with everyone she could find, including her daughter-in-law, Jennie Hilsee, 71, and her three grandchildren, all of whom live in Roxborough.

She discussed it often with her sister, Grace Murphy, just 97, with whom she spoke every night at 9:30. Mrs. Murphy lives at the Quadrangle, a retirement community in Haverford.

Mrs. Murphy, who often scolded Mrs. Hilsee for taking a bus to the groceryby herself, encouraged her big sister to move into personal care.

Mrs. Hilsee didn't think she needed extra care, but she was afraid of falling. She had fallen nine years earlier, when she was 90, and had broken her hip. It required six weeks in Kearsley's nursing wing, but she bounced back.

In her apartment, Ruth Hilsee, with great-granddaughter Vanessa Hall, loved having visitors.

Forty percent of Americans over 65 who fracture a hip die within a year. But Mrs. Hilsee didn't even stop driving. She didn't stop until she was 93, after her son finally convinced her: "He said there were so many wild drivers on the road. And you know they do cut in and all."

The one lasting consequence of her fall was a slight loss of flexibility. Mrs. Hilsee can no longer kneel when she prays. Now she must sit, usually on her love seat.

A frequent subject of her prayers is that she will not fall, especially when climbing over the lip of the bathtub, the hardest single physical act in her life.To make bathing easier, Kearsley installed grab bars in Mrs. Hilsee's bathroom and a stool in her tub.

But personal care had a walk-in shower! Mrs. Hilsee noticed that feature the moment she toured the apartment.

One morning in May, she decided she needed to know more about personal care so she telephoned Connie Spencer, another Kearsley staffer and dear friend.

Sitting on her perfectly made bed, she put the question to Spencer:

"What does personal care mean? Does that mean if you have to go to the dentist, somebody will take you?"

Mrs. Hilsee had no intention of going to any dentist. She was extremely proud of her teeth. She had all but one. And she took excellent care of them. She would bite into nothing, cutting up even a tuna melt or tomato sandwich. She thought she had one cavity, but hadn't been to a dentist in years.

"They'll probably want to extract a tooth, and that will make me furious," she had said. "I won't have it."

Spencer said rides to the dentist could be arranged, but were not part of personal care. Mrs. Hilsee thanked Spencer and hung up.

"It's such a difficult decision," she said. "I'll just put it in the hands of God."

IN TERMS OF DISTANCE, moving from her apartment to the personal-care wing was not great -- from the fifth floor to the first, down a new corridor. But emotionally for Mrs. Hilsee, it would be a leap.

Familiar geography and routine mean so much to the elderly. Mrs. Hilsee loved knowing precisely where everything was in her apartment -- from her four magnifying glasses to her three walkers -- just as she loved her routine in it.

The morning of May 31 was typical.

Ruth Hilsee shops for groceries, picking only single bananas because she hasn't the strength to separate bunches. At her retirement home, Kearsley, in West Philadelphia, she would prepare her own breakfast and lunch and eat dinner in the dining hall with other residents.

After washing her face, combing her hair, and hanging her nightgown on the bathroom door, Mrs. Hilsee pulled on her slip and dress, put on her shoes and tied them, and headed into the kitchen to boil water for her coffee.

First she took her medicine -- two aspirin, two vitamin C, a heart pill, and a thyroid pill. She swallowed one pill at a time, each with a sip of her instant coffee, which she cooled with a splash of tap water. Then she had toasted oats, a generic brand. "They're much cheaper than Cheerios and just as good," she said.

She carefully opened the bag, untied the twist, poured some into a bowl, and got a milk carton out of the refrigerator.

Mrs. Hilsee prepares breakfast and lunch in her apartment, but eats dinner with other residents in the Kearsley cafeteria. Each night at dinner, she gets a half-pint of milk and takes it back to her apartment for her cereal the next morning.

Opening milk cartons is an adventure. She doesn't have the strength to do what any schoolchild can: push the sides of the carton back, then squeeze them together. This morning she got a sharp kitchen knife and dug into the mouth of the container. Finally, she carved a hole big enough to pour milk into her cereal and coffee.

Sitting happily on her kitchen stool, she ate her toasted oats, spoonful after spoonful, down to the last oat, without spilling a drop.

"My, they're delicious," she said, putting the bowl in the sink and rinsing it.

Then she made her bed. It took her 14 minutes, going from one side of the bed to the other, again and again, pulling up the sheet and bedspread, smoothing out wrinkles, punching her pillows.

Putting on her wristwatch took five minutes. Fastening the band challenged her dexterity.

Then, as she does every morning, Mrs. Hilsee read a verse in her religious day book. This morning it was Romans 12:2: And be not conformed to this world: but be ye transformed by the renewing of your mind. . . . Afterward, as usual, she wrote the citation on her desk calendar.

The two most important dates in her calendar are those of the hairdresser's and podiatrist's visits. She records them months in advance -- every third Thursday for the hairdresser, and every sixth Tuesday for the podiatrist.

Her hair is thin, short and snowy gray. It doesn't grow anymore, she says, so she never has it cut. The hairdresser washes, brushes, and curls it. Once in a while, Mrs. Hilsee gets a perm, but she can't remember the last one.

She always visits the podiatrist when he comes to Kearsley, having her nails cut and her calluses trimmed. Mrs. Hilsee's greatest ailment is her sore feet. The cushioning, the fatty tissue beneath the balls of her feet, has simply worn out. This is common with old people.

As usual, Mrs. Hilsee ate lunch alone, tomato and mayonnaise on bread. She cut the sandwich into small pieces.

After lunch she relaxed on her love seat and watched children's shows on public television. She especially lovesShining Time Station. Her father worked for the Pennsylvania Railroad, and the show reminds her of him. "Those little engines, their eyes and mouths are so expressive. I try not to miss that one."

She joined other residents in the cafeteria for dinner, carefully cutting up her tuna melt, and returned to her room in time to watch the The NewsHour With Jim Lehrer. At 7, she switched to Jeopardy! She was joined by a neighbor, Henrietta Peterson.

At 9:30, just before going to bed,she called her sister. They chatted a while, reminisced. Every call ends the same way.

"Good night, darling," said Mrs. Murphy.

"Good night, dear," said Mrs. Hilsee.

AS OF 1994, 2.2 MILLION American women, like Mrs. Hilsee, were either unmarried or widowed and surviving entirely on Social Security. Mrs. Hilsee receives $734 a month.

For most in her position -- and by then, most are women -- life can be a struggle. But Mrs. Hilsee lives quite comfortably at Kearsley because its mission is to provide housing to people with low and moderate incomes. Her rent is $231 a month.

In its own way, Kearsley is as pioneering as Mrs. Hilsee. It provides a continuum of care -- independent apartments, personal care and a nursing wing -- all in one place, and all for low- and moderate-income residents. Kearsley is nonprofit and has combined aggressive fund-raising with tax credits and low-income loans to accomplish its mission.

Mrs. Hilsee knows she is quite lucky to live there.

The challenge to America is to provide more places like Kearsley. In Pennsylvania, New Jersey and Delaware, there are about 100 continuing-care retirement communities, often beautiful facilities such as the Quadrangle, where Mrs. Hilsee's sister lives. These places offer all levels of care, but most of them can cost $50,000 or more just to enter.

Newer on the landscape are personal-care, or assisted-living, communities.

These facilities typically can cost $1,000 to $3,000 a month.

For 15 years, Ruth Hilsee enjoyed the freedom of a retirement-community apartment, knowing that help was nearby if she needed it. If she moves from the nursing-home wing, where she's recovering from falls, it will be to the personal-care wing.

At Kearsley, aside from her modest rent, Mrs. Hilsee must also pay $5.40 for dinner in the Kearsley cafeteria, as well as for her telephone, groceries, and other personal items. She manages just fine, writing checks and recording each expense in a large ledger, custom-made on graph paper by her grandson. Mrs. Hilsee doesn't trust her arithmetic any longer and allows her daughter-in-law, Jennie Hilsee, to balance her account once a month.

Mrs. Hilsee recently received a windfall -- a check from the John Hancock Mutual Life Insurance Co. for $802.63. Mrs. Hilsee's father started the policy with $1 on June 1, 1898. Mrs. Hilsee's parents, and then she herself, contributed a dime a week toward the policy until 1965, when the company stopped collecting nickels and dimes.

The account stood idle for 30 years until Jennie Hilsee, sorting through her mother-in-law's papers, noticed a record of it and wrote the company. Mrs. Hilsee considered getting her love seat reupholstered with the money, but wasn't sure she'd be alive long enough to make the investment worthwhile.

Mrs. Hilsee had known Miss McHenry all her life. In 1981, after Mrs. Hilsee's house in Germantown had been burglarized three times, Miss McHenry persuaded her to move into Kearsley with her. She made sure that Mrs. Hilsee got the apartment right next door.

In those early years, Miss McHenry took personal responsibility for Mrs. Hilsee, introducing her and involving her in activities. They were inseparable.

But about three years ago, Miss McHenry's diabetes and arthritis and many other ailments began catching up with her, and she moved to Kearsley's nursing wing. In the last year, it was Mrs. Hilsee who became responsible for 95-year-old Miss McHenry.

Every night after dinner, Mrs. Hilsee visited her.

"She couldn't hear or see or watch television," Mrs. Hilsee recalled. "We couldn't have a conversation. I used to get hoarse shouting to her. So we would just sit. Sometimes it was a little effort to get down there every night. As soon as I got there, she'd say, `I'm so glad you're here.'

"Every night she would be so sad," Mrs. Hilsee continued. "She was just so tired of all her infirmities. She was tired of living. She kept saying `I wish I were dead. I wish I were dead.' It wasn't really a matter of suffering as with being bored with life."

Miss McHenry died one afternoon in May while eating lunch. Mrs. Hilsee rejoiced. She knows her dear friend is now happily in heaven, though she does admit she's felt a void since her friend's death.

Mrs. Hilsee believes God keeps her alive for a purpose, and her purpose these last few years had been to comfort Miss McHenry.

But now Miss McHenry is gone.

Mrs. Hilsee is unclear of her purpose now, though confident God will find her another one.

If not, Mrs. Hilsee is perfectly ready to die.

NOT ONLY ARE AMERICANS living longer, but they are enjoying better health.

Research by Ken Manton of Duke University, one of the nation's leading demographers, shows that every year a smaller percentage of the elderly suffer from disabilities.

Of course, the burgeoning number of older Americans includes millions in declining health. But, according to Manton's research, a smaller percentage of older Americans each year will be sick.

Manton has analyzed the National Long Term Care Surveys, studies of 20,000 Medicare recipients in 1982, 1984, 1989 and again in 1994. His analysis showed that those needing help with daily activities declined from 24.5 percent of elderly Americans in 1982 to 22.6 percent in 1989.

He also looked at 16 major illnesses among the elderly, from heart disease to arthritis, and found an 11 percent decrease across the board between 1984 and 1989.

Manton has many explanations: better diet and exercise; fewer smokers; better medicine; common surgeries that help people remain self-sufficient, such as hip replacements and cataract removals. Even simple devices such as grab bars for bathtubs or walkers with hand brakes help older Americans maintain their independence longer.

Though this improves the quality of life, it's the genes that enable people to live as long as Mrs. Hilsee has.

That is the conclusion of Thomas Perls, a Harvard geriatrician, who is author of the New England Centenarian Study.

The United States has 57,000 centenarians.

"If people have the genetics that is destined to make them die at 70, then they're certainly not going to make it to 99," said Perls. "There are things they can do to get them to 75, whether that is diet or exercise, avoiding smoking and so on. But to get into that old-age, extremely-good-health group, you've got to have those good genes behind you."

Science is hard at work trying to alter the biological time bomb that ticks inside of every cell in the human body. Just Tuesday a conference was held in New York: "Biotechnology: Innovations for Longevity -- Living Better as Well as Longer."

Dreamers believe that within the next 50 years, science will extend the limit of human life -- now considered 120 years -- to 150, 200, or 300 years. Many, like Perls, believe that is pure romance.

Perls' research has shown that when people as old as Mrs. Hilsee begin to decline, their health fails swiftly.

"You start to have problems in the last year, and then you die," he said.

Her husband, Donald Ashcroft Hilsee, a retired Philadelphia schoolteacher and Wharton School graduate, died of cancer in 1969, at age 72.

sHer only son, David, died in 1993 at age 68 from end-stage kidney disease.
Mrs. Hilsee explains her longevity this way: "We were brought up very sensibly, eating things that were good for us, using common sense. That's all."

Yet, she has her limitations.

She buys single bananas because she's too weak to pull bunches apart.

At dinner in the cafeteria, she gets frustrated."I can't eavesdrop anymore," she lamented. "People are talking around me, and I can't hear what they say."

Magnifying glasses compensate for weak eyes. She has four magnifiers -- in her handbag, by the phone, on top of the Biblical Archaeological Review, and on her desk. Still reading is difficult.

"I can't look up things in my Bible concordance, and I miss that."

She walked over to her desk and picked up a small, powerful magnifying glass.

"Now this one is the best one of all," she said. "And it's so easy to lose it. Jennie found it in the wastebasket once."

Mrs. Hilsee was so excited. She made lemonade and had enough trays and chairs for everyone. The visitors brought the birthday cake, ice cream, and soft drinks. Mrs. Hilsee was so pleased that her great-granddaughters preferred her lemonade to soft drinks.

The girls, 11 and 9, got a little bored at their great-grandmother's, but they found things to do. They swung on her walker as if it were parallel bars and colored at her desk.

Mrs. Hilsee gave Don a card and a $10 check for his birthday. Don couldn't blow out his candles because they had never been lit. Even the slightest smoke triggers the smoke alarm, which seems appropriate in a building full of old people.

As Mrs. Hilsee happily ate her piece of cake, she recounted how, soon after her arrival at Kearsley, somebody burned toast three times, and the fire department came each time. "The last time," she said, "they took the toaster with them."

Mrs. Hilsee reported to her family that she was already planning her 100th birthday party -- which, God willing -- will be in April.

That got her talking about moving. She would never be able to entertain in a personal-care apartment.

"Can you imagine," she told her grandson, Don, "me going to personal care? One lamp. One chair. One table. Why, what would I do without that love seat? I couldn't have Sue and Fred. Where would they sit?"

ON MONDAY, JULY 8, Mrs. Hilsee's next-door neighbor, Henrietta, showed up as usual for Jeopardy! But Mrs. Hilsee didn't answer her knocks on the door.

She thought Mrs. Hilsee wasn't back from dinner. So she tried again a half-hour later. Still no answer.

Henrietta summoned another neighbor, Marie McAndrew, who banged with her umbrella on Mrs. Hilsee's door. Finally, the two women thought they heard the faintest moaning sounds.

They rushed down to the front desk to tell the security guard, who had an extra key. They found Mrs. Hilsee on her bedroom floor. She was coherent but badly bruised. She had fallen. Mrs. Hilsee told the women that she had no recollection of falling. Security called 911.

Mrs. Hilsee spent the night at the hospital. Nothing was broken, and an ambulance returned Mrs. Hilsee to Kearsley, leaving her on her bed, alone, at 7 a.m.

About noon, Marie learned from other residents that Mrs. Hilsee had come home. She had kept Mrs. Hilsee's purse and key. Letting herself in, she found Mrs. Hilsee on the floor again.

Again the ambulance was summoned. This time she was admitted to a hospital down the street from Jennie, who spent the afternoon and evening with Mrs. Hilsee.

"No broken bones as far as we can tell," said Jennie. "She's badly bruised all over her body. She's conscious and able to answer questions pretty well. She's still upbeat, believe it or not."

Mrs. Hilsee didn't want to return to an empty apartment. "I'm really glad you're going to keep me," she told the nurses.

That night, Mrs. Hilsee's sister called.

"I'm so glad to know you're all right," Mrs. Murphy said.

"I can't let you get ahead of me," joked Mrs. Hilsee, a reference to a fall her sister had taken.

They talked a little longer.

"Good night, darling," said Mrs. Murphy.

"Good night, dear," said Mrs. Hilsee.

DOCTORS NEVER figured out what caused Mrs. Hilsee to fall. Perhaps she turned her head too far in one direction, cutting off blood to the brain, and she blacked out.

After three weeks in the hospital, Mrs. Hilsee returned to Kearsley.

But not to her apartment. Nor to the personal-care apartment she had been considering.

Instead she was taken directly to the nursing wing. Her family later emptied her apartment.

Jennie kept the bedspread, hoping that Mrs. Hilsee might use it again one day. Sue and Fred took the oil painting of Mrs. Hilsee's son, as well as the love seat. Mrs. Hilsee found space in her nursing-wing room for the television, an easy chair, her Bible and concordance, and her favorite magnifying glass, as well as several African violets.

AFTER WRESTLING SO HARD with the question of moving out of her apartment, Mrs. Hilsee was surprisingly accepting of the sudden turn of events.

In fact, she was relieved. For the first time in her life, she was willing to let others do for her. She was glad to have the safety net.

At 99, Mrs. Hilsee has entered a new phase. She has lost her independence, and that requires an adjustment. But she is improving. She can now dress herself, and when she sees her Bible on a chair across the room, she can get up and get it. Once in a while she is wheeled into the main dining room to eat dinner with her friends.

Though she has come to accept her new life, she has one goal, if only she can get strong enough:

She wants to move to the personal-care apartment.