Individuals who are particularly vulnerable to having unmet healthcare needs are often found in rural areas of the nation. Unlike the past, in the beginning of health care development, (Starr, 1998, pp. 16, 64) entry into care by new physicians challenges the entry of physicians into rural health care, in large part because of the disproportionate cost of providing care for the underinsured and for only a small potential patient group. Those then who are often the most vulnerable to having unmet health care needs are often aged individuals living in rural areas. These individuals live far from services and often live in areas where service sites for basic primary care, preventative medicine, dental and vision care and not to mention specialized geriatric care for chronic debilitating diseases are located far from home in areas that lack basic public transportation services. "Life expectancy in the U.S. has increased from 48 years in 1900 to 83 years in 2000…" (Couper & Lapham, 2002, p. M16)
Though we must identify this as a social problem only in that it significantly increases the number of people requiring care in formal settings for age related problems and health needs. In a sense we can think of increased life expectancy as a positive outcome of strong social policy of the past. "Reduced death rates for children and young adults (largely because of better public health systems like clean water: better nutrition, and better medicines like antibiotics) are the main factors behind increasing life expectancy over the last century." (Couper & Lapham, 2002, p. M16) Recognizing this change as a positive social outcome, does not however resolve the fact that this demographic is in need of social services at a higher rate than a smaller aging population did in the past. This work will look at unmet health care needs in the rural elderly by first analyzing and then recommending expansion and further development of a EMS referral program to help those in need find sources for unmet health care needs including; primary care, preventative care, vision and dental care.
Additionally, many diseases and conditions are specific to the elderly, just as a result of the fact that the older one grows the higher the chances for living with debilitating diseases become, this is also true of basic health care needs, as aspects of ill health in the areas of basic medicine, preventative medicine and vision and dental care are greater the older one gets and have a higher potential to do further health harm in the elderly than in younger healthier people. According to the text for this course, the elderly and particularly the rural elderly are an identified vulnerable population experiencing many unmet health care needs (Shi & Singh, 2008, pp. 88, 313) Today only 4 out of 100 adults who are aged 65 years old or older live in nursing homes, (Couper & Lapham, 2002, p. M16) there are many who could avoid such care if there were capable individuals and institutions to meet their needs during daytime hours so traditional family care can be offered for a longer period of total years (Shi & Singh, 2008, 141).
The provision of care for unmet health care needs, such as was designed and researched by an upstate New York EMS service could significantly increase the ability of family to care for aging adults for longer periods as such care offer respite for family care givers where they exist and provides the opportunity for the elderly to remain viable and pursue activities that enrich their own lives, and make it possible to continue to be able participating adults in the community (Shah et al. 2006). The unmet care needs of these individuals as well as possible cases of abuse and/or neglect feed the problem and emergency care personnel are poised as a common point of entry to medical intervention as well as to identify severe cases of neglect or maltreatment that can occur due in large part to the environmental isolation the elderly in rural areas often experience. Often times the burden of detection and planned intervention falls to emergency room staff and often EMS or nursing staff as in many cases these health care providers serve as a primary care access point for rural elders. "While nurses in emergency departments are well placed to identify cases of suspected elder abuse, a crucial factor influencing patient outcomes is the quality of the community care/emergency department interface." (Day, 2007, p. 169) Therefore in the case of the upstate New York program initiated to improve basic care and identify areas of need through EMS referrals is a significant program model that might really assist in improving the incidence of unmet health care needs for rural adults.
The emergency medical services (EMS) system is one potential nontraditional resource to identify and address the needs of older adults.6 The concept of EMS-based prevention is based upon the notion that emergency medical technicians (EMTs) have unique opportunities to screen and educate patients during emergency medical responses and then refer those patients for interventions. For instance, EMTs are able to provide services to all patients throughout a community without regard to financial or physical limitations, to evaluate the home environment, and to provide services to the patients who refuse transport to an emergency department (ED), which may total up to 17% of older adults requesting EMS assistance.7,8 Additionally, EMTs frequently care for older adults who are in need of medical or psychosocial assistance but who are not critically ill.9,10 This group may particularly benefit from screening and interventions, because the lack of immediate need for medical intervention gives EMTs time to perform these tasks. (Shah et al. 2006, p. 956)
The study itself had a very limited scope of screening issues of unmet needs, including only three areas of screening interest: "…the study evaluated whether EMTs could successfully screen at least 80% of community dwelling older adults to identify those at risk for falls, influenza, and pneumococcal disease," (p. 957) The study then went on to evaluate the type of referral intervention employed, " The study also evaluated whether notifying patients' primary care physicians (PCPs) to intervene in identified deficiencies had an effect on risk status. It was hypothesized that this program would be feasible, with EMTs screening at least 80% of patients, and would alter the proportion of at risk older adults," (p. 957). The results indicated that positive changes in health outcomes were seen, most specifically in the result of increasing the number of older adults who were vaccinated for pneumonia and influenza, both high risk diseases for the elderly and considered necessary primary preventative care interventions (p. 958). It must be noted that the research also had a secondary (unstudied) effect of getting the elderly in need to their primary care doctors or to other health care clinics who could evaluate them on a more thorough level.
In the U.S. health care has been an on demand product for nearly all of its existence (Starr, p. 47) The problem then comes when individuals who need care do not demand it by making and keeping appointments to see their doctor, because of the difficulty they perceive in doing so. The elderly are most at risk for this and therefore demonstrate the real and potential occurrence of a greater number of unmet health care needs, especially with regard to primary, preventative, vision and dental care as they as a population have a greater need for all but are less likely to seek it if they feel they cannot independently follow through (Shi & Singh, 2008, p. 88). This is then compounded by issues of access in rural areas where actually following through with care provision could require a several hour time commitment for a family member or even an expensive trip to care with private medical transportation. Therefore the program described above and in the article by Shah et al. is promising as EMS providers often serve as a primary access point for health care as many elderly in either emergent or non-emergent care situations find themselves avoiding care until EMS is needed or have no other way to receive transport to medical care. EMS providers can therefore be identified as those that are most likely to see, provide care for and need referral resources for the elderly in rural areas. The program should then be expanded to allow EMS to allow for a greater number of screening and referral criteria. This could be done with an overall health assessment tool being added to the EMS triage screening systems as a way to both identify real need across a broader set of unmet medical care needs and to provide EMS as an integral contact point for community-based services and systems that serve the rural elderly better and allow on demand care to expand with intervention.
The rural elderly are clearly a vulnerable population when it comes to unmet health care needs, as they are more…