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  1. Buckwalter, K. and Davis, L., Elder caregiving in rural communities., White Paper commissioned by the U.S. Administration on Aging (Spring, 2002) [Caregiving%20in%20Rural%20Communities.htm]
    (last updated on 2010/10/20)

    Executive Summary: Projected increases in older persons over the next decade, particularly in minorities and the "oldest-old" population segments (those 85+years), make elder care one of the most pressing health care issues for the 21st century. In that the characteristics of a community influence the health care of its residents, nowhere is the delivery of elder health care more challenging than in rural communities, where low population density and large catchment areas combine with lack of service access and reimbursement in creating barriers to community-based elder care. Such factors contribute to long-term care admission rates for rural elders that exceed those of urban communities. Community norms and cultural values as well as the strongly-held belief that families should "take care of their own problems," influence service acceptability in rural communities. Family members, friends and neighbors often fill the service gap, providing both direct and indirect care services for poor, socially isolated, underserved, frail and chronically ill elders in rural communities. Spouses, adult children, children-in-law and other extended family members are expected to provide informal care services for elders. However, out-migration of adult children to urban centers for employment often reduces the number of family members available to function as caregivers and many elders must depend upon loosely-articulated combinations of informal services from friends and neighbors. Issues of limited service access and reimbursement that create care barriers for elders also complicate delivery of assistance programs for their informal caregivers. Various surveys document the difficulties informal caregivers in rural communities experience in attempting to secure the information, disease-specific education, skill training, respite and on-going support necessary to care for a frail and impaired elder in the home. However, descriptive studies of caregiving in rural communities indicate that almost half of all caregivers do not receive assistance because they: Do not know they are eligible for caregiver assistance services; Are unaware that such programs exist in their community; Are too embarrassed to accept services they view as 'welfare'; Are reluctant to seek services unless there is a "crisis" and, Find existing services too geographically distant to be helpful Demonstration projects in rural communities across a variety of states indicate that successful rural caregiver assistance programs are those: developed in collaboration with rural caregivers: endorsed by community leaders; and, staffed by persons who live in or are familiar with the cultural and social values of the community. Programs that compensate for geographic isolation through the combination of periodic home visits and innovative information technologies and telecommunications (e.g., peer caregiver telephone networks, telemedicine and telenursing contact systems), may offer the greatest promise for helping informal caregivers of rural elders.