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Promoting Quality of Life Among Rural Older Adults

By Robyn I. Stone

Over the valley and through the woods to grandmother’s house we go.





Who doesn’t think of Thanksgiving when hearing these lines from Lydia Maria Child, an 18th century novelist, historian, children’s writer, and social critic? The musical version of Child’s iconic poem—called the New England Boys Song About Thanksgiving Day—plays on a continuous loop in my brain this time of year.


Granted, Thanksgiving 2020 will be an unusual—and, I fear, sad—holiday, as we adjust our expectations and make peace with our need to social distance and forego some traditions in the face of the continuing COVID threat. But I’m convinced that this Thanksgiving will also give us a renewed appreciation for the values we traditionally celebrate on the last Thursday of November: family, relationships, and the memories of past holiday gatherings in the homes of our mothers and grandmothers.


Those homes were on my mind recently during a Zoom event with research and policy colleagues in Maine, which has the distinction of being the oldest and most rural state in our nation.

By 2030, 28% of Maine’s population will be 65 or older, higher than any other state, according to census figures. Two-thirds of Maine’s older adults (62.7%) lived in rural areas between 2012 and 2016, according to the U.S. Census Bureau. Only Vermont, at 65.3%, surpassed Maine in its percentage of rural elders. More than half of the older populations in 3 other states—Arkansas, Mississippi, and West Virginia—lived in rural areas.


When my colleagues in Maine asked me to offer guidance on how they might re-imagine residential care in the Pine Tree State, my first instinct was to broaden the discussion. Rather than focusing on building residential care settings to meet the needs of older Mainers, I suggested that policymakers consider the myriad ways in which the homes of older Mainers, however older adults define home, might find their rightful place on a true continuum of residential care options.


To understand what I mean by this, it’s imperative to let go of 3 false assumptions we’ve made for decades about how to provide housing and services to older Americans.


First, we can no longer assume that older Mainers—and older rural older adults around the country—will be willing to move away from their homes and communities when their care needs increase.


Second, we have to toss out our long-held assumption that it makes sense to provide housing in one place and care in another place. Instead, we must find ways to make housing and services equal, interconnected, and complementary parts of a new kind of continuum.


Third, we have to stop referring to “age in place”—which implies a solitary existence—and focus more on offering rural older adults the opportunity to “age in community,” even if they are living in their long-time, single-family, detached homes.


How do we accomplish all this?


First, we need local data. Policymakers must take the time to understand the landscape of a particular locale before developing policies governing how housing and support services will be designed and delivered there. Before putting pen to paper, they must ask fundamental questions: Where are people living now? What are their projected needs for housing and supportive services? What is the condition of existing housing? Can that housing be deployed in different ways to better meet the needs of older adults?


With this critical information in hand, local governments can then develop coordinated policies that meet both the housing and service needs of older adults. Those policies might call for new construction of affordable residential options that incorporate health services. They might also offer mechanisms through which older homeowners can use the equity in their homes to pay for modifications that make those homes safer and more supportive.


Coordinating housing and service policy can also help us make enormous headway in addressing other issues affecting rural older adults, including the threat of social isolation. For instance, we could consider ways to apply to rural communities the principles of NORCs—the naturally occurring retirement communities that are most prevalent in urban areas.


Bringing the NORC concept to rural areas would involve identifying small towns and other geographic areas where large concentrations of older adults live, and then finding ways to improve the quality of their housing, build “granny flats” on unused land to house those who can no longer remain in their own homes, and create a hub system to bring needed health, supportive, and social services to that population in a cost-effective way.


None of this can happen unless policymakers from both the housing and service sectors sit down at the same table, agree on common goals, and commit to working together in a coordinated fashion to promote quality of life and quality of care for older adults living “over the valley and through the woods.”


Robyn I. Stone

Robyn I. Stone, DrPH, is senior vice president of research at LeadingAge, and co-director of the LeadingAge LTSS Center @UMass Boston. Her widely published work addresses long-term care policy and quality, chronic care for people with disabilities, the aging services workforce, affordable senior housing, and family caregiving.

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