By Liza Berger, Staff Writer
The government-funded PACE program, which has a total of 62
programs across the country, coordinates a spectrum of home- and
community-based services to people over 55 who are eligible for
nursing home care. As a result of a lack of home- and
community-based services, nursing homes tend to be the only
option for seniors as they become unable to care for themselves.
There are more nursing home beds per 1,000 people (66.7) in
rural areas than in urban areas (51.9). That is according to
“The 2004 Report to the Secretary: Rural Health and Human
Service Issues.” The report comes from The National Advisory
Committee on Rural Health and Human Services (NACRHHS).
Transportation represents another major hurdle for caregivers
in rural areas. A total of 40 percent of rural residents
live in areas with no public transportation system, 80 percent
of rural communities have no public bus service, and 57 percent
of rural residents do not own a car, according to the NACRHHS
report. Rural elderly, as a result, are dependent on family
members, friends and neighbors for transportation.
Low population density also makes the caregiving situation
more difficult. The rural elderly population is spread out over
80 percent of the country. The proportion of elderly in rural
counties (14.7 percent) is higher than in urban areas (11
percent), the NACRHHS report found. This is largely due to
younger people migrating to urban areas.
A consequence of this migration is there are fewer young
family members available in the area to provide care. As is the
case with transportation, many elderly must turn to friends,
their church, and neighbors for informal services. Fewer young
people coupled with a lack of transportation in these areas have
made the elderly population more isolated generally across the
Still another issue plaguing rural areas is poverty. About 11
percent of rural caregivers report annual incomes under $15,000,
according to the “Caregiving in Rural America” report. Rural
elderly also are more likely to have poor health and certain
chronic conditions. This could be because the rural elderly tend
to be less educated and earn less.
Also concerning is that rural caregivers often face
significant financial hardships. Rural caregivers (27 percent)
report experiencing a moderate to high level of financial
hardship. That compares with 23 percent of urban and 19 percent
of suburban caregivers, the “Caregiving in Rural America” report
said. Many have to make workplace accommodations, such as take
time off and/or leave a job early.
One point to consider is that cultural habits also may
prevent rural caregivers from taking advantage of available
care. They may be more attached to their homes and, therefore,
less willing to seek help outside them. Many also may be more
self-reliant and, therefore, less open to the idea of receiving