# Presentation: 011859

## Barriers to Resources for Rural Caregivers

- Rhonda J.V. Montgomery
- University of Kansas

## Not All Rural Barriers are Unique

- Common to other socially and economically disadvantaged groups

## Alzheimer’s DemonstrationGrant to States

## Geographic Region of Elders

**Geographic Region of Elders**

**Total of 6938 clients**

## 112 Direct Respite Care Providers

_**76 Day Care Providers**_
- Ave. Service Cap = 792 Hrs per year
- Mean hrs monthly= 91.6
- Staffing
- All Paid = 33%
- Paid and Volunteer=67%
- Type:
- Adult day 51%
- Group Day 39%

_**50 In-Home Providers**_
- Ave.  Service Cap = 406 Hrs per year
- Availability
- Daytime only  = 64%
- Anytime = 36%
- Staffing
- All Paid = 62%
- Paid and Volunteer = 36%

## Elders by Ethnicity in Longitudinal Study

**Elders by Ethnicity in Longitudinal Study**

**Total of 4369 clients**

## Data Sources

- Interviews with 500 clients
- Interviews with 50 service providers
- 42 front line staff
- 8 administrators

## Unique Qualities of Rural Clients

- Isolated
- Independent

## Isolation Means

- Fewer educational opportunities
- Limited access to medical care
- Limited range of services

## Limitations Translate

- Dependence on local general practitioner for information
- Limited knowledge of dementia or other specialized diseases
- Limited knowledge of treatments

## Independence means

- Belief in self-reliance
- Family First
- Church as central to community

## Strong Independence linked to

- Views of services as Welfare
- Guilt when services are used
- Fear of Bureaucracies

## Increased Familiarity

- Know families
- Know family histories

## Familiarity breed special concerns

- Privacy
- Suspicion of outsiders including
- Staff
- Government
- Researchers
- Discrimination based on
- Race
- Economics
- Religion
- Preferences for service by “ones own”

## Rural Program Issues

- Transportation
- Limited Resources
- Lack of Economy of Scale
- Staff and Staff Retention
- (especially professional staff)

## Solutions to these issues

- Innovation and Creativity
- Responsiveness to clients Needs

## Examples of Approaches

- Emphasis on service as a compliment not a substitute for family
- Co-payment through service

## Empowerment of Families

- Teach them to ask questions
- Teach them to talk with the doctor

## Examples of Creative solutions

- Mobile Day Care
- Shared Staff
- News letters
- Long Distance Support Groups
- Caregiving Buddies
- Thrift shop respite

## Quality still counts! A lot!

- Become familiar with your service community
- Develop appropriate and responsive service programs
- Build trusting Relationships
- Educate the community

## Become familiar with your service community

- Get to know culture and language
- Become aware of other available resources and services
- Understand issues related to service use such as socio-economic levels, education, employment status
- Understand family structures and caregiving beliefs

## Develop appropriate and Responsive Service Programs.

- Culturally appropriate materials and activities
- Hire “from the community”
- Individualize care plans
- Match hours of service availability to caregiver needs
- Create a homelike environment
- Use “socializing” context for support groups
- Use sliding fees to negate welfare stigma

## Build trusting Relationships 

- Create clear expectations for care with clients
- Follow through! Follow through!
- Recognize and reward excellent staff members
- Hold team meetings and give staff members and opportunity to provide input
- Build partnerships with key community providers/organizations

## Educated the Community

- Let families know about the purpose of your services
- Inform community leaders about the ways that your service can enhance family care
- Create new partners through education