Barriers to Aging in Place for Rural, Institutionalized Older Adults: A Qualitative Exploration

ABSTRACT

Objectives

Although the majority of older adults wish to “age in place” in their communities, rural contexts pose challenges to maintaining long-term independence. The purpose of this study was to develop an understanding of the experiences of rural older adults who live in Skilled Nursing Facilities (SNFs) and thus have not aged in place. By retrospectively analyzing their pre-institution care situation, we aim to generate foundational knowledge on the barriers to aging in place in rural settings.

Methods

A series of individual and group interviews was conducted in SNFs across seven rural communities. A grounded, thematic analysis was used to interpret interview findings, and coding was informed by the socio-ecological model (SEM).

Results

Participants were 32 adults with a mean age of 72 years (SD = 5.7 years) and an average SNF residence of 3.9 years. Two themes emerged as primary barriers to successful aging in place: (1) Caregiver-related support issues and (2) Present focus, or lack of advanced care-planning.

Conclusions

Findings suggest the importance of specifically supporting caregivers, to ease burden and allow for increased agency for rural older adults. A lack of access to caregiver supports and other services limits the ability of community-dwelling rural older adults to age in place or plan for the future.

Clinical Implications

Existing networks of rural community resources and innovative solutions should be leveraged to improve access to services for older adults and their informal caregivers.

KEYWORDS:

• Older adult
• aging in place
• skilled nursing facility
• aging
• rural health

Clinical implications

• The existing network of senior centers and service providers should be leveraged by geriatric providers in clinical settings to raise awareness of these supports to the rural older adult and caregiver populations.

• Funding should be allocated to support the innovative ways these and other centers choose to address rural barriers to preparing for and successfully aging in place.

• Informal caregivers are instrumental in the ability of older adults to age in place, especially in rural areas; clinician advocacy is essential to support legislative policy which promotes community living for older adults and provides for the financial and service needs of informal caregivers.

Acknowledgments

We acknowledge the honesty and vulnerability of all older adults interviewed for this study, and would also like to thank all of those who supported this project from its inception: the Community Living Section (CLS) and Director’s Unit for Policy, Research and Evaluation (DUPRE) at the Wyoming Department of Health, especially Sharon Simpson, Mark Kelly and Franz Fuchs. We appreciate the input of Catherine P. Carrico, PhD and Dominick Duhamel, MFA at the Wyoming Center on Aging for consultation on data management and study framing. Thank you to SNF and ALF directors and nursing staff, especially Laura Moore and Sharon Skiver, for guidance during interviews and data collection. We also appreciate those who provided report feedback and support, including John Freeman, Dirk Dijkstal, Dan Sicorsky, Gabe Rody-Ramazani, Kevin Murphy, and Veronica Gibson.

Disclosure statement

The authors have no financial or personal conflicts of interests related to the present research and have nothing to disclose. Ethical approval was granted by the Wyoming Department of Health Institutional Review Board. This study was approved with a waiver of consent, and did not collect individual identifiers with protected health information.

Notes

1. The emphasis on “partners” rather than the traditional “caregiver” title in recent literature emphasizes the increased likelihood that adult children caregivers would use more support services than spouse caregivers (Pinquart 2011–Toronto) and choose to “manage” care rather than provide it hands-on (Brodaty 2009–Toronto).