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Rural Project Examples: Elderly population

Promising Examples

funded by the Federal Office of Rural Health Policy Health Coaches for Care Transition
Updated/reviewed December 2019
  • Need: To help older patients with chronic conditions learn to manage their illnesses and thereby reduce hospital readmissions in Oconee County, South Carolina.
  • Intervention: Community volunteers trained as health coaches mentor discharged patients with certain chronic conditions, to help them transition from home health care to self-care.
  • Results: Participants had improved health behaviors and reduced readmissions.
Health Motivator Program
Updated/reviewed July 2018
  • Need: To increase physical activity and other healthy habits for older adults in West Virginia.
  • Intervention: Community members called Health Motivators lead senior centers and community groups in a monthly educational activity.
  • Results: In a 2016 survey, 97% of Health Motivators and 92% of group members said that their health improved because of the program.

Other Project Examples

Great Plains Senior Services Collaborative
Updated/reviewed November 2020
  • Need: To help rural, low-income older adults in rural Minnesota, Montana, and North Dakota maintain their independence and improve their health and well-being.
  • Intervention: The Great Plains Senior Services Collaborative improves service coordination, promotes social engagement, and provides programs like healthy cooking classes and caregiver support.
  • Results: Phase I served more than 1,550 vulnerable older adults in 80 communities, who reported lower stress and better quality of life.
Age-Friendly and Dementia-Friendly Winnemucca and Humboldt County
Updated/reviewed September 2020
  • Need: To make a rural community more inclusive for older adults.
  • Intervention: Winnemucca, Nevada, holds monthly meetings around topics like health, housing, social events, and transportation.
  • Results: So far, these meetings have led to more accessible transportation and parking. The effort went countywide in 2017.
Rural Resources Diner's Choice Program
Updated/reviewed September 2020
  • Need: Many older adults are lacking proper nutrition, due to an inability to prepare food, lack of financial resources, depression due to social isolation, or general frailty associated with aging.
  • Intervention: The Diner's Choice meal program provides 12 coupons each month to older adults for local restaurants in two rural counties in Washington.
  • Results: Older adults in Pend Oreille and Stevens counties receive much-needed nutrition and social interaction, leading to healthier lives.
CAPABLE (Community Aging in Place—Advancing Better Living for Elders)
Updated/reviewed July 2020
  • Need: To help older adults age in place.
  • Intervention: For five months, CAPABLE participants receive home visits from a registered nurse, occupational therapist, and home repair services.
  • Results: The CAPABLE site in rural Bath, Maine, has helped 15 clients so far, one of whom went from 15 falls and one hospitalization in the 6 months prior to starting the program to one fall and no hospitalizations. The site in Hawaii has served three clients in the last year and has reconnected clients with their families and communities.
SMiles Senior Transportation
Updated/reviewed July 2020
  • Need: To provide transportation to rural seniors who are no longer able to drive.
  • Intervention: SMiles, a rural senior transportation program, was implemented in Blount County, Tennessee.
  • Results: Since 2013, SMiles has provided over 35,000 rides to its rural seniors.
Hospital2Home
Updated/reviewed May 2020
  • Need: To prevent readmissions and improve the recovery process for older adults in rural southern Ohio.
  • Intervention: Hospital2Home identifies high-risk individuals and provides vouchers for services like personal care and home-delivered meals.
  • Results: In the program's first year, Hospital2Home served twice as many patients as the region's previous program and used 27% less funding. In addition, 89% of patients did not readmit for 3 months post-hospital discharge.
HealthStreet Cognitive Screening Project
Added March 2020
  • Need: Because of the benefits associated with early identification of conditions causing memory problems, Florida's rural populations will benefit from access to screening for possible Alzheimer's Disease and other types of dementia.
  • Intervention: A state university uses a state health department grant to develop a cognitive impairment screening program implemented by rural Community Health Workers. An additional grant provides rural medical practitioners with a free online continuing education module covering cognitive impairment and dementia.
  • Results: To date, over 400 individuals have completed health screenings and over 900 referrals have been made to community social and medical services. At grant cycle completion, formal analysis of cognitive screening and referral to medical services will be shared.
funded by the Federal Office of Rural Health Policy Community Healthcare Integrated Paramedicine Program (CHIPP)
Updated/reviewed January 2020
  • Need: To reduce 911 use and improve older adults' health in rural Santa Cruz County, Arizona.
  • Intervention: Community paramedics make scheduled visits to patients and connect them to other community resources.
  • Results: CHIPP has assisted over 150 people so far, and 911 calls have decreased.