| Description |
Because the older population is living longer and the numbers in this group are increasing exponentially, a change in the current structure of long-term care is needed. This is especially true in rural areas where there are even greater proportions of persons age 65 and older and the younger population has moved to metropolitan areas. For those with a declining family support network, a formal long-term care network becomes increasingly more important to meet as many needs as possible for the elderly in rural areas. According to Monroe (1994), rural long-term care in particular may have to fill an unplanned void as rural hospitals have begun to close or drastically cut specialized services such as physical therapy and diabetic care. However, some rural hospitals with declining acute care volume have already extended into long-term care services such as swing beds, home health, Continuing Care Retirement Communities, as well as home and community-based services. (Schlenker & Shaughnessy, 1996). The only way to maintain sufficient revenue when there are empty beds is to diversify into other profit centers by adding services such as therapies, pharmacies, and transitional care units to obtain Medicare funding. (Brown, 1994; Monroe, 1994). Shaughnessy, et al (1994) point out that very few rural communities have a reasonable cross-section of long-term care services. What is needed is a variety of health related as well as home- and community-based services into more rural areas. Branching into community-based services such as assisted living or adult day care , for example, can also supplement the revenue in a nursing facility in addition to enhancing the services available. (Caywood, 1996). Coward (1995) found that place of residence predisposes a person toward admission to a nursing home, implying that rural elders enter nursing homes at a higher rate than their urban counterparts. He suggests one reason is that there are too few community and home-based services to serve rural needs, and nursing home beds are typically available in rural towns and communities. In addition, services such as home care and assisted living are often not available in rural areas, so many elderly are put into a nursing home unnecessarily ("New program...", 1994). Furthermore, Coward (1989) reports Nelson's conclusion that rural elderly are at greater risk for institutionalization , and the reason is more than likely due to deficiencies in communitybased services. Also, rural elderly tend to be institutionalized at a younger age and when less disabled than urban elderly. Coward (1989) suggests a continuum of care to respond to the needs of rural elders as they age, especially those who are relatively healthy. However, in rural areas, there are few links between health and social services that offer alternatives to institutionalization, so, even if this type of service was implemented, many of the rural elders who would have gone into a nursing home before would still be resigned to that fate (NINR, 1993). Moreover, establishment of a coordinated continuum of care system could link up services and coordinate the care of the elderly so that their specific health needs are met. Because there is not a universal set of longterm care services that fit all rural communities, each community's unique characteristics should be considered when considering adding more services. Some often view all rural areas as extremely homogeneous, but the opposite is actually true. Just like individuals, each rural region and community have unique features which should be identified before trying to develop health care programs. In fact, Graham Rowles (1991) states the importance of learning the traditional values and culture of the community before implementing a new program, otherwise it may not be effective. Unfortunately, according to Coward (1998), there is not much research on what services do and do not work in rural areas nor the impact of these programs on rural elders The rural community where an elder lives can have a major impact on residents' attitudes and perceptions; therefore, it is important to identify how and why this happens. This kind of information, once identified, can help to determine what environmental influences may lead to specific opinions about services and long-term care needs. Smith (1975) wrote the following about the influence of a community on resident attitudes: |
