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.
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