Healthcare Access and Coordination Models for Rural Healthy Aging

Older adults who are aging in place need access to timely and appropriate medical care. Access to healthcare is important for:

Improving or maintaining overall physical, social, and mental health
Preventing disease, illness, and chronic conditions
Detecting, diagnosing, and treating disease, illness, and chronic conditions
Improving quality of life
Avoiding preventable deaths
Extending life expectancy

Care coordination refers to the process of organizing patients' care across multiple healthcare providers, ensuring that patients, doctors, and specialists communicate with each other and that patient preferences inform their healthcare. Care coordination aims to provide safe, appropriate, and effective care to patients. For older adults, moving from a hospital stay to the home can be challenging, and care coordination can help ensure a smooth transition between settings.

Healthcare access and care coordination pose challenges in rural communities. People in rural areas travel longer distances to access medical care. This can be burdensome for older adults with mobility impairments and/or who lack transportation. There are also shortages of healthcare providers in many rural areas. Some federal initiatives aim to bolster the rural health workforce. The National Health Service Corps (NHSC) supports providers through scholarships and loan repayment programs. See the Healthcare Access in Rural Communities and Rural Health Workforce topic guides for more information.

Community health workers (CHWs) play a key role in increasing access to care and improving the health outcomes of older adults living in rural areas. For more information on implementing a rural CHW program, see the Community Health Workers Toolkit.

Given a persistent shortage of healthcare providers, some rural areas have become creative to fill gaps in services older adults need. Community paramedics and other trusted partners with medical care training, such as fire departments, can provide or connect older adults with basic medical care, such as offering blood pressure checks. See the Rural Community Paramedicine Toolkit for resources and strategies to support rural communities in implementing a community paramedicine model.

Rural Health Clinics (RHCs) and Federally Qualified Health Centers (FQHCs) are primary care providers in rural areas. Integrated services, such as primary care and behavioral health, may help address service gaps. Rural community-based integrated primary and behavioral healthcare may include a flexible approach to care (for appointments and treatment duration based on patient needs); collaboration between the clinic and community; and focusing on health-related issues such as health behavioral changes, advocacy, and disaster relief.

For short-term care after being discharged from the hospital, home health services can provide support to older adults with chronic conditions or disabilities. These services promote recovery and well-being, reduce the need to travel for services, and are often less expensive than hospitalization or post-acute care. However, some rural communities may have limited access to affordable home health services. For more information, see the Rural Home Health Services topic guide.

Some rural older adults who are unable to live independently at home turn to long-term care facilities such as nursing homes, assisted living facilities, skilled nursing facilities, and residential services for people with disabilities. Long-term care facilities provide residential living arrangements and a variety of services such as:

Assistance with activities of daily living, such as bathing, getting dressed, preparing meals, and shopping for groceries
Support for chronic healthcare needs
Mental or physical rehabilitation
Nutrition programs and services
Occupational and physical therapy
Skilled nursing care

For more information, see the Rural Long-Term Care Facilities topic guide.

There are evidence-based and promising program models to support older adults in receiving accessible, coordinated, and high-quality healthcare:

Telehealth offers rural older adults an opportunity to receive healthcare services and information using telecommunications technology (via video, telephone). Telehealth introduces opportunities for older adults to save time, money, and resources while obtaining needed healthcare. Some barriers to accessing telehealth include discomfort with using technology, limited access to technology and the internet, or lack of insurance coverage to make telehealth services more affordable. The Rural Telehealth Toolkit includes evidence-based models for rural telehealth programs.

Aging in place models allow rural older adults to remain in their home while receiving needed medical care.

Home-based primary care can be delivered effectively within an older adult's home from visiting healthcare professionals. Home-based primary care offers an evidence-based approach of closing gaps in healthcare access in rural areas while improving outcomes for older adults.
While there is currently limited evidence on the positive impacts of home-based palliative care, this may be an emerging model to provide older adults with end-of-life pain and symptom relief at home.

Advance care planning involves having discussions with older adults and their family in preparation for medical care given during unexpected or severe illness. Older adults, regardless of age or health status, can establish Advance Care Plans. These plans can include establishing a living will, power of attorney, and the preferred medical choices if a person is no longer able to make decisions. For more information, see Advance Care Planning: Strategic for All Adults, Even the Healthy.

The Program of All-Inclusive Care for the Elderly (PACE) provides comprehensive medical and social services to certain frail, older people living in the community. This model has been successfully implemented in both rural and urban areas, such as Midland Care PACE, a fully integrated care model serving older adults with complex healthcare needs across 15 Kansas counties. Midland Care PACE addresses older adults' medical, behavioral, and social needs so that older adults can maintain quality of life, independence, and safety in their homes and remain in their community for as long as possible.

Considerations for Implementation

Telehealth models require older adults to have internet access and navigate technology to receive care. Limited connectivity in rural areas as well as lack of comfort, experience, and proficiency with computers, phones, or other technology may pose barriers accessing telehealth for some rural older adults. See more information on this challenge in Module 4.

Costs for some healthcare access and coordination models may be covered in full or in part by Medicare or Medicaid. State Health Insurance Assistance Programs (SHIPs) offer counseling on Medicare benefits for older adults and their families and caregivers. Area Agencies on Aging may also be able to assist older adults with counseling and connect older adults to local healthcare services (for example, home health).

Some models like PACE, advance care planning, and home-based palliative care are best implemented by specialized and trained healthcare providers. It may not be feasible for communities with provider shortages to implement some programs.

Program participants may need a specific diagnosis or prognosis to qualify for some models (palliative care, PACE, advance care planning), while other models such as care coordination, in-home primary care, and telehealth can be widely available to rural older adults.

Resources to Learn More

National Consortium of Telehealth Resource Centers (NCTRC)
Website
Federally funded telehealth resource centers for healthcare providers seeking assistance in developing telehealth in their service area. Centers provide technical assistance, policy resources, toolkits, and webinars to support rural communities.