An Overview of Rural Health: Meeting People Where They Are

Jennifer Ottowitz: Welcome to OIB-TAC’s monthly webinars, where our presenters share valuable information and helpful resources to support professionals working with older adults who are blind or vision impaired. Let's check out this month's webinar. 

Alana Knudson: Well, first of all, thank you so much for inviting me to share some background on rural health and some of the issues that we are navigating.

I, I wanna first share a little bit about myself because when we're talking about rural, it's often helpful to find out where we're coming from. And I actually grew up on a farm outside of town or North Dakota, the cattle capital of North Dakota. It has fewer than 500 people that live in it. In fact, in 2024, the estimated population was 474 when everybody was home.

Uh, there are more cattle in my county than people I know. Some of you can probably relate to that. Uh, in fact, there were fewer than three people per square mile. Where I lived. So I lived in an area that is very sparsely populated and uh, we often refer to those types of areas with fewer than six, uh, people per square mile as frontier.

And I share with you not only a picture of the wonderful billboard welcoming you to town or North Dakota, but also to the obelisk. Uh, where I was born, I was born in Rugby North Dakota, which is. The geographical center of North America and I, I share pictures of the hospital, uh, the hospital on the very bottom, if you see the high rise, all four stories, uh, that was built, uh, in the 1950s.

And, and that is the hospital where I was born and they recently built a brand new one level hospital, uh, and uh, that opened last September. So they continue to address. The health needs of the populations that live in that rural area. I also, um, my, I grew up, as I said, on, uh, a farm in, uh, Northern North Dakota.

I was a half an hour from the Canadian border, and I went to undergrad at Luther College in Decorah, Iowa, and graduate school at Oregon. State University and Oregon Health Sciences. So I, I've kind of got a, uh, mixture of the world and I now reside in, uh, Bethesda, Maryland, uh, right outside of Washington DC So I've been on the west, the east and right down the middle of the country.

So, uh, with that, uh, let me share a little bit about where I work and, uh, some of the background of what we are seeing in our rural communities. When I present about rural areas, I remind people why it should matter, and it should matter because it is the source of most of our food, our clean drinking water.

Where energy is produced in our outdoor recreation, and one in five Americans live in rural communities, and we have a disproportionately higher number of people who serve in rural communities in the military now or previously as veterans. So the, the viability of rural America is critical to all of us and.

If we do not have a viable rural America, we will not have a viable country. So understanding and appreciating what is important to rural really helps to understand the foundation for a lot of the activities that keep our overall country moving forward. And just a little bit about the center where I work.

Uh, this center was actually founded almost 30 years ago, and it was, um, named in honor of William Walsh. And just a little bit about William Walsh. He was the personal physician to President Eisenhower. And after World War ii, he noted that there were a lot of ships that were going to be decommissioned following the war, and he wondered if it would be possible to decommission a ship and refurbish it to be a floating hospital to bring needed healthcare in areas of the world that otherwise would not have access.

So they named that ship. That was the floating healthcare facility project Hope. And our Wall Center actually started where Project Hope is located in that, in that organization. Um, in 2003 20, um, now 22 years ago it was brought to Newark at the University of Chicago and we now, uh, continue in that same tradition of.

Not only conducting rural health research and evaluations, but also being able to provide support to different types of rural health entities across the country. So today, I'm just gonna start with. Meeting people where they are, because I think that's a really important frame in rural America, and I know with the populations that you work with in your communities, that is a good place for you to start as well.

And, and I remind people the best thing that we can do when we think about rural health is first, listen. And I went to a presentation recently where someone commented that there is a reason why we have two ears and one mouth, and, and I really took that to heart because I think in a lot of ways we feel in rural America that a lot of decisions are made without input from people who actually live in rural America.

And so our work in our center, and I believe a lot of our colleagues in other rural health research centers across the country, we are all committed to making sure that lived experience is included in the work that we do. And part of that also stems from. Oops. Um, looking at how we frame things, and I don't know if you're familiar with the Frameworks Institute, but they have, uh, some wonderful, um, resources that you may find helpful in the work that you do as well, especially with ensuring that we lead with the idea of dignity.

I, I think there's a lot of rural communities that have felt that people haven't listened to them, and if they have, they may not. Listen to them in a dignified manner. And so when we're looking at how rural health differs across the country, it, it's also really important to remind people that rural America is not homogenous.

It's very diverse and depending on where you go, not everything looks like rural North Dakota. Not everything looks like rural Texas or rural Tennessee, or rural Mississippi. Every place is different and every place has a unique and special history. And so being able to speak to that history and really connect the dots from the past to where they are today is important, especially when we're looking at solutions to address current problems and thinking about the future of rural health.

So this is the first resource I'm gonna leave you with today. I'm just gonna pause. Are there any questions to this point? So that's a good place to start. Excellent. I.

Health equals wealth and, and that is because financial accessibility is really the gateway to a lot of access, particularly in rural areas. And if people do not have health insurance, if people do not have. Financial means for transportation because there's very, very limited public transportation in rural America.

You really have to be able to rely on your own transportation or have friends or families to help you in that regard. It it, it is indelibly linked, and so I'm going to begin with just a little overview of how those linkages are made and what implications they have for rural health and access to services.

Uh, first of all, we see that we continue to have, uh, higher poverty rates, uh, for people over the age of 65, and I think. Uh, that is not, um, something new. I mean, if you look at the differences in 1970, uh, compared to where we are today, we have made some strides, but we still see, uh, over time that there are still challenges with poverty among our older adults.

And this also is, uh, differs, if you will, by age group. And when I was in graduate school, we used to talk about the fem uh, feminization of poverty. And that is in part because women historically have had lower paying jobs, which contribute to lower retirement. Incomes and over time they also, if they have a partner, they often outlive their partners and are on their own to an older age.

So we see that the percent of those living in poverty, uh, for women in particular, increases, uh, significantly from age 65 to over 80. We also know that it differs across the country and this data is based on data from 2022. And as you can see, the darker, the purple, the higher the poverty for people over the age of 65.

And if you look across the country, you can see that we have, uh. A fair amount of poverty in the Southeast, particularly when we look at the Delta, uh, Louisiana, Mississippi, Arkansas, Kentucky, as well as Appalachia into, uh, West Virginia in some areas. Uh, of course, uh, when we start looking into New York, uh, we also see that there are different levels of poverty just in general across the country, which affects, again, access to services.

It also affects the way people view their health status. And I think it's really important because again, wealth equals health. Health equals wealth. And when you look at people that have higher levels of poverty, we see that they are more likely to report that they are in fair or poor health in contrast to those that have higher.

Incomes. And again, you can see, uh, this, the difference here between looking at official poverty measures, the supplemental poverty measures include, uh, a few more items to, uh, consider in this. But as you look across, you can see that the higher percentages of reported poor health are among those with under poverty or under 200% of poverty.

We also see how changes are occurring in how health insurance coverage affects older adults in our rural and urban areas. Uh, how many of you are familiar with Medicare Advantage? I'm guessing many of you have, uh, familiarity or at least, uh, have had some. Um, uh, exposure to Medicare Advantage. Medicare Advantage is the insurance product that, uh, is, um, administered by commercial health insurance on behalf of Medicare.

And as part of that, it includes, uh, in some cases a broader array of services. Um. But it also in some cases, limits the network of providers who can provide that service. And so in some of our rural communities, we hear particularly from independent rural hospitals and independent rural clinics, that some of the larger Medicare advantage insurance plans are not interested in contracting.

With these smaller independent entities, it's a higher administrative burden. And, um, there are other providers that sometimes mean, uh, people must travel farther. Uh, one of the challenges that we also hear from rural Medicare beneficiaries is that when they sign up for these plans, it is not always clear whether or not their local provider is covered under it.

So they may see care, for example, in an emergency department that they've always gone to all their lives and then find out it is not covered under their Medicare Advantage plan. And if it is not covered, it may mean, uh, uh, much higher out of pocket for them or in some cases, um, full payment. So, uh, as we can see though, there is an increasing, uh, percentage of people that are.

Opting into Medicare Advantage, it's a growing share of our overall Medicare beneficiaries. And again, on this bar, um, the total, uh, enrollees. Are represented by the yellow bars, and the green bars represent non-metropolitan or rural. And again, over time you can see we have a growing percentage. We're now up to almost 50% of rural Medicare beneficiaries that are opting into Medicare Advantage plans.

This also differs by how large the rural community is. So when we're looking at rural non-adjacent, I explain as very small or more sparsely populated areas. Rural adjacent areas are those that are located closer to metropolitan areas and are usually larger. And then urban areas, of course, are, uh, overall urban areas.

And again, you can see that there is a, a different, uh, proportion of people who are enrolled in Medicare Advantage. Uh, it, it increases, um. In the larger rural areas as compared to the, um, smaller rural areas.

We also see a difference across the country, and this map depicts where people are enrolled in traditional Medicare. And as you can see, there are more people enrolled in traditional Medicare, uh, throughout the Great Plains and West, uh, than we see in the, uh, south, uh, or the northeast.

We also have a fair amount of coverage, uh, for Medicaid in many of our rural areas, particularly for people over 65, and I wanted to make sure that you were all aware of how these Medicaid dollars. Are covering people and what the spending look like. This is as of 2021, and as you know, we have significant Medicaid cuts that we will be seeing in the next few years as the HR one bill rolls forward.

But I, what I wanted to call your attention to is that even though individuals over the age of 65. Comprise only 10% of the number of enrollees in Medicaid, they use 20% of the resources, and that's because many of these older adults that rely on Medicaid are receiving home and community-based services to help remain in their homes.

Or they are getting assistance in nursing home settings to be, um, there at that point where they need, where they need care. And many people, we have done some research actually asking people about whether or not they are prepared to pay for long-term care expenses and. About half of the people respond, and it doesn't matter, rural or urban.

Uh, they respond that they believe Medicare will take care of all of their long-term care and aging expenses. And as on a personal note, uh, my father has been in a nursing home or had been in a nursing home and his cost of care was $15,000 a month, and that came out of his pocket. And, you know, it's, um, it, it, it can be very expensive and, you know, a lot of people do not have the resources, you know, set aside to pay a hundred thousand or 180,000 a year for nursing home care.

Also, there's a lot of, uh, personal care attendant support that is not covered by Medicare or Medicaid unless you qualify for Medicaid, that also must be paid out of pocket. So I just remind people that, um, this coverage, um, is something that. Medicaid has been supporting and this is a growing, uh, percent of costs as we see increasing costs in being able to provide nursing home care.

Um, likewise, uh, the support for Medicaid for individuals with disabilities, uh, they represent about 13% of all Medicaid enrollees, and they use about 31% of the resources. And as you can see, the highest number of enrollees for Medicaid are children, and they are, they represent about one outta three Medicaid enrollees, but they consume about 14% of all resources.

So per capita, uh, children use the least amount of resources of, uh, people that are enrolled in Medicaid. And I'm just gonna pause and just make sure if there are any questions.

All right. Hearing none. I'll go on. And if you have some as we go, I'd be happy to address those as well. Um, I also wanted to just show you how Medicaid differs across the country. And this is, uh, uh. Picture of the country that represents Medicaid spending per full benefit, enrolling per person that's enrolled.

And you can see there are certain states that, um, uh, the darkest blue indicates over $9,000 per person, uh, that is enrolled while the lighter blue is uh, seven to nine. And then we go down to the lightest color, which is less than 5,000. And we see the least amount per person that, uh, Medicaid covers is included in, uh, the Southeast.

And the majority of those states are states that have not expanded Medicaid. So that gives you a difference. Oops. There you are. That shows you a difference. My apologies.

So what does this mean then, for access to care? Well, we have had some rural hospital closures, and I bet you've read about that in, uh, the news. And again, you can see there are some areas in the country that have been hit harder by those hospital closures than other areas, uh, particularly, uh, more in the southwest or southeast rather, where you see.

Uh, Texas, Georgia, Tennessee, Missouri, and Kansas, having, uh, the highest number of closures in the last 15 years. And again, some of that has been attributed to not expanding Medicaid and not increasing, uh, the opportunity to capture revenue for some of the patients. We also have a different distribution of hospitals in some of our rural communities.

Uh, many of these hospitals had been built during the, it was called the Hill-Burton Act of the 1950s and sixties, where the federal government. Invested in the physical plants or the physical buildings of hospitals and nursing homes. And as I said, I was born in one of those, uh, hospitals that was built with Hill Burton dollars in the fifties, and we still have a number of those left across the country.

And they were also built during a time when we didn't have the same kind of, um, interstate systems that we do now. And we had a very different mode of transportation than we have now. And so, you know, as we look at hospital closures over time, we are also concerned about hospitals that continue to be vulnerable.

Many of these hospitals have negative operating margins today. Some of them have less than, you know, 10 days of cash on hand, which makes it very difficult to be able to respond to changing needs in rural communities. And as you can see, um, we have a number of states that are looking at up to 41% of their hospitals being vulnerable to closure because of the challenging financial state.

That these hospitals are in, and, and part of it is related to low volume. You know, some of these hospitals are critical access hospitals that have 25 or fewer beds, but some of them. Also have fewer than two patients per day, and you still need a lot of fixed overhead, if you will. You still need to make sure you have adequate staffing on time and laboratory, and the emergency department staff and the like.

All of that takes a lot of resources to keep these hospitals. Going and to be able to be available when the needs arise in their communities. So, uh, this is something that in our rural policy world, we're keeping a very, very close tab on. I also mentioned nursing homes, and this is a continuum of long-term services and supports.

And, uh, this information was put together, uh, by Kaiser Family Foundation. And, um, these are built, uh, uh, based on averages of cost. And as you can see in adult, um, day healthcare is. The least expensive, uh, annually, uh, for, um, providing support, whereas a nursing facility is the highest. And again, 108,000 is the average.

Um, as I said, our family was paying about 180,000, um, a year from my dad's care, and I, I know others have paid far more even than our family has. And, uh. Uh, these different, uh, services again may or may not be covered by Medicaid depending upon, uh, that person's need and their financial situation, but it's something to keep in mind as we look at the ever aging baby boomer.

Who will need support as they age. And you know, one of the considerations that we are really looking at is the issue of workforce. Because we have some rural communities in our country where 33%, one out of three people are 65 or older. And when you're looking at a workforce to be able to provide services, and not only on the health side, but the whole continuum of what a community needs to be able to support itself.

Um, when we start looking at, uh, a smaller and smaller workforce to be able to support that community from a a, an age, um, range. It, it also gives you pause about what services are able to be. Uh, provided in those communities. One of the things that it affects on the workforce side is that nursing home, and as you can see, uh, we've had a number of nursing home closures, uh, during this time period.

This study was done by. Uh, my colleagues at the Rural Policy Research Institute, uh, research center at the University of Iowa, and they are updating this study, uh, we expect at least 500 nursing home closures this year, uh, with the highest proportion of those coming out of rural areas. And again, part of the issue of closure relates to accessibility of workers.

It is very difficult to, uh, keep frontline workers, especially, um, certified nursing assistants. That frontline worker, uh, it, it's very difficult. It's a very hard job and it is, uh, very challenging because there are other, uh, sectors now. That people can work and, uh, not have to work nights or weekends or, uh, do some of the heavy lifting and, and some of the really challenging and physically challenging and emotionally challenging work that needs to be done as a CNA,

Stephanie Welch-Grenier: we have a quick question, if you don't mind.

Alana Knudson: Absolutely.

Stephanie Welch-Grenier: Is there any way to know if an individual is enrolled in the Medicare Advantage Program? Other than them telling you,

Alana Knudson: um, at this point in time, that is how, um, because that information is usually not, um, publicly available. Um, but, uh, the, the person should, you know, obviously is with their enrollment card, you should be able to identify if they are in an MA plan, for example.

There's not a public roster of who's on MA. Mm-hmm.

Stephanie Welch-Grenier: Okay. Thank you.

Alana Knudson: I will, I will also say for somebody who is on MA that tries to get back to traditional, um, Medicare, uh, that can be a, a difficult leap back. So, um, I, I know when, even though it's a very small percentage, I know that the. That rural Medicare beneficiaries were more likely to want to switch back to traditional, uh, Medicare coverage than urban.

And again, that percentage was very small. I think it was like two and a half percent versus one and a half percent. But, but there, there was a higher percentage of rural that. We're looking to, um, go back to a, a traditional plan. So, um, you know, it's just really important to know what your coverage is and, um, to know what providers in your service area are covered by a plan.

Should you have people that, um, seek, uh, information about what plan is best for them.

Well then I'll move on to just a little bit about employment. And, you know, I, I share this because I think it's really important to understand where rural is coming from. Um, you know, rural has never recovered, uh, from the great recession that started at the end of, uh. 2007, early 2008, and we saw the dramatic drop in employment across the country.

But as you can see on this particular, uh, graphic, um, as of 2022, rural has not recovered to the employment levels that it had in 2007. So that is, that is a concern for, um, community viability. And also looking at where resources are being invested to increase access to different types of services in our rural communities.

Again, just another look at what the poverty, uh, levels are. Um, you can see that rural poverty has consistently been higher, and, uh, likewise you can see rural unemployment has consistently been slightly higher than rural urban, except for the blip during COVID. Uh. Unemployment was actually higher in our urban areas than in our rural during that time.

Uh, and, uh, since it, it has, uh, uh, started to, uh, reverse itself again. But consistently over time, we continue to see higher rates, uh, poverty in our rural communities.

Um, I also wanted to share just a little bit of background as well about who is employed in the health sector in rural areas. And, uh, this graphic, uh, depicts nicely, uh, the changes that we have seen since pre COVID to, uh, February of this past year. Um, as you can see, the ambulatory cure. Services have increased, uh, by 14% during that time period.

Um, however, uh, our nursing and residential care facilities, um, have, uh, just barely recovered, uh, since, uh, pre COVID numbers, pre COVID, uh, percentages. So, uh, it, it makes it a little bit challenging. Um, rural hospitals are right in the middle at 8%.

I am gonna just take a pause. I'm gonna just talk a little bit about what does this all mean for rural America. Are there any questions thus far about hospitals or nursing homes or access to services?

Hearing none. Then I am going to switch gears a little bit and just share, uh, this research from some colleagues at, uh, the United, uh, states Department of Agriculture, and they were looking at mortality data. And they were looking at age adjusted mortality data for people in the workforce. 25 to 54 years of age, and they started at 1999.

And again, the light green represents rural or non-metro. The darker, um, blue or greenish blue, uh, represents, uh, metro or urban areas. And as you can see, uh, the me, the mortality rate has been started slightly higher in 1999, but the difference has dramatically increased between rural and urban. Now the reason why these people died was not because of any kind of opioid or substance use overdoses.

These people, what we are looking at with natural cause mortality rates, these people are dying between 25 and 54 from issues like diabetes, heart disease, respiratory. Cancer. The, these are, these are things that are, uh, usually, uh, not contributing till to death until in later life. And we see a 42% difference.

So. One of the concerns that we have as researchers looking in rural is what is gonna happen if this trajectory does not turn around if we are not able to start reducing mortality? Because the good news, bad news of this particular data is that we are seeing decreases in urban for this age group and for the cause of their deaths.

We are not seeing decreases. In rural, we are seeing increases. So we need to figure out what we can do to improve health, to make sure there's more access to prevention and, uh, screening and ensure that we have a healthy workforce because you cannot have economically viable communities if you do not have a healthy workforce.

Who can work in those, uh, businesses and organizations and industries to, uh, be able to keep those economic engines moving forward. But I'm going to share some really fun things. Now, this is just some background. We have some people across rural America that are. Implementing really interesting solutions, and one of them is the community health center of Southeast Kansas.

And this particular health center has been in operation for slightly over 20 years. And one of the things that they have been very concerned about in their community was. Uh, the, the types of housing that people had available because we know that people need healthy housing also to remain healthy, particularly as we age.

And it's very helpful if people are able to live. As their mobility, uh, may decline that they can live on one floor and not have to navigate steps, uh, that they get grab bars in the bathroom to be able to help support them as well as different other types of assisted technology. And I know many of you are very involved in supporting different types of assisted technology, and one of my favorite projects that I had was looking at a community health worker program in, uh, a very rural area.

And one of the things that they were doing was going in particularly for people who were older adults that were having. Issues with their vision, uh, they were becoming, uh, vision impaired. They were, um, starting to see declines in their ability to navigate on their own and with the community health worker.

Uh. I actually went on one of the visits, the, the gentleman was 93 years old and he was able to show me how he could now use the microwave because he had gotten some additional knobs that helped him to not only better see what, uh, what he was doing, but also were more accessible because he also had arthritis.

And so it was a win-win to be able to have those different types of assisted technology or assisted tools to help him remain independent. Because as he told me when I left, he was gonna go to the golf club that night and he was going to, uh, have a drink or two because he wasn't dead yet and he was still having fun.

And, you know, for him to be able to remain. Independent in his home with technology supports or resource supports that allowed that, that gave him the zeal for life to continue to live the way he wanted to. And so, um, different types of, uh. Innovations such as being able to support housing and, and what's really cool about this particular, um, housing investment is that they are also helping to train, um, people in their community in the skills of construction.

And so they are able to also provide jobs as well as apprenticeships for people to learn how to build homes. Uh, they are apprentice in electricity, uh, electricians as apprentices, plumbering, and it has given them. Uh, just a, a multitude of resources that had never been there in the past, and the community has all come together.

They've also had, um, independent, um, funding from some former people who used to live in the community that want. To make sure that the community continues to thrive. They've also gotten some, uh, federal and foundation grants and, uh, they have really pulled together to be able to meet an unmet need of housing, uh, particularly housing for people as they age.

Another issue that we hear in almost every single rural community that we visit is the challenge with transportation. And as I mentioned, rural America does not have a. Uh, a plethora of transportation options. And so many rural Americans, particularly older Americans, if they are unable to drive themselves, they then rely on friends and family.

And, uh, sometimes that gets to be a real challenge because we have many people in rural America. That, um, travel to distance sites for their own work. And so it makes it even more difficult for them to be able to, uh, provide transportation without taking time off of their jobs. And so, uh, the community health center in southeast Kansas, uh, started their own, uh, general transportation to be able to help meet.

That unmet need. We've also looked at other types of transportation solutions that rural communities have implemented. Um, I'm always impressed by the ingenuity and creativeness of rural communities when it comes to addressing, uh, the barriers that they see in their communities. And coming up with solutions that overcome these barriers.

And we've seen everything from putting together a barter system in which younger, uh, older adults, uh, drive the older adults and, um, then they bank hours, for example, so that when they get to be older, um, the next, uh, group of younger. Older adults coming behind them, um, will be able to then drive them if they need that support.

So they, they really try to keep a network, uh, together and be able to, um, support one another. Um, as you know, there's not a lot of rideshare options, for example, Uber or Lyft in rural communities. Um, some larger communities, uh, may have, uh, more of a, a local transit. Um, that can support them. But, um, for the most part, uh, most rural communities, uh, uh, rely on a volunteer system, uh, to be able to, uh, support the transportation needs, uh, that people have.

I would also put a plugin. Our team has put together a number of different toolkits. I'm gonna highlight where to find them in the resources section, but just so you know, we have a housing and a, um, transportation toolkit. We have an aging in place, and we have a transportation, uh, toolkit where you can see.

Different approaches and solutions that have been successful in rural communities. And what's really cool about it is you can go to a clearinghouse on these programs and see not only where they have been implemented, but you can also contact the people who are the implementers, because what we have found.

Rural people like to talk to rural people. And so, uh, making those connections is a great way to be able to, uh, further share those innovations and help other communities, uh, be able to meet their unmet, unmet needs.

We also approach all of our work in a strengths and asset perspective. Uh, I have never been to a rural community that doesn't have many different strengths and assets, be it people, be it organizations. Be it community assets and cultural assets. And if you go to Appalachia, you'll often hear, uh, their pride in storytelling and in bluegrass music, if you go to the.

Great, uh, great Plains. Uh, you will also hear a lot of stories about, uh, resiliency and living on the prairie and, uh, different types of ethnic foods that, um, people still eat In my area, I, I came from a very Scandinavian and German background and, uh, we, uh, ate a lot of lsa and, um, a lot of, uh, German broths.

So, uh, you know, every, every place has music, uh, special food, um, and stories that that really help to ground people and place. And we have a resource that you may want to take a look at. Uh, this is part of a study that we conducted on behalf of the Robert Wood Johnson Foundation. We were really looking at how.

Assets could be leveraged in rural communities, again, we have seen that foundations have not historically. Um, invested in rural communities at the same level that investments have been made in urban, in part because there's a concern about the, you know, the numbers of people that will be touched is smaller or there may not be an infrastructure in place and what have you.

But one of the things that we have really come to appreciate is that in a rural area, you can test something and change things on a dime. People in rural areas are often very interested in trying a new solution because they have been so frustrated addressing the problem. So they are very innovative and creative at coming up with solutions and once.

They are able to get them funded. Uh, they like to change on a dime very quickly. And because there aren't so many different competing projects in place, you can really understand the impact of those investments on, or those interventions and how they are making change. And again, um, this is a resource, this is part of a, a tool that, uh, we have, um, in our report.

Uh, again, um, please, uh. Use it. And if you have any questions, uh, please let us know. Uh, we have found this to be very, very helpful as we have worked in many rural co uh, communities across the country. Um, it, it's really helpful to start with what their strengths are and, um, then, uh, if need be, then go on to, uh, what some challenges are and, uh, identify some solutions.

So what's coming up? Well, we know that we have a lot of exciting things coming in, uh, the independent living and rehab space. Uh, there's a lot of technology that we are, uh. Expecting. Um, again, there is great interest in how, uh, technology may be able to support people, uh, particularly older adults living in place.

Uh, for example, um, different types of artificial intelligence. In terms of, uh, helping to monitor lights, uh, for example in, uh, when we're looking at different types of also fall preventions, uh, different types of monitoring systems so that we can ensure that if there's the fall we can, uh, get to people.

Uh, we also see additional transportation, uh, looking at how, um, for example, artificial intelligence AI can be used to help, um, put together transportation routes to be able to leverage, for example, transportation to a VA facility from a rural community. Uh, is there an opportunity also to include, for example, other people from that rural community to go to.

That, uh, uh, VA center, um, uh, location. Um, usually our VA hospitals are located in areas where there are other, uh, for example, um, uh, specialty care located. Is there a way where we can better leverage some of that transportation? Likewise on the housing standpoint, are we, are we gonna be able to do better and more comprehensive, uh, remote patient monitoring so that again, when issues arise, we can identify them before they necessitate a call to the ambulance or a trip to the emergency department.

Um. It, it's, it, it's, uh, uh, very exciting to see, uh, what lies in store with that. And again, we know there are a lot of assisted devices out there, either wearables or other types that will better help support people to remain as independent, uh, safely, uh, as we possibly can. Uh, I have never met anybody who, um.

Wants to move into a, a nursing home, if you will. But, um, most people that I meet are, are very committed to wanting to live in their homes, uh, live in their communities as long as possible. So with that, I'm gonna just take a quick, quick tour on some resources and then let's, uh, have some time for some dialogue and some questions.

Um, as I mentioned, uh, our team creates rural, um, health information hub toolkits. These are evidence-based toolkits. We create them in a modular approach where you can plug into wherever your community or your group is interested in looking at, uh, creating a program to address, for example, transportation.

Um, how does one go about developing it? How is implementation achieved? What are some considerations? One of the things we learned in our transportation interviews is the importance of looking at insurance. Who is going to, um, how is that insurance liability going to affect somebody? Uh, if you have. Uh, a volunteer system, for example.

Uh, so different types of considerations as you implement a program. And then how do you evaluate anything that we implement, because inevitably we're going to need to sustain those programs somehow. So how, how can we go about that? And this Rural Community Toolkit is a general overview on different ways to look at programs, but, um, it, it also provides some ideas for funding.

Down here is our, um, access to toolkits. Uh, the health equity toolkit has been taken down, but if you just go to rural health info.org at toolkits, uh, you will be able to, uh, find a, a whole group of toolkits that can support your work. Uh, and then as I said, we have, um, different ways to look at, uh, the modules.

And then lastly, uh, we have a rural health research gateway. Uh, the wall center where I work is one of eight federally funded rural health research centers across the country. And there are a number of different studies that we can, uh, that we conduct that are available. So with that, I will, uh, stop sharing and, um, we can, uh, have some discussion.

Jennifer Ottowitz: Thank you. This has been OIB-TAC’s monthly webinar. Thanks for tuning in. Find recordings of our past webinars on our YouTube channel and discover all of our many resources at OIB-TAC.org. That's OIB-TAC.org, like us on social media and share our resources with your colleagues and friends. Until next time.