Disparities in Older Adults in Rural America



Student Name: Susan VansteelHealthCareDisparitiesandHealthCarePolicy Paper RubricSectionGuidelinesPossiblePointsEarnedPointsPopulation anddisparitydefinedClearlydefinesthepopulationunder considerationDescribesthehealthdisparity(ies)experiencedby thispopulation.Supportsalldatawithreliableresources.10%10ReviewofsocialdeterminantsWhat social determinantsare relevant tothe identifieddisparity?Theconnectionbetweenthe socialdeterminants andthedisparityisclearlyexplained.Supportthedata,explainthereasoning.15%15Policiescontributingto disparitiesIdentifypoliciesthatnegativelyorpositivelyaffect thedisparitiesandthesocialdeterminants. SourcethepoliciesMaketheconnectionbetweenthepoliciesandthe outcomesonhealth.15%15ContributingfactorsWhatunderlyingbeliefsorvaluesmightcontribute tothedisparities?Thisisthetoughcriticalthinking part.Whatvaluesheldbythoseinpowermight influencethehealthstatusof a particular population.Clarifyyourthinking.30%30Content Grade100%100WritingFINAL GRADE less Deductions: DEDUCTION OF UP TO 30 points (-30%) will be made for APA/writing/grammatical/punctuation errors.-30%-6Total100%94You covered your topic well. This is a very relevant topic. This population is continually struggling with today’s healthcare challenges. You touched on some great areas of concern. You brought up some very important points for us all to consider when educating and advocating for this population group with our community members and elected officials. I did note a few formatting, spelling and punctuation errors. See comments in paper. Great job!!JoDisparities in Older Adults in Rural AmericaSue Vansteel RN, BSHA, MSMFerris State UniversityAbstractThis paper will discuss the health disparities of older people in rural America. The social determinant includes age, low income, education, poor health, and access to health care. Enhancing the economic condition in rural areas will stimulate growth and bring new services to rural area creating healthier communities. Creating agriculture and manufacturing jobs through growth of biobased products, accelerating job opportunities and improving information technology access to meet the demands of healthcare are initiatives being implemented. The Affordable Health Care Act offers some relief for the elderly in rural America.Disparities in Older Adults in Rural AmericaThe older adult population is among the fastest growing age group in the United States(USDHHS, 2012). As the first waves of the baby boomers are reaching retirement age, affordable health care is further from their reach. Health needs among this population are substantially greater at a time when economic resources are fixed and healthcare insurance coverage tends to be costly. With the downturn in the economy, factories and businesses are closing; a part of the American dream is dying. The older adult generation was taught that if you work hard and remain loyal to your employer, a pension and company provided health care would be their reward. We now have reached a turning point where the old rules no longer apply, leaving many older adults working beyond the retirement age in order to maintain health insurance.Population and Disparity The population under consideration is those individuals 65 years of age and older living in rural areas. According to the Census Bureau the population of adults 85 and older will increase more than any other age group (Rogers, 2002). With the older people living longer, it is expected that the population 85 years and up will double by 2025, and will increase five times by 2050 (Roger 2002).Important information and data is obtained from health disparities, inequalities and inequities to establish prevention guidelines. According to the Center for Disease and Prevention (CDC) these prevention program will aid in reducing morbidity and mortality of identified disease entities (CDC, 2011).The2010 Census Bureau report shows the total population in the United States to be 306 million (Short, 2011). Of this total population 38.6 million are 65 and older with nine percent of themliving in poverty (Short, 2011). Today the rural elderly have higher poverty rates and poorer health than the urban elderly population (USDHHS, 2012).In general,the rural areas have a greater elderly population than urban areas (Morris, 2008). Contributing factors for the increasing elderly population in rural areas include aging-in-places, some immigration of older persons from metro areas and an outmigration of young adults (Short, 2011). As a result of this movement rural areas are having a difficulttime obtaining and retaining physicians and nurses. This change in the makeup of the rural area has resulted in an overall decrease in population leaving the areas more populated with older adults (Capalbo & Heggem, 1999). This movement has placed a strain on rural community resources to provide adequate health care, housing, and transportation for the older population living in rural areas.Many older Americans suffer from chronic health conditions such as arthritis, diabetes, and heart disease. These conditions can affect their physical functioning ability to live independently and may impair their ability to seek care (Rogers, 2002).? Social DeterminantsThe disparities in access to health services affect many individuals and impacts society as a whole. The barriers to health care services include, lack of availability, ease of access in low population areas, high cost, and lack of insurance coverage. As a result, there is an inability to obtain preventative services, health needs are unmet, andthere is a delay in receiving appropriate treatment (USDHHS, 2012). ?Living in a rural area is a determinant to accessing health care. Today the elderly find that their longevity comes at a higher price. With fixed incomes of retirement, they are forced to reduce living expense in order to remain viable. With the aging process, they must be prepared to spend more money on their healthcare. Even for those not on a fixed income, the expense of health care is already too costly. Most elderly pensions and other retirement funds are not enough to cover all the expenses. Some elderly have migrated to the peacefulness of a rural community to decrease their living expenses which includesreduction in taxes paid on real estate. The slower pace of a rural community is less congested allowing the elderly to remain behind the wheel of a car longer than in a crowded city. Others remain in the rural communities because it is the place they know and love. Many elderly living in a rural community are at a greater distance from family and friends. They are often unable to secure the assistance they need when they become incapacitated. The older person’s inability to manage their own care imposes reliance on social and psychosocial support which is limited in rural area. Other social determinants in older people who live in rural areas versus those living in urban areas are poor health , lower income and less education (Rogers, 2002). The need to maintain routine visits for the elderly is greater at this stage in life yet getting there remains one of the biggest challenges.?For elderly living in rural America, barriers to gain access to health care include transportation and travel costs. While some seniors remain very active, many have aliments that prevent them from travel.? To compound this problem many older adults are losing their driving abilities. They must rely onfamily, friends or public transportation, of which there is little to none in the rural areas.?Many retirement communities are emerging in areas that do not have the support of public transportation.?During the economic down turn, communities began scaling back on public transportation in an effort to balance budgets. This resulted in altering bus schedules, routes and in some cases eliminating them all together. A report released by Transportation for America (2011) “ projects that by 2015, more that 15.5 million US citizens ages 65 and older are expected to live in communities where public transportation options are poor or nonexistent”( p. 4)Policies Contributing to DisparitiesThe current administration has elected to improve the economic condition within the rural community. To do this the administration has identified three initiatives that will impact the health and welfare of the elderly. The first initiative is to increase the amount of bio-based products purchased by the government over the next two years. These bio-based products are designated by the United States Department of Agriculture(USDA)and are composed of whole or renewable domestic agricultural material from forestry (USDA, 2012). The goal will be to create jobs through innovation and growth in the farmingand manufacturing industries(USDA, 2012).The second initiative is to increase and promote economic growth in rural areas. The goal is to infuse $15 million from four different agencies to acceleraterural job opportunities.This includes assisting in areas of business formation, job creation, and housing and community development projects (USDA 2012). It is hoped that the creation of these jobs will stimulate the economy of the rural community. The third initiative is the rural health information technology (IT).The intent is to help connect the community colleges and technical colleges with resources to support the training of Health Information Technology (HIT) professionals (USDA 2012). The introduction of HIT within these rural areas will bring additional jobs and meet the demands of today’s health care services.The intent of these initiatives is to elevate the social economic status of the rural community. It is believed that through prosperity, existing services will be improved and new services will be added. Although this long term strategy will improve the lives of the community, it does little to help those in need today.The current administrationsmajor accomplishment has been the passage of the Affordable Health Care Act. Under this coverage, insurance plans are required to cover preventative services, and extend health care coverage to children up to age 26 on their parent’s health care plans. In addition,this plan prevents insurance companies from dropping coverage if you get sick or are diagnosed with a chronic illness. Medicare provides a major portion of the elderly insurance with expanded prescription coverage. This prescription coverage is complicated and in some incidences more expensive if they find themselves in the black hole of the coverage. The Medicare coverage offers very limited coverage for long term care. If they require this type of care, the cost of long term careburns up what savings they may have and then becomes the burden of their family.Contributing FactorsThere are several factors that contribute to the disparities in healthcare for elderly living in the rural area. According to Capalbo & Heggem (1999) “the healthcare literature commonly cites several reasons, including changes in the makeup of rural population, difficulty in retaining physicians, and the restructuring of Medicare reimbursement” (p.9). The quality and level of healthcare services available have a great impact on a rural community’s viability (Capalbo & Heggem 1999). There are two different approaches to healthcare implemented across rural America. The firstconsists of technology using telemedicine. This delivery of healthcare services is usedto bring the provider to the patientusing real-time interactive communication through the use of video or Skype services.The second approach is the conversion from a full service hospital,to a limited-service facility which includes emergency, primary care and outpatient care. The limited care centers allow for cost- base reimbursement by Medicare for up to 96 hours of inpatient care or until transfer to an acute care facility (Capalbo & Heggem, 1999). These facilities are to stop the gap and provide care when there is no place else to go until the patient can be transferred to another hospital for longer term inpatient care (Capalbo & Heggem, 1999).Both of these delivery methods have received Federal support and funding in an effort to restructure rural health care delivery.“Federal funding – including grants for equipment and research, subsidized long-distance telecom rates, and Medicare reimbursement policy – has nurtured the development of telemedicine” (Capalbo & Heggem, 1999, p. 10).However with both of these methods, an evaluation must be performed between cost-effectiveness and the quality of care. Some rural communities might need to use a combination of a limited access facility and telemedicine to overcome the barriers to accessingthe care they need. Other communities may not be able to obtain the technology required for telemedicine leaving them with the limited facility access option. Determining factor for which delivery method will be established may be based on demographic indicators, percentage of elderlyand available health care providers.Continued effort needs to be focused on cost effective health care, prevention and promotion programs, continuous education andresource availability. Rural residence and the elderly are entitled to some level of health care. The battle in America continues as to what is the most cost-effective method to deliver the care.ReferenceCapalbo, S. M., & Heggem, C. N., (1999) Innovations in the delivery of health care services to rural communities: Telemedicine and Limited-Services Hospitals. Rural Development Perspectives, V 14/ 3. P. 8-13 Retrieved from for Disease and Prevention (CDC)(2011) Morbidity and Mortality Weekly Report (MMWR). CDC Health disparities and inequalities report — United States, 2011. January 14, 2011,Vol 60Morris, T., (2008). Aging in rural America: Preserving seniors' access to healthcare. Retrieved from: HYPERLINK "" \t "_blank" , C. C., (2002). The older population in 21st century rural America. Rural America. 17/3 Retrieved from HYPERLINK "" \t "_blank" , K. S., (2011).?Who is poor? A new look with the supplemental poverty measure. Retrieved from HYPERLINK "" \t "_blank" for America (2011).Aging in place, stuck without options: Fixing the mobility crisis threatening the baby boomer generation. Retrieved from States Department of Agriculture (USDA). (2012). We can't wait: Obama administration announces steps to boost the rural economy, promote jobcreation. Retrieved from . Department of Health and Human Services (USDHHS) (2012). Healthy people 2020: Older adults. Retrieved from HYPERLINK "" \t "_blank" Department of Health and Human Services (USDHHS) (2011). Overview of the uninsured in the United States: A summary of the 2011 current population survey. Retrieved from HYPERLINK "" \t "_blank" Aging elders age independently with dignity. can determine if they want to cover telemedicine service under Medicaid. According to the Center for Medicaid and Medicare Service, states have the option/flexibility to determine whether (or not) to cover telemedicine; what types of telemedicine to cover; where in the state it can be covered; how it is provided/covered; what types of telemedicine practitioners/providers may becovered/reimbursed, as long as such practitioners/providers are “recognized” and qualified according to Medicaid statute/regulation; and how much to reimburse for telemedicine services, as long as such payments do not exceed Federal Upper Limits. ................
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