When Healthcare is Not Accessible

Q. I grew up in Northern Virginia and still live here with my wife and two children. Five years ago, my parents sold their home and moved to a more rural part of the state to get away from the traffic and congestion. My mother passed away since then and my father developed an illness that requires ongoing specialty physicians who are all here in Northern Virginia. He is considering a move back, unless there is another way.

When people retire and relocate to a rural area, many don’t consider that they may have less adequate healthcare. What alternatives do these people have, especially in light of the current coronavirus pandemic?

A. Living in a rural area certainly has its advantages, with many remote communities being beautiful and peaceful. But, where access to health care can be limited, living in less populous places isn’t always doable for some seniors who need access to specialized care.

In rural areas, less people mean less patient demand for certain medical services, though in some ways there’s more need per individual, as residents in rural communities tend to be older retirees.

According to a Washington Post article from March 19, very rural areas have a 60 percent higher death rate from flu than the big metro areas, according to analysis of CDC death records, and people living in rural areas will have a much harder time getting neded treatment in connection with COVID-19. According to the National Rural Health Association, “the rural health safety net was fragile before the national emergency . . . Now rural health care is being crippled by COVID-19.”

Virginia Department of Health Releases Healthcare Needs Assessment that Addresses Rural Health Care

Virginia’s population is growing older. According to population projections from the University of Virginia’s Weldon Cooper Center, Virginia’s senior population will increase by almost 75% by 2040 while the population over age 85 will more than double. This will have a large impact on Virginia’s health care system and its health workforce.

Currently 63% of Virginia is rural with 1.47 million Virginians residing in rural areas. According to the assessment,”(s)uccess in supporting a growing senior population requires a workforce: a) of sufficient size and productivity, b) that is accessible in the areas where seniors live, and c) trained to meet the needs of the senior community, including both medical needs and supporting services that improve quality of life and continuity of care, such as aging in place and community-based care.” Virginia’s rural communities face unique health care concerns that include lack of health care providers and difficulty accessing those providers due to transportation and technology barriers.

Maryland’s Plan for Rural Health Care

The Maryland Rural Health Association (MRHA) also has a plan for its rural communities, with 18 out of the 24 counties/jurisdictions in the state being rural. Similar to Virginia’s rural areas, Maryland’s rural areas face similar challenges. MRHA believes that rural hospitals and health care providers “deserve special consideration so that they can continue to provide high-quality services and meet the needs of rural residents.” The most recent Maryland Rural Health Plan highlighted six areas of need including: access to care, sustainable funding mechanisms for health care services, care coordination, chronic disease prevention and management, health literacy and health insurance literacy, outreach, and education. Read the full plan here.

Here are some other solutions for seniors who live in rural communities to access health care:

Plan for emergencies: Have a plan for when medical emergencies arise. Know where you’ll go and how you’ll get there when time is of the essence. Think about things such as: Where is the nearest ambulance emergency services? What’s their average response time?

Organize community members: While house calls are ideal, experts stress that rural residents especially have to be proactive to access needed health care. It can help to connect with other community members to determine what the gaps are and to engage health care providers outside of the immediate area to address those. As a community, consider whether you should be providing some support – tax support or otherwise – to assure that if you don’t have a local site of care, you do have adequate emergency response.

Utilize community health care workers: Community health care workers are people who have – compared to doctors and nurses – relatively limited training, but they literally go into the homes of people with chronic disease – people with diabetes, high blood pressure or congestive heart failure. Because they’re less costly to employ, they can spend more time with patients and can provide patient education. Dr. Nancy Dickey of Texas A&M discusses community health care programs and other topics in rural health care here.

Virtually bridge the distance with telemedicine: Telemedicine enables individuals to receive a variety of services remotely from physicians and advanced practice providers, such as nurse practitioners and physician’s assistants, who might be the ones providing that immediate care.

To Keep Seniors Safe at Home, Medicare Expands Telemedicine

The Centers for Medicare and Medicaid Services (CMS) said earlier this week that it will immediately expand coverage for telemedicine nationwide, due to the evident need stemming from the coronavirus pandemic.
The new option will allow millions of older people to take care of ongoing medical problems as well as new concerns, while heeding public health advice to stay home during the COVID-19 outbreak. For example, a patient with diabetes wouldn’t have to postpone a regular follow-up visit with the doctor to keep safe — he or she could do it via Skype or FaceTime or a special physician video web portal. And people concerned they may have the virus could “see” their doctor or nurse practitioner virtually to find out how to get tested in person. “It helps us prevent the spread of the virus,” said CMS administrator Seema Verma.

For seniors who don’t navigate technology, relatives or friends can assist. “If it’s your mom, you may need to go over to her house to help her do this,” said Verma. Bring your smartphone — but remember, don’t visit if you’re feeling ill, as risk of serious illness from the coronavirus is greater for older people and those with underlying health problems. Many Medicare beneficiaries are managing chronic health issues that put them at heightened risk. The telemedicine expansion is geared directly to this vulnerable group.

Is Telehealth Now Covered by Traditional Medicare?

Current telehealth coverage under traditional Medicare has been limited until now. It has been available in rural areas, and patients need to go to specially-designated sites for their visits. Since last year Medicare has also been paying for brief “virtual check-ins.” Tuesday’s announcement goes beyond that, allowing clinicians and hospitals to expand the current telehealth covered services, to help you have access from more places (including your home), with a wider range of communication tools (including smartphones), to interact with a range of providers (such as doctors, nurse practitioners, clinical psychologists, and licensed clinical social worker). During this time, you will be able to receive a specific set of services through telehealth including evaluation and management visits (common office visits), mental health counseling and preventive health screenings. This will help ensure you are able to visit with your doctor from your home, without having to go to a doctor’s office or hospital, which puts you and others at risk of exposure to COVID-19.

If telemedicine shows its worth in the coronavirus emergency, it could lead to permanent changes making it more widely available to seniors. But researchers say patients have been relatively slow to try telemedicine, especially if they are used to in-person visits. Learn more about Medicare-covered telehealth here.

Plan in Advance for Long-Term Care

If you or your spouse is over 65 or suffering from any sort of serious health condition, it is wise to plan for your future now. Whether you or your spouse is years away from needing nursing home care, is already in a nursing facility, or is somewhere in between, the best time to do Medicaid Asset Protection planning is the present, not when you are about to run out of money. Please don’t hesitate to call us at any time to make an appointment for an initial consultation. For those who feel safer in their homes, we offer videoconference or phone appointments in lieu of in-person meetings (but we are still open for in-person meetings).

Elder Care Attorney Fairfax: 703-691-1888
Elder Care Attorney Fredericksburg: 540-479-1435
Elder Care Attorney Rockville: 301-519-8041
Elder Care Attorney DC: 202-587-2797

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About Evan H Farr, CELA, CAP

Evan H. Farr is a 4-time Best-Selling author in the field of Elder Law and Estate Planning. In addition to being one of approximately 500 Certified Elder Law Attorneys in the Country, Evan is one of approximately 100 members of the Council of Advanced Practitioners of the National Academy of Elder Law Attorneys and is a Charter Member of the Academy of Special Needs Planners.