Arizona's rural elderly lacking access to medical care, services
Outside of senior centers, aging population gets little help
SUPERIOR — Barbara Pope didn’t think much about it when black ants stung her left middle finger as she worked at a thrift shop here four years ago.
A day later, with the finger swollen and throbbing, and she knew she needed medical care.
But there was a problem: It was Thursday, and the only medical clinic in this former copper mining community east of Phoenix was only open Mondays, Tuesdays, Wednesdays and Fridays.
A friend drove her to a hospital in Gilbert, about 50 miles away. Diagnosed with a infection, she was transferred to a Phoenix hospital for surgery. Despite six operations, she lost the finger.
That was only the start of her problems.
When she was released from the hospital, she was still recovering and taking strong painkillers. In her mid-60s, widowed and without family in town, she lacked someone to help her with basic tasks such as housekeeping, not to mention driving to medical appointments in Phoenix.
“I didn’t have anyone to help me,” Pope said.
Finally, she told her story to a waitress, who volunteered her daughter to provide rides and look after Pope’s house.
“I don’t know what I would have done if it hadn’t been for her,” Pope said.
Arizona is growing older. An estimated 13 percent of Arizonans were age 65 or older in 2009. That percentage is expected to almost double by 2020, according to the Arizona Department of Economic Security’s State Plan on Aging.
That aging is especially pronounced in rural areas. Of the four counties that already had more than one out of five residents age 65 or older in 2009, according to the U.S. Census Bureau, all are in rural areas: La Paz, 32.1 percent; Yavapai, 23.8 percent; and Gila and Mohave, 22.4 percent.
As this shift occurs, experts and advocates warn that rural areas in particular will lack the doctors, care homes, transportation and other services needed by an older population.
Of these, medical care is of particular concern to Len Kirschner, president of the Arizona chapter of the American Association of Retired Persons.
“I describe our current health care system as chaotic, costly, confusing, inefficient, inequitable, and occasionally superb,” he said. “That’s not what people need.”
‘Dollars are short’
It’s lunchtime at the Superior Senior Citizens Center, and Barbara Pope is among a dozen or so residents gathered to chat and eat.
For Pope, the center provides a healthy meal and provides the companionship many elderly residents need.
“It gets us out and makes you feel like you’re alive,” she said. “If the center wasn’t here, there would be a lot of people in trouble.”
The center, which is open Monday through Friday, also sets up bingo tournaments and on rare occasions plans out-of-town group trips. Rebecca Brothers, the director, uses a van to take seniors who can’t drive themselves to the center or town’s medical clinic. The other two employees work in the kitchen.
Seniors pay a modest amount for lunches, but other services are free. The center relies almost exclusively on grants.
Brothers said the seniors here need much more, including transportation to medical appointments in the Valley or in Globe, about 25 miles to the east. But that’s impossible.
“We don’t have the manpower or the budget,” she said.
Those age 65 and older make up about 20 percent of Superior’s 3,500 residents, according to the Census Bureau. Yet outside of the senior center services for older residents are scarce.
The only medical clinic is staffed by a physician’s assistant, not a licensed doctor. There is no pharmacy, no chiropractor.
Volunteers are difficult to come by in Superior, Brothers said, and the town government hasn’t stepped in to offer help.
“Unfortunately, our seniors end up suffering because of it,” she said.
Mayor Michael Hing said local leaders lack the resources to offer more help.
“We’re shaking like everybody else right now because of the economics,” he said. “Dollars are short, but we are trying to hold it together.”
Melanie Starns, assistant director for the Arizona Department of Economic Security’s Aging and Adult Services Division, said that while not all rural communities face the same challenges there are clear trends when it comes to availability of care.
“There is an absence of service providers, and there is also an absence of trained qualified workforce to do the job,” she said.
According to the Department of Economic Security’s State Plan on Aging for 2011-2014, the elderly population is increasing while resources are decreasing. Cuts to community-based services and programs helping seniors remain in their homes could force more people into institutional care, the report said.
Jim Dickson, president of the Arizona Rural Health Association, said the distribution of services and providers serving the elderly is a statewide issue.
“Most areas of Arizona are in this category, with the exception of the urban areas,” he said.
Elisa Davis, director of the Western Arizona Council of Governments’ Area Agency on Aging, said the more remote a community the more difficult it is to provide services because there are smaller budgets and fewer seniors to serve.
“It is more expensive to provide services for rural communities,” she said.
In Sedona, Sunrise Center for Adults provides seniors with healthy meals, nursing care and activities Monday through Friday. Those who come here are paying customers.
On a recent weekday, a social worker has a small group drawing their childhood classrooms, an activity that stimulates memories and mental health. A jewelry-making class is scheduled for later in the day.
Linda Yee, a retired registered nurse, founded this business four years ago after moving from California to take care of her elderly mother. She was surprised to find so few services for older residents in the Verde Valley.
“They need to have someone to take care of them, and they might not want to go to a nursing home. They may not want to have somebody in their home 24 hours on the clock to take care of them,” Yee said. “This gives them another option.”
But making such an operation work can be a struggle in a rural community because there isn’t as large a customer base as in a metropolitan area, she said, adding that similar businesses in Cottonwood and Flagstaff have failed due to a lack of business.
Yee’s center supplements its revenue through fundraisers such as selling tickets to an “American Idol”-style singing competition.
“It’s very expensive to open up a business, hire registered nurses, hire social workers, hire an office manager, hire caregivers and keep it running on what people can pay us,” she said.
Another challenge, Yee said, is that many elderly people in rural areas simply don’t know that such services exist.
Ramsey Alwin, director of the Economic Security Initiative at the National Council on Aging, noted that many rural areas lack broadband Internet access. And even in areas with broadband, she said, seniors can find it overwhelming to search for services in their areas.
“It’s challenging to get the latest and greatest information to those that need it more,” Alwin said.
In Superior, Mayor Hing said that seniors can get information at the senior center, but those who don’t go there are at a disadvantage. Beyond being able to work televisions and radios, he said, many elderly people in his community aren’t savvy when it comes to technology.
“The elderly are not educated in that area,” Hing said.
Barbara Pope said she felt cut off after returning to her Superior home after her surgeries. Her greatest difficulties: locating services that allow her to get to medical appointments and obtain medication.
“It’s almost like it’s a secret,” she said. “It’s out there, but they don’t really want you to know.”
Since she suffered a heart attack in 1999, Irene Ruiz has had to make frequent trips from Superior, her home for more than a half century, to the Valley for medical appointments. Today, 87 years old and not comfortable driving long distances, arranging those trips is a challenge.
When family members can’t drive her, she calls the Pinal County Department of Public Health’s On-the-Go Express service for the hour-long trip to Mesa. But limited availability forces her to schedule appointments only on certain days during the week and at times that get her back to Superior by noon.
“Nobody lives with me,” she said. “I live alone and I don’t depend on a lot.”
Elisa Davis of the Western Arizona Council of Governments’ Area Agency on Aging said seniors in rural areas often have to travel for medical care not offered in their communities, such as seeing specialists or chiropractors.
“There are a lot of areas that don’t have a lot of specialties that an urban area would have,” she said.
Meanwhile, according to the state Department of Economic Security report, transportation services such as those available to seniors in Superior are almost nonexistent in rural areas.
Melanie Starns with the DES Aging and Adult Services Division said it’s costlier to give rides in rural areas because providers have to drive long distances in order to serve just a few people as opposed to an urban area with a large clientele.
“That geographic distance affects the cost and availability,” she said.
Paula Kneisl, a board member for Aging Services of Arizona, a nonprofit group made up of industries serving the elderly, said seniors in remote communities suffer because of it.
“They can only get to the doctor infrequently, or at a particular time that may not work out with them,” she said.
Nearly one out of three Prescott residents is age 65 or older, according to the Census Bureau. But there aren’t as many doctors to serve them as there otherwise would be because of the way they pay for care, said William Thrift, a family practice doctor there.
Medicare, the federal government’s health plan for the elderly, doesn’t pay enough to make it worthwhile, he said.
“The amount that doctors get is less and less,” Thrift said.
A 2008 report by the Medicare Payment Advisory Commission, which advises Congress, said physicians get 20 percent less from Medicare patients than from patients with private insurance.
“It’s harder to get doctors, and many doctors are no longer taking Medicare patients,” said Paula Kneisl with Aging Services of Arizona.
In Superior, Mayor Hing said doctors don’t want to practice in a place that has so many residents on Medicare.
“They have to make a buck, so they’re not going to put somebody here if they’re not going to get that return,” he said.
That’s just one of the reasons for a doctor shortage in rural areas, and that shortage is a problem transcending age. But it affects the elderly disproportionately.
According to National Rural Health Association, rural areas have higher rates of chronic diseases, including heart disease and cancer, party because of a population that is older, poorer and less educated.
Len Kirschner, president of Arizona AARP, said the problem stems from medical students who, facing large loans and financial incentives, are driven to pursue specialties rather than general medicine.
“And if you’re into specialty, you don’t go to rural areas,” he said.
Melanie Starns with the DES Aging and Adult Services Division said that despite its challenges, Arizona is ahead of many states in addressing its the needs of its growing elderly population.
For example, she said, the Aging 2020 initiative launched by former Gov. Janet Napolitano’s brought together state agencies, tribal governments and community partners to discuss pressing issues.
One change that stemmed from that effort has the Arizona Department of Public Safety training cadets to better recognize elderly drivers in need of assistance. More than 30 states have followed suit, she said.
Arizona started the Mature Workforce Initiative, providing opportunities for older people to work and remain self-sufficient.
“We need to make sure there is a level playing field,” she said.
Meanwhile, the state is looking to update the services it provides for a new generation of seniors, the Baby Boomers. Old-fashioned senior centers will be revamped to include fitness equipment, dance classes and even computers. The use of telemedicine, the opportunity to use video and Web-based technology to provide medical care for people in rural areas remotely, is also something the state is looking to incorporate.
“I think we’re headed on the right tracks,” Starns said. “I think we have a long way to go, and by 2020 we will have made significant strides towards modernizing the different needs the Boomers have compared to the current population.”
It took Barbara Pope five months to recover from her surgeries. She can use her hand, minus the middle finger, but not fully.
“There are a lot of things I can’t do that I used to do,” Pope said.
After her experiences, she hopes Arizona will improve services available to the elderly in rural communities.
“Yeah, we’re old, but we still want the quality of life that we can have,” Pope said.