An Outreach Intervention for Older Rural African Americans

Abstract

This article describes the process, approaches, and selected outcomes of a rural care management outreach intervention for older African Americans in South Carolina. The model is a community-academic partnership between a federally qualified community health center, a rural health clinic, and the Medical University of South Carolina. Its aim is to improve access to and utilization of health care and social services to enhance the quality of life of older African Americans. This is being accomplished by using paid, trained outreach workers (called geriatric coordinators), who function as advocates in linking clients to needed health and social services through activities such as arranging transportation to health care, rescheduling missed medical appointments, providing health promotion, and making referrals to public benefits and indigent drug programs. Outcomes demonstrated that the use of geriatric coordinators as care managers is a feasible way of increasing quality of life for older African Americans. The most notable outcome showed that 54% of clients who were eligible but not receiving benefits prior to this intervention were signed on for programs such as Supplemental Security Income, Specified Low-Income Medicare Beneficiary (SLMB), Qualified Medicare Beneficiary (QMB), disability, railroad pensions, and Veterans Administration benefits. Health centers realized an increase in reimbursable services and new clients. Increased capacity for older adult services is being accomplished through geriatric-coordinator-directed collaborations with social service agencies and participation in community events and committees.

Advice from Rural Elders: What it Takes to Age in Place

“…Research has demonstrated the effectiveness of community health workers in several areas relevant to the needs of rural seniors: hypertension control (Krieger et al, 1999); appointment keeping; continuity of care (Brownstein et al, 2005); development of a ''therapeutic alliance'' between patient, provider, and family=community support systems; risk reduction; improving patterns of health care utilization (Nemcek & Sabatier, 2003); diabetes control (Norris et al, 2006;Krieger et al, 1999); increasing the use of preventive services; keeping appointments; increasing adherence to recommended regimens; promoting appropriate use of health services (Witmer, Sarena, Finnocchio, Leslie, & O'Neil, 1995); and linking older clients to social services (Forti & Koerber, 2002).…”

“…Some of the services they could provide to rural adults include conducting needs assessments to identify problems, delivering educational programs, making referrals, coordinating care plans and service delivery options, and conducting follow-up monitoring, education, and support. Researchers have found that paraprofessionals known as indigenous lay educators or lay health advisors (LHAs), have been effective in increasing access to healthcare services among minority, low-income older adults (Krieger, Collier, Song, & Martin, 1999); linking older clients to social services such as Medicaid and the Food Stamp Program; and educating older adults on how to manage financial resources (Forti & Koerber, 2002). While these recommendations broadly provide a framework for action, recommendations for what will work in specific rural communities can only come from the residents themselves.…”

Access to Transportation and Health Care Utilization in a Rural Region

“…[3][4][5][6] Transportation is reported as one of the major concerns reported by rural residents in discussing limitations to their access to health care or their participation in health programs. [7][8][9][10] However, while the contribution of distance to utilization has been dissected in numerous studies, transportation is generally lumped with other explanatory variables in analyses of rural health care utilization. [11][12][13] Two areas in which access to transportation has received substantial attention are those of emergency medical services and the needs of older adults.…”

“…While access to transportation for routine care has been ignored, access to transportation for emergency care in rural communities, whether on the ground or in the air, is a major theme for rural health. 14 The need for access to transportation for health care utilization among older adults in rural communities has been the focus of several studies and reviews, 7,8,13,[15][16][17][18][19][20] with the need to provide alternatives to the private automobile if older adults are to independently access care being a major theme.…”

Health Care in Appalachia: A Population‐Based Approach

“…Access to health care services remains an ongoing problem and one which community health nurses must deal with on a day‐to‐day basis. No one in health care will dispute the relationship between the health of a population and its access to health care services (Byck, Walton, & Cooksey, 2002; Forti & Koerber, 2002; Rosswurm, 2001). The problem of access to health care services is often compounded in those rural areas that are remote and exist well outside urban boundaries where transportation is limited (Cox, 1997).…”