When it comes to providing quality healthcare, rural communities are a natural antidote to the power of larger, less caring institutions, says Tim Size of the Rural Wisconsin Health Cooperative. The status of underdog can be a strength.Like the rest of us, Garrison Keillor’s Lake Wobegon is aging. It won’t be long until he is telling us that “all elders are strong, all health care is local and all children are returning home.” Healthy rural places are needed now more than ever.
AARP in their handbook Aging in Place reminds us “that aging in place is simply a matter of preserving the ability for people to remain in their home or neighborhood as long as possible. The current healthcare system has not been coordinated with in-home care to efficiently and effectively support the senior population.” AARP suggests that there are five key principles for any community to promote aging in place:
Choice–“Healthcare and housing options should be affordable along the income spectrum so all citizens are able to choose from a range of alternatives.”
Flexibility–“Individuals will have his or her own concerns and needs; flexible services will allow individuals to tailor different health and housing services to their own situations.”
Entrepreneurship–“Economies of scale increase as the percentage of older adults in a community grows, presenting new opportunities for affordable service delivery.”
Mixed Generations–“Maintaining mixed-generation communities–there are valuable links to be made between the needs and skills of different age groups.”
Smart Growth–“Designing communities that are more accessible and livable benefits everyone but for many older adults is a fundamental necessity, not just an amenity.”
Rural health care is a discipline focused on “place” that naturally supports these priorities.
But the reality of rural health is a tension between “place” and the potentially different interests of increasingly larger multi-state organizations, as well as a too often unsupportive federal government. One recent example is the November 4 issue of JAMA Internal Medicine that passed on two cheap shots against financing rural health care without offering a balancing rural view. (Here and here, subscription required.)
Rural health care has much going for it in support of local communities and the values of place.
Healthcare’s mandate for increased quality and decreased cost is good for rural and primary care. Primary care is a local service that does not lend itself to being outsourced overseas, let alone to the next county.
With the growing incentives for healthcare providers to work collaboratively, the distinction is fading between providers that are independent and part of a larger system; providers in rural communities are often seen as valued partners.
Advances in telehealth are increasing the resources available to rural communities to keep care local.
And perhaps most importantly, as providers are increasingly at financial risk for the health of the population they serve, those organizations with the strongest local connections will be most effective.
The American Hospital Association (AHA) recently renewed its pledge “to work with Congress and the Administration to make certain that rural hospitals and communities are understood and protected.” Along with the National Rural Health Association, AHA encourages us “to continue to reach out to our legislators to explain the importance of rural hospitals in providing health care to communities across America.”
Malcolm Gladwell in his newest book, David and Goliath: Underdogs, Misfits, and the Art of Battling Giants, provides a great reminder to those who feel their community or hospital is at risk:
“Giants are not what we think they are. The same qualities that appear to give them strength are often the sources of great weakness. And the fact of being an underdog can change people in ways that we often fail to appreciate: it can open doors and create opportunities and educate and enlighten and make possible what might otherwise have seemed unthinkable.”
Being an underdog can be a source of great strength, if we use it.
Tim Size is executive director of the Rural Wisconsin Health Cooperative, located in Sauk City.