Rural aging
Trapped. That’s how many aging Mainers feel as they struggle to find ways to stretch their fixed incomes to meet the growing cost of medicine, food and fuel to heat their homes. Sorting such priorities can be difficult for elders, considering the reality: Not meeting any one of these needs could seriously affect their health and well-being.
While not a new dilemma, the number of elders living in Maine’s many rural areas is growing, and with it the challenge of meeting their needs. With budgets shrinking, social services frequently are the first to go. And while many of the needs of the state’s elders can be met in more populated areas, accessing those services poses one of the biggest hurdles for elders in outlying areas.
This fall, in an effort to help address issues related to rural aging, the University of Maine School of Social Work and the UMaine Center on Aging has launched a new training program leading to a Certificate in Leadership in Rural Gerontological Practice. According to Professor of Social Work and Center on Aging Director Lenard Kaye, the certificate program may be the only one of its kind in the country targeting the gerontological needs of those living in rural areas, where it’s commonplace that service options and alternatives are scarce.
The intervention can’t come soon enough in Maine, where the median age of rural Maine residents is 43, according to Kaye. Aroostook, Washington and Hancock counties have the oldest populations in Maine. Statewide, there is a scarcity of professionals trained to meet the needs of elders in rural areas.
“They are loyal adults committed to aging in place, as well as those retiring here from out of state,” Kaye says. “Add to that the tradition of younger Mainers leaving the state to experience life in the ‘big city,’ and we’re left with a much older population than most states.
“There are towns, there are communities that are simply immobilized by this issue (of a lack of adequate services),” he says. “The local infrastructure needs to be strengthened.”
At the Center on Aging and in the School of Social Work, the vision is to make social workers an intrinsic part of that community infrastructure addressing the needs of rural elders.
“The state is not in a position to make meaningful change, so we want not only to meet that burden, but also to take advantage of the opportunities — wisdom and expertise — that older adults bring to their communities,” says Kaye. “Serving older and retired citizens effectively and humanely while encouraging them to contribute themselves, when able, to the health and well-being of their own communities can become a hallmark of the Maine way of life.”
At UMaine, social work students in their junior year are required to do four rotations of field placements. Beginning last year, one of those four had to be in an elder facility.
Now those in the certificate program must demonstrate a basic understanding of gerontological practice and aging issues; participate in geriatric field rotations; complete assignments informed by geriatric practice competencies in advanced practice, policy, and research courses; and complete a specialty/certificate course on Advanced Gerontological Practice and Leadership in Rural Communities. They also are encouraged to practice social work and to establish themselves as leaders in the community upon graduation.
“The idea is to sensitize them to the specific cultures and traditions of rural life and aging,” says Kaye. “Mainers traditionally don’t like to ask for help, or to appear that they need assistance, so it can be difficult to even determine when someone needs services. Getting to know the residents of their communities is particularly important for social workers practicing in rural areas.”
Kristianna Hall of Bangor, Maine, did one of her rotations at an assisted living facility operated by the Penobscot Indian Nation on Indian Island. Hall’s interest in geriatric social work started when her grandmother needed a primary caregiver. Her field experience only deepened her resolve to better understand the needs of the elderly population.
“It was very eye-opening,” says Hall, now a senior social work major. “You don’t really see (elders) as a population that needs that much. (The reality is) this is a population that is very neglected.
“Getting a feel for their situation — their mentality and how it feels to be in a nursing home — it made my heart go out to them,” says Hall.
With the loss of traditional town nurses, many communities in Maine lost that single contact person with whom aging adults felt comfortable and were able to build a relationship.
“We know that personal outreach and a caring touch is very influential in determining what people need and how they ask for help and accept services and benefits,” says Kaye. “We know that rural elders are very proud and stoic people who resist asking for help.”
To get over this hurdle, those in the certificate program learn methods and strategies for convincing aging adults that accepting help is okay. But even once aging adults realize they need assistance, it can be a struggle for them to access the services they need. Often it means people have to travel great distances to larger cities, such as Bangor, Portland and Lewiston.
Mental health services also are extremely rare in rural areas and its particularly difficult for depressed, substance abusing, and elder victims of abuse to easily obtain the services they require, according to Kaye. And even if the services are available, there often are long waiting lists.
“One of the greatest difficulties for older adults in this state is to continue to manage on their own in their own homes,” says Kaye. “Health transportation is an issue of great concern to older adults — how they’ll get there on a regular basis, the distance, cost and weather conditions are major barriers.”
A study conducted by the Center on Aging in 2005 for the Eastern Maine Transportation Collaborative and funded by the Maine Health Access Foundation found that medical offices are frequently assisting patients with transportation needs and that 80 percent of offices reported that providing this assistance was a major challenge for them.
Reasons for this difficulty included there being no one to drive the patient, having to accommodate the family work schedule, and scheduling conflicts with a transportation provider. Thirty-five percent of offices noted that cancellations due to lack of transportation occur at least once a week at their medical office and 40 percent reported that such cancellations occurred at least once a month.
Finding creative solutions is a skill that is stressed in the Rural Gerontological Practice program, particularly when elder advocate organizations such as the Bangor-based Eastern Area Agency on Aging have been forced to cut back on assisted living opportunities and other services.
“A lot of the towns are trying to be creative and trying to work with different health centers or visiting nurses to bring in services,” says Dyan Walsh, community services director for the Eastern Area Agency on Aging and a 2007 graduate of the School of Social Work. “It’s about creativity. It’s about using what’s already out there and not reinventing the wheel, but this puts more stress on caregivers.”
