In A Student’s Words…Kristin D. (Entry 5)
Health Care for Rural Elderly
During one of my clinical rotations a man posed the question, “Why don’t people just move to be close to good healthcare?” After recovering from the shock of this question my clinical instructor responded by asking the man if he was willing to leave everything he had ever known, his family, friends, home, his whole life, just to ensure he can access the doctor more easily when a health issue arises. The man quickly realized the insensitivity of his question. However, despite the man’s thoughtlessness, he did recognize a major problem: people in rural America are not receiving the care they need.
As the baby boomers continue to age, healthcare will face unprecedented challenges. Sixty-one million people live in rural America and almost 15% of those people are age 65 and older (Rosenthal & Fox, 2000). The high percentage of elderly living in rural America is a fact that healthcare professionals need to address.
According to Rosenthal and Fox (2000), rural elderly are more likely to report a functional problem and to rate their health as poor than urban elderly. However, their lower financial resources prevent them from seeking care. For example, a person with an injury will state that the burden of the expense outweighs the severity of the symptoms. Another problem for rural elderly is transportation. People may not have adequate personal transportation, may be unable to drive, or may be unable to use or access sufficient public transit, which is more available in urban areas. Limited availability of transportation is a major factor in a person’s ability to access healthcare and especially specialty care.
Rosenthal and Fox (2000) state that 57% of all physicians in rural areas are generalists and of them, 60% are family physicians. Often, if a generalist does not meet a patient’s needs, the needs will remain unmet. Therefore, many physicians face long work hours and must rely more heavily on the community for supporting patients. As a result, patients may not get the care they need or may even get overlooked. Additional problems exist for patients needing specialized care that the generalists cannot offer. People will often be required to travel hours to access specialty care in urban locations, which is not always possible. Furthermore, after hospital discharge, rural families have more unmet needs that remain unmet after 3 weeks as compared to urban elderly (Rosenthal, 2000). In addition, rural communities have fewer assisted living centers and skilled nursing centers. Consequently, informal caregivers, such as family and friends, must spend more time and money than urban families.
Telemedicine, education centers, and tertiary care clinicians have been expanding in recent years; however, few studies exist to show patient outcomes as a result of these programs. According to Rosenthal and Fox (2000), a telemedicine program in ruralKansashad a savings of $980 per patient care episode and improved patient compliance. It is apparent that studies must be done to determine the current state of health care for rural elderly. In addition, programs must be developed and outcomes analyzed to determine the most cost effective and beneficial health care services and method of delivery to rural elderly. Furthermore, policy makers and health care advocates must take both urban and rural elderly into consideration when determining health care policy in the future.
Rosenthal, T. & Fox, C. (2000). Access to health care for the rural elderly. Journal of the American Medical Association, 284, 2034-2036. Retrieved from http://jama.ama-assn.org
- Kristin D.
