By J. M. Smith. Review of the Literature and Introduction to the Survey Services for elderly people in rural areas are slow to develop and tend to start out as “watered down” versions of urban programs. Williams (1976) advocates that rural service providers must structure their service delivery systems differently from those suitable for urban areas. Rural service providers encounter several unique problems. These problems include the reluctance of the rural elderly population to participate in government programs, lack of adequately funded programs, a diffusely populated service area, and an inadequately trained and skilled staff. Many senior adults in rural areas do not want government handouts. These proud people often refuse services available to them. Elderly people who do not use congregate nutrition services reported the reason as being their view of these services as charity or because of their reluctance to become dependent on government sponsored programs (Schneider, 1979). Funding of programs for elderly people is suspect due to the present public outcry for tax relief. This public outcry tends to overshadow the pressing concerns of the older population. Sparsely populated rural areas cause unique service coordination difficulties. Extending services into sparsely populated areas is complicated and expensive. Kraenzel (1973) points out that rural residents pay more for services due to the sparsely populated geography of their area. The great distances rural residents must travel to obtain services increases their time and expenses. With inadequate funding, the rural service provider is not always able to hire and train professional staff. Rural service staff often leave lower paying rural jobs for higher paying ones in urban areas. Rubenstein and Rockwell (1978) found that less than half of rural service staff are full-time professionals. Cochrane (1978) advocates that an increase in the number of trained personnel working in rural areas is a crucial need. There is an ever increasing volume of statistical research on the urban elderly population. It is unclear, however, whether the research carried out in urban areas applies in rural areas. Research on the problems of rural elderly people needs to be performed and documented (1978). This documentation can be used to help justify requests for funding of services in the rural areas. Hudson (1978) points out that competing social welfare constituencies are lobbying for a piece of the federal budget now earmarked for social programs for the elderly. The needs of the elderly population in all regions of the country must be documented in order to maintain present funding allotments. The needs of elderly people have been assessed in many areas of the country. Pippin (1980) identifies transportation, health services, housing, home health services, assistance in securing benefits, meals served in congregate settings, home delivered meals, and recreation as needs of elderly people. Kamerman (1976) advocates that the services of income maintenance, medical care, and housing must be established as the core of personal services if they are to have any real value to elderly people. Low income presents a problem for many elderly people today. Chatfield (1977) reported that lesser life satisfaction of the recently retired elderly is a problem which is probably a result of partial loss of income. Furthermore, greater life satisfaction is expressed by the elderly with higher family income. As inflation spirals upward, many elderly people are concerned that their life savings may not keep pace. Health problems rank high for both urban and rural elderly people. Yet there are fewer physicians, dentists and nurses per capita in rural areas than in urban areas (Improving Services, 1980). Access to medical care is a problem, as well. Because many rural elderly people neither drive nor have access to public transportation in rural areas, they are unable to get to those medical facilities which exist. A large proportion of substandard housing in this country is occupied by the rural elderly. Many of these structures were built prior to 1940 and lack insulation necessary to reduce the high cost of heating and cooling. In fiscal year 1976, less than 20 percent of American public housing resources were allocated for non-metropolitan areas (Improving Services, 1980). Avant and Dressel (1980) emphasize that assessment of needs of elderly people at the local level cannot be made on the basis of a national profile. In fact, Auerbach (1975) reported that a needs assessment survey of rural elderly people had documented that 85 percent of the respondents stated they needed nothing at all! Documentation of the needs of the rural elderly population must be recorded to establish effective service delivery systems. The Needs Assessment Survey in Perry County, Illinois Questionnaires were mailed to 400 elderly people in rural Perry County, Illinois. Of these, 232 (58%) surveys were returned within one month. Two hundred and twenty (55%) surveys were used to compile the results of the needs assessment section of this research. The remaining 12 questionnaires (3%) were not usable in compiling the results for the following reasons:
Of those who returned the survey, 28% were aged 60-69, 48% were aged 70-79, and 24% were age 80 or older. The mean age of the respondents was 74.6 years and the mode and median age of these individuals was 73 years. Women represented 52% of the respondents and the percent of elderly living in single person households was 47%. Of those living in multi-person households, 42% reported that those living with them were aged 60 or older (although 33% did not respond to this question.) Ninety-four percent of the respondents reported living in a house, 4% in a mobile home, 1% in an apartment, and 1% in public housing. Seventy-eight percent of the respondent reported that they or someone in their household drives a car. Asked if they had gone out the previous day for shopping, visiting, business, etc., 77% had and nearly half had gone out more then once. Almost two-thirds of the respondents indicated they experienced one or more problems. Of those experiencing problems, 53% denoted home repair or maintenance as a problem for them. Health was a problem for 41%, housekeeping for 30%, and paying their taxes and utility bills was a problem identified by 30%. Other areas revealed as problems were filling out forms, transportation, meal preparation, lack of adequate income, insurance premiums, and medical care. Other problem areas reported by just a few included getting information about services, legal assistance, no spare time activities, and driving. Most respondents (59%) noted that their health was about average for someone their age and nearly one-third (30%) reported their health to be better than average as compared with others their age. Nearly 87% of the respondents indicated that they have no difficulty receiving enough medical care. Forty-four percent of the respondents reported that they usually eat alone. Fifty-two percent of the respondents usually prepare their own main meal of the day and 32% reported that someone in the household prepares the main meal. Only 7% of the respondents indicated that the amount of money they receive each month did not take care of their needs very well. Most respondents (70%) indicated that they usually had enough money to buy the little extras they want. Discussion and Summary More respondents to the survey either lived alone or were aged 75 or older than is representative of the county’s elderly population. One could speculate that the social need as indicated by this survey is greater than what actually exists for elderly people in Perry County, Illinois as these results may represent a somewhat biased view because of this over-representation. It is not known why the survey was returned by a larger number of elderly who live alone or are aged 75 and older. Perhaps these elderly individuals are more keenly aware of needed services for themselves and are more willing to participate in the survey than those individuals in less need for service. In general, respondents to the survey expressed greatest needs for home repair or maintenance, housekeeping, and relief from the high cost of living. Health was of concern to the respondents yet they reported their health generally as good. Perhaps the provision of services for rural elderly residents should address the need for self sufficiency and independence. According to the results of the survey, possibly a larger emphasis should be placed on helping elderly people maintain their homes. Restoring deteriorating homes and providing housekeeping assistance are two of the basic services needed for self-sufficiency. Also, a housekeeping service is needed for elderly people on an emergency, short term basis for those people who are temporarily incapacitated or ill. Currently, home repair services are available on a limited scale, and subsidized housekeeping services in Illinois are available only for people with few financial assets. The high cost of living affects everyone but is especially disconcerting to elderly people. Rapid inflation (in the 1970’s and early 1980’s) seems to be inconceivable to elderly people who have lived so long under relatively stable economic conditions. Not since the great depression years has the economic state of this nation disoriented so many people. Elderly people most likely resent paying more for what seems to be less. Federal and state authorities must take the proper steps to control the high cost of living. Elderly people spend a large amount of their income on medical care. Elderly people account for 29 percent of the medical care expenditures even though they represent only 11 percent of the population (Gelfand & Olsen, 1980). Medical research has provided many life saving and extending techniques and drugs. But this research and new medical care is expensive and is paid for by those who use its benefits most. Medicare and Medicaid help elderly people meet their medical costs, however, these programs are not a limitless source of money for all billed medical expenses. Quite the contrary, Medicare and Medicaid by law have paid less than the entire amount billed to these programs. Perhaps controlling the increase in the cost of medical care and eliminating unnecessary medical procedures is the only salvation for frail elderly people. Perhaps no community service agency or collection of agencies can provide all the of services needed by elderly people. The rural elderly probably receive even fewer benefits than their urban counterparts. Rural elderly people may have been overlooked when programs for the elderly were legislated and designed. The future for social service agencies may lie more on creative management than funding from the government. Agencies should move in four directions in order to better serve the elderly population:
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