Barriers to Solutions: Service Delivery and Public Policy in Rural Areas

Abstract

Improvements in individual and community resources are complicated by inadequate rural public policy and increasing difficulties in the delivery of services, including health care. This article examines rural service delivery, particularly the delivery of health care, and public policy issues in the context of persistent rural poverty. Barriers, including those at both individual and community levels, are discussed as well as artificial barriers that professionals may impose as they work to improve the life status of older rural adults. Initiatives currently underway for the improvement of rural service delivery and issues regarding the development and implementation ofpublic policy responsive to rural areas also are discussed. Recommendations forfuture service delivery in and public policy for rural areas are noted. Central to this discussion is the recognition that any attempt to improve the quality of life for older adults m rural areas, particularly when applied to the reduction of current financial distress, will be developed and implemented during times of increased program and employee accountability at all levels.

Home-Delivered Mental Health Services for Aged Rural Home Health Care Recipients

“…In many rural areas, home health care programs have become vitally important health care resources for older persons because of the closing of hospitals and decreases in the availability of other types of medical services (Bull, 1998;McCulloch & Lynch, 1993). According to the National Center for Health Statistics, in 1994, approximately 1,889,400 patients received home health care services in the United States.…”

“…The availability and utilization of home health care services have expanded significantly in the last several years, fueled in large measure by increased funding of these services by Medicare, Medicaid, and private third party health insurance (Hudson, 1996). In many rural areas, home health care programs have become vitally important health care resources for older persons because of the closing of hospitals and decreases in the availability of other types of medical services (Bull, 1998;McCulloch & Lynch, 1993). According to the National Center for Health Statistics, in 1994, approximately 1,889,400 patients received home health care services in the United States.…”

Rural Elderly Women

“…A lack of consensus over how to define rural residence also creates difficulties in policy decision-making (McCulloch & Lynch, 1993). For present purposes, a general definition is set forth to describe a rural area as having a low population size, and being geographically distant from any metropolitan area.…”

“…It is clear from the literature that rural elderly women do not control these decisions. Nor are their needs and preferences adequately represented (i.e., Butler & DePoy, 1996;McCulloch & Lynch, 1993; see also Neese & Abraham, 1997).…”

Treating the aged in rural communities: the application of cognitive‐behavioral therapy for depression

“…Where specialized services do exist, they tend to be concentrated in more densely populated cities and suburban areas. Obtaining mental health services for older people is most problematic in rural areas of the country where there is a general overall scarcity of such services for all age groups and a lack of specialized expertise in diagnosing and treating the mental health problems of the elderly (Buckwalter et al, 1991;McCulloch & Lynch, 1993). Although it is unclear exactly what confluence characteristics of living in a rural area contribute to mental health problems, several explanations have been suggested, including neighborhood or residential stability and its isolating effects, lack of community resources and health services, and diminished family and social support because of migration of younger cohorts to more populated areas.…”