The 4.2-mile trip took Ann Gilvarry four floors down an elevator, across the city's East End in an Access van, past a driveway sign that advertises "Live Life Your Way" and up nine stories to her new home.

The chatty 70-year-old with a litany of chronic ailments had spent 445 days in a nursing home under 24-hour care She'd wanted out for months, longing for a tasty meal and a good night's sleep.

On New Year's Eve, Ms. Gilvarry returned to a more appetizing but more challenging world. She staged no celebration of her new year and new life.

But she was in her own space once more, aided by a young and expanding government program to pull competent people out of nursing home beds and return them to the community. This is the story of how Ann Gilvarry joined the movement.

The longtime Bloomfield resident is a diabetic who has also struggled with arthritis, high blood pressure and cholesterol, poor circulation, lung and sinus problems, and shingles. With often-swollen feet and fingers stuck in a permanent curl, she doesn't walk or grasp objects well.

But Ms. Gilvarry, a childless former church secretary widowed in 1973, has a sound mind, though stubborn at times. She's no fan of the medical community, whose practitioners find her sometimes reckless. Back in 2005 and 2006, she discontinued medication to control her diabetes because she didn't like some of the side-effects.

Her physical problems grew. She fell once, fracturing her hip. Her mobility declined.

By Oct. 12, 2006, her problems had mounted to the extent that she admitted herself to Forbes Road Nursing and Rehabilitation Center in Larimer for treatment and rehabilitation.

Notes from her assessment at the time called her "noncompliant with medications." She was also diagnosed with congestive heart failure and anxieties, and a doctor wrote she has a "history of falls while living alone."

There was no telling how long she would be at Forbes Road, which still carries the institutional appearance of the old Pittsburgh Hospital, founded at Frankstown and Fifth avenues in 1898. It was converted to a nursing home in 1978, with 134 beds for a mix of residents staying short- and long-term.

The one thing Ms. Gilvarry praises about Forbes Road is its therapy program, which helped her back on her feet. By early this year, she was shuffling through the hallways, her rosary beads draped over her walker as she moved along. A fixture with thin hair dyed red, she bantered about animals and offered friendly "How ya doin'?" comments to patients and staff.

She handled many of her own needs, such as washing and dressing. In nursing home parlance, she was a "set-up" or "limited assist," rather than someone entirely dependent.

But still she stayed on the fourth floor, among people with dementia or severe physical limits, as the months wore on. A succession of roommates either died or got better and moved out. She hated the food. She couldn't sleep at night. She felt over-medicated and groggy during the day. Nursing assistants to whom she had become close told her she shouldn't be in the institution.

"Some people need nursing homes -- I'm not one of them," she said in the fall.

When Sonia Thomas, a care manager from the Allegheny County Area Agency on Aging, met Ms. Gilvarry at the nursing home Oct. 22, it brought the patient's first optimism after a year of institutionalization.

Ms. Thomas, with long braids and a broad social work background, represented the Nursing Home Transition program of the county agency and the Pennsylvania Office of Long-Term Living.

After several years trying programs that moved people out of nursing homes on a limited basis -- usually disabled people under age 60 -- the Rendell administration expanded the effort in July 2006. It funded aging agencies around the state for special staffing and to provide moving costs to assist patients capable of leaving institutions. Officials deemed it a prudent investment, as such moves would save money in the long run by reducing Medicaid-financed nursing home stays.

Many people enter nursing homes on a short-term rehabilitation basis, usually funded by Medicare after a hospital stay. The Nursing Home Transition effort is targeted at those of modest income who stay months, and then have difficulty making it out.

For the more than 2,000 people moved statewide in the past 18 months, the average nursing home stay was 158 days. In that span, they may have lost their former housing or family supports. They may need special ramps or other modifications to their homes. They may need more daily home assistance than they are capable of arranging themselves.

Ms. Thomas is experienced in such matters, having assisted 44 transitions before Ms. Gilvarry's. They don't all work out. Two of them died soon after their moves, and three had to return quickly to nursing homes because of difficulty coping.

The program officials say their job is to give a chance to those who want their own home again. Each individual has a potential $4,000 budget to cover such essentials as furniture, household goods, groceries and security deposits. Ms. Thomas and other transition specialists identify affordable housing options and arrange government-funded home services for basic help such as housekeeping and shopping.

By the time Ms. Thomas met Ms. Gilvarry, she knew of a vacant apartment at the Riverview Towers senior high-rise off Browns Hill Road in Squirrel Hill. Her federally subsidized rent would be 30 percent of her income, or about $255 of the $850 monthly she receives from Social Security and a small pension.

"There's a lot of little extras there that most places don't have," Ms. Thomas said, alluding to nightly dinners, 24-hour staffing and pull-cords in the apartment to alert the front desk of emergencies.

Ms. Gilvarry asked if dogs were allowed. Ms. Thomas paused. Her new client has a history of friendship with dachshunds, and would love another, but Ms. Thomas advised: "At this point, taking care of an animal could be a little much for you."

It's not the last time the subject will come up. But they refocused on more immediate subjects, such as the furniture that will be needed, the home assistance that will be required, the monitoring that must be arranged for her blood sugar levels.

"I don't want to spend another Christmas here, that's for sure," she said. "I've been here" -- and then she paused to drop her voice to a whisper and tap a permanently curled finger on a nursing home tabletop -- "long enough."

The coordination of such moves take months, not weeks. More than 330 Allegheny County residents have received help moving out of institutions since mid-2006.

That number surpasses goals for the county set by the state in funding the transition program, but statewide, only 1,625 individuals were helped out of nursing homes in the program's first full year instead of a goal of 2,500. Transition program officials attributed the shortfall to the startup period that other smaller counties needed to understand and embrace the initiative.

Plus, not every person viewed as capable of moving wants to, and their relatives are often wary of returning them to independence.

"There's a feeling that nursing homes are safe, that there's a certain amount of security there," explained Jennifer Burnett, chief of staff for the Office of Long-Term Living.

Some nursing homes may not be eager to give up their patients through referrals to the Nursing Home Transition program, but Forbes Road social worker Judy Lange said she had no hesitation about doing so. Ms. Gilvarry had spoken to a prior social worker and other staff members earlier this year about her desire to leave, but it was only after Ms. Lange's hiring in June that serious discussions began, leading Ms. Lange to contact the county's transition staff.

"I look for someone who is cognitively intact, who is realistic, who could, with some education, deal with their medications -- somebody who is relatively compliant," Ms. Lange said. "I look for people who really desire this."

Under the Medical Assistance program in which the state and federal governments share costs, Forbes Road receives $189 a day to care for Ms. Gilvarry. Typically, one aide was assigned to care for her and nine other residents; nurses supervised them and handled medical issues.

"They do the best they can," Ms. Gilvarry muttered noncommittally last month when asked about the staff, though she has befriended several of them.

She received three meals a day, with breakfast the only one she enjoyed. She skipped some of the other meals entirely, substituting a peanut butter and jelly sandwich. Bingo and other activities are organized for the residents, but she ignored most except for occasional group outings to a restaurant or store. Her time was spent watching television or making hallway chatter with the people going past in wheelchairs or staff uniforms.

By Christmas Eve, Ms. Gilvarry was ready to go, though final details of her future health care arrangements still had to be ironed out. She spent her second Christmas in the nursing home. Still, on a holiday outing to McMurray to visit her only Pittsburgh relatives -- a brother-in-law, niece and nephew and their families -- she was more upbeat than they'd seen her in years.

They noted with concern, however, how slowly she moved with her walker to the front door, how she needed help getting her coat off and on, how she needed assistance with eating utensils. They were happy for her optimism, but dubious she could manage in her own apartment once more.

"We see how she manages in our company, and needs help, but it's a great opportunity," was the comment afterward of Lou Sliman, who is Ms. Gilvarry's late sister's husband, since remarried. "Hopefully the dream will play out like she hopes."

By that time, Ms. Gilvarry had been to Value City with Ms. Thomas and used $2,000 of her transition budget on a bedroom suite, sofa, dinette set, a small desk and other furniture. In the next week, Ms. Thomas and a shopper contracted by the transition program would spend $650 more at Wal-Mart for household supplies. Ms. Thomas allocated another $500 to Riverview Towers for a security deposit and for holding a small, one-bedroom apartment until the move was ready. And on moving day last Monday, another $140 was spent to stock her cabinets and refrigerator with food.

Ms. Gilvarry was wheeled out of Forbes Road at 1 p.m. Monday by one of her favorite aides, Maralia Nance, who gave her a hug and personal phone number to "call at any time," and a nurse, Rhonda Bowling, who had tears in her eyes while embracing her. The patient herself was less visibly emotional. She'd had only a few hours sleep the night before, and rejected an offer of a last Forbes Road lunch.

She arrived at Riverview Towers 916B to find Ms. Thomas and a co-worker hanging her clothes and putting away household items. Most of her furniture was in place, but not the phone or cable service, and empty boxes formed temporary clutter.

"It looks a little crowded," Ms. Gilvarry remarked, in her first look at her new environment. By 6 p.m., the county's workers were done readying the apartment for her and reviewing details of her future care. After they left, Ms. Gilvarry found herself cold as night set in and she didn't know how to adjust the thermostat.

Other problems arose during the week. Medications weren't immediately delivered because the pharmacy that had been lined up had no contract with her Medicare Part D insurer. It took three days to get her phone service connected. She had a lack of comfortable clothes.

And most seriously, Neva Hardy, her new four-hour-a-day aide, observed severe swelling and redness in Ms. Gilvarry's legs, with potential for blisters and ulcer wounds. A series of phone calls involving Ms. Hardy, Ms. Thomas, a home health nurse and her attending physician at Forbes Road, Dr. Lillian Cavanaugh, resulted in the doctor showing up at the apartment Thursday morning to order antibiotics and other new medications.

If Ms. Gilvarry develops open sores, she will be forced back into a hospital or nursing home, Dr. Cavanaugh said. Ms. Thomas credited Ms. Hardy with hurrying the doctor's medical evaluation. With such monitoring, for which the government pays Ms. Hardy's home care service $76 a day, the apartment should be viable long term for Ms. Gilvarry, according to Ms. Thomas.

Ms. Gilvarry, for her part, was in discomfort from the swelling and hadn't yet made it to one of Riverview Towers' communal dinners, but she's dealt with such effects for years in and out of the nursing home. She had no doubt, despite the several days of transition hiccups, that she was ready to "live life her way" -- just like the sign outside said.

"I'll miss some of the people [at Forbes Road], but I didn't belong there any more," she said. "If there's all kinds of blind people and others out on their own, I can be too."