Shelly Ten Napel, MSW, MPP Policy, Program and Outreach Manager

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Rural Seniors and the Medicare Prescription
Drug Benefit

• Shelly Ten Napel, MSW, MPPPolicy, Program and
  Outreach Manager

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About the NRHA

• The National Rural Health Association is a
  national membership organization whose mission is
  to improve the health of rural Americans and to
  provide leadership on rural issues through
  advocacy, communications, education and research.

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. . . with over 8,000 members

• Clinical Services
• Community Operated Practices
• Frontier
• Hospitals Health Systems
• Population-based Services
• Research and Education
• Rural Health Clinics
• Statewide Health Resources
• Community Members
• State Office Council
• State Association Council

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. . . about rural residents

• Rural America 20 of the population living on
  80 of the land mass
• Rural residents are older
• 18 of rural residents are over 65
• 15 of urban residents are over 65
• (Sources of information
• Aging in Rural Settings Life Circumstances and
  Distinctive Features, Raymond T. Coward and John
  A. Krout, editors
• Rural Health Can Lead the Way, by Tim Size)

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. . . about rural residents

• Rural residents are lower income
• 14 of rural residents live below poverty
• 11 of urban residents live below poverty
• Median income for non-metro elders is lower
  (9,229) than for metro elders (10,351)
• Rural residents have higher health care needs
• 28 of rural adults describe their health as
  fair/poor
• 21 of urban adults describe their health as
  fair/poor

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. . . less access to health care

• Rural America has 20-25 of the population and
  10 of the countrys physicians
• Specialist rate per 1,000 population is
• 40.1 rural
• 134.1 urban
• Medicare per person spending compared to national
  average
• 85 rural
• 106 urban

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Family Support for Rural Elders

• Higher percentage of rural elders are married
• For rural widows
• Husband assumes more traditional roles such as
  transportation, so death can cause increased
  isolation
• Widowed elders have more limited social support
  resources than urban counterparts

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Family Support for Rural Elders

• Rural elders are less likely to have proximate
  children than urban elders
• Rural elders are less likely to live with their
  children
• There is some evidence that long-term
  relationships with friends and neighbors
  partially compensates for the absence of adult
  children

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Rural Women and Social Supports

• Older rural women are infrequent recipients of
  formal social supports
• Related to unavailability of formal services, and
• Negative attitudes about using formal services
• Most in-home care provided by informal sources
• About 45 of rural women reported financial
  assistance from friends

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Community-based Care in Rural Areas

• Rural elders have access to smaller, more narrow
  range of community-based services
• Considerable variation found between rural
  communities in care available
• Clear gaps exist in the continuum of care
• Few service professionals trained to understand
  the dynamics of rural communities or how to plan
  services for rural populations

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Principles on Serving Rural Elders

• Expect a limited formal service sector
• What are informal sources of assistance?
• Look beyond immediate family as informal
  care-givers/sources of information.
• Who are the trusted information brokers?
• How to involve the medical community?
• Rural media
• Expect a low-income, high need population

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Work of NRHA

• Outreach and education to rural health care
  providers
• Outreach and education to state-based policy and
  program staff
• Emphasize need for rural-focused enrollment
  efforts
• Need for follow-up on the local level
• NRHA and state rural health associations can
  provide contacts with health care providers and
  policy-makers

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Membership

• Join online at www.nrharural.org
• Contact us for membership 816-745-3140.
• Membership brochures available.
• Contact your state rural health association too!

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• Kansas City Office Alexandria, VA Office
• One West Armour Blvd 1307 Duke Street
• Suite 203 Alexandria, VA 22314
• Kansas City, MO 64111 [phone]
• [phone] [phone]
• [phone] fax dc_at_NRHArural.org
• Mail _at_NRHArural.org