Changing The Status Quo

By Jennifer Wilson, Staff Writer


By the year 2020, it’s predicted that there will be over 52 million older adults, representing about 16% of the population. Out of these 52 million, one-fourth will reside in rural areas, and will comprise at least 15% of the total rural population. The aging process, along with geographic distances, higher unemployment, lower literacy and the lack of medical treatment, are all current challenges facing people living in rural areas. When asked, rural Americans often assess their health as being only fair or poor, with more than 50% of them reporting to have at least one disability. This number greatly increases among the elderly adults who are enrolled in rural minority care management programs; they report having at least two or more disabilities. Older Americans are one of the only groups to have health care insured as an entitlement, yet why are so many of the rural elderly and physically challenged having such a hard time receiving care? One reason is due to the fact that rural seniors receive lower Social Security payments than their metropolitan counterparts, mainly because they didn’t earn as much when they were working, so they are unable to pay for healthcare now. Another reason is because Medicare tends to pay less for the same services in rural areas as compared with urban and suburban areas, so the rural elderly tend not to utilize Medicare has often as those who reside in metropolitan areas.

Long-term care, generally defined as comprehensive health, personal and social services, is designed to meet the needs of older Americans, especially those who have chronic illnesses and disabilities. Publicly funded, long-term care is usually provided in a nursing home setting, but older adults, especially those in rural areas, prefer to remain in their own homes. Medicaid covers long-term care, but only for those who are poor or who become poor after paying for their long-term care services. Only about 73% of rural elders have a combination of Medicare along with private insurance coverage, compared to 78% of seniors who live in metropolitan areas. Also, long-term care in rural America is usually found within hospitals, rather than in assisted or independent living facilities as is common in a metropolitan area. Because of this fact, rural Americans have fewer long-term care options, as well as being disproportionately affected by changes in Medicare and Medicaid policies often developed with more metropolitan areas in mind. Quite frequently, programs and policies implemented in rural areas are nothing more than “scaled down” models of services which work well in an urban or suburban setting, but become ineffective in rural areas. Since the reimbursement rates are lower for Medicare recipients in rural hospitals, many providers feel that these people are a financial risk, therefore, forcing the provider to make difficult choices about what services they can afford to offer their patients. Other problems sited for why rural America isn’t receiving good, long-term care include: the long distances traveled in order to get medical services; a lack of good public transportation systems; problems with applying and receiving services; as well as a lack of awareness by seniors and service providers regarding which services are actually available.

One surprising study showed that 54% of the older Americans enrolled in a rural care management program were not receiving benefits from public services such as Supplemental Security Income for which they were eligible. Problems also exist among rural America’s healthcare workers, since many of them have inadequate training. The availability of trained healthcare professionals in rural areas, like social workers, physical therapists, and nursing aides, are few and far between. Loved ones who are in skilled nursing facilities in rural areas have been found to be much more sickly and frail than those in urban facilities. Their physical condition highlights the combination of problems that can be found in rural facilities due to the apparent inability to manage medically complex patients, along with the financial problems. It is also very difficult to recruit long-term care workers for rural areas, since many of them prefer to live in metropolitan areas.

In order to meet the ever-growing health and social needs of rural America, healthcare not only needs to be accessible, but it also needs to be more affordable. However, the unfortunate truth exists that the government is just now beginning to do studies and take a serious look at what rural caregivers and their loved ones need.

Rural Long-Term Care Issues   

The integration of long-term care along with other needed non-medical social services in rural areas.

Strengthening the collaboration among government, private corporations and local community organizations in order to meet the healthcare needs of rural seniors and their caregivers.

Department of Veterans’ Affairs should begin to seriously consider offering more long-term care options with so many combat veterans living in rural areas.

Rural advocates must begin to research and evaluate where future financing will come from for long-term care services, and how these services will be implemented.

Include the term “rural” in the distribution of federal dollars for long-term care services and integrate any implications of policy decisions or changes on rural elders in all policy debates.

Create a rural, long-term care task force that will address the existing and future problems of the increasing number of elderly in rural America.

Evaluate Medicaid and Medicare reform options to include the expansion of  affordable, accessible, and available long-term care into rural America.


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