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Community Supports for Rural Aging in Place and Independent Living – Models and Innovations

These stories feature model programs and successful rural projects that can serve as a source of ideas and provide lessons others have learned. Some of the projects or programs may no longer be active. Read about the criteria and evidence-base for programs included.

Evidence-Based Examples

Fit & Strong!®
Updated/reviewed August 2020
  • Need: Osteoarthritis is a chronic condition which often causes multiple related disabilities in older adults.
  • Intervention: An 8-week physical activity, behavior change, and falls prevention program geared to older adults with osteoarthritis.
  • Results: Participants gained confidence with increased exercise, lessened stiffness, improved joint pain and improved lower extremity strength and mobility.
Telepsychology-Service Delivery for Depressed Elderly Veterans
Updated/reviewed December 2019
  • Need: To provide evidence-based psychotherapy for depression in elderly veterans who are unable to seek mental health treatment due to distance or stigma.
  • Intervention: Telepsychology-Service Delivery for Depressed Elderly Veterans compared providing behavioral activation therapy via home-based telehealth and the same treatment delivered in a traditional office-based format.
  • Results: A 2015 study and two 2016 studies show that providing treatment via home-based telehealth to elderly veterans in South Carolina resulted in the same improved health outcomes, quality of life, satisfaction with care, and cost of healthcare compared to those receiving face-to-face treatment.

Effective Examples

LIFE - Living well through Intergenerational Fitness and Exercise
Updated/reviewed December 2020
  • Need: Older adults in rural Iowa have inadequate access to physical activity specialists and/or exercise facilities, which limits their ability to remain sufficiently active.
  • Intervention: Iowa State University implemented an intergenerational "exergaming" program to encourage fun and safe physical fitness among rural older adults.
  • Results: Pilot studies showed that older adults demonstrated increases in strength, flexibility, activity levels, and confidence in their ability to be physically active. Younger adults experienced reduced ageism and increased knowledge and expectations of aging.
funded by the Federal Office of Rural Health Policy Livingston County Help For Seniors
Updated/reviewed May 2020
  • Need: Meeting the health needs of geriatric patients in rural Livingston County, New York.
  • Intervention: The Help for Seniors program was developed and using its 'vodcasts,' local EMTs were trained in geriatric screening methods and health needs treatment.
  • Results: In addition to developing a successful model for educating EMS personnel, the program screened over 1200 individuals and identified various risks among the geriatric population.

Promising Examples

funded by the Federal Office of Rural Health Policy ARcare Aging Well Outreach Network
Updated/reviewed March 2021
  • Need: To reduce falls and improve chronic care management for adults 50 or older in rural Cross County, Arkansas.
  • Intervention: The ARcare Aging Well Outreach Network, run by an FQHC, provided services like falls prevention assessments, transportation to appointments, medication management, and senior-specific exercise opportunities.
  • Results: From May 2015 to April 2018, the network served 639 patients through 1,580 medical encounters.
SASH® (Support and Services at Home)
Updated/reviewed February 2021
  • Need: In Vermont, the growing population of older adults, coupled with a lack of a decentralized, home-based system of care management, poses significant challenges for those who want to remain living independently at home.
  • Intervention: SASH® (Support and Services at Home), based in affordable-housing communities throughout the state, works with community partners to help older adults and people with disabilities receive the care they need so they can continue living safely at home.
  • Results: Compared to their non-SASH peers, SASH participants have been documented to have better health outcomes, including fewer falls, lower rates of hospitalizations, fewer emergency room visits, and lower Medicare and Medicaid expenditures.
Health Motivator Program
Updated/reviewed November 2020
  • 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.
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.

Other Project Examples

Disabled Adults Oral Health Initiative
Updated/reviewed April 2021
  • Need: To help rural Maryland adults with disabilities learn more about oral health and access care.
  • Intervention: Health Right community health workers gave educational presentations at agencies serving those with disabilities.
  • Results: From March 2014 to February 2016, educational presentations reached 1,084 adults with disabilities and 344 staff and caregivers, and 256 people received dental treatment.
Hospital2Home
Updated/reviewed April 2021
  • 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 four years the program has been in operation, 86.5% of participants have not readmitted to the hospital in the first two months after hospital discharge.

Last Updated: 4/28/2021