Aging in place in rural areas of Colorado
Aging in place, which means opting to remain in one’s own home or community into later years of life, is the preference of most older adults. However, those living in rural communities often encounter unique barriers to accessing resources and services that could help them maintain independence and well-being (Crosby et al., 2012; Skoufalos et al., 2017; Singh & Siahpush, 2014). For some, retiring in the mountains may sound like a dream, but the lack of resources available in remote areas can complicate that reality. Therefore, as part of the Senior Access Points (SAP) project, key community partners have teamed up with Colorado State University (CSU) to better understand the challenges and needs of aging in the more rural areas of Larimer County, Colorado.
The Benefits and Challenges of Rural Aging
Rural areas tend to have a higher proportion of people over 65 years old compared to more urban areas (U.S. Census Bureau, 2019). And, whether individuals move to a remote area upon retirement, or whether they have lived there for decades, the experiences of rural aging are complex and multifaceted (Greenlee, 2019). Those who choose rural living cite benefits of natural beauty, peacefulness, and a sense of independent and productive living in cooperation with the land. Sometimes there is a family legacy tied to the home, the land, and the community. Oftentimes, neighbors in rural areas have developed informal networks to check in and support one another (Greenlee, 2019).
In addition to the benefits, rural aging comes with a host of challenges. Previous research has identified factors such as the lack of medical services; infrastructure needs regarding transportation and internet connectivity; affordable, safe and manageable housing; and an increased risk of social isolation (Anarde, 2019; Weirich & Benson, 2019). Of course, the benefits and challenges differ from rural community to rural community, and therefore it is crucial to understand the unique perspectives of local residents in a given area.
Planning and Preparing for Aging
Being able to access the appropriate supports and resources may make the difference of whether someone can safely remain in their rural home or not. Older adults who do utilize services tend to report high satisfaction with them (Schulenburg & Coward, 1998). Yet, decades of research findings indicate that most people do not plan ahead for potential care needs (Sörensen & Pinquart, 2001). Having to make critical decisions about living situations and care needs in an emergency situation leaves families less satisfied and more stressed (Magilvy & Congdon, 2000; Scheibl et al., 2019). So how can families better prepare for an unknown future?
Three A’s: Resource Awareness, Access and Availability
The first A stands for Awareness. Many people, especially those in rural areas, do not know that aging-related resources even exist (Schulenburg & Coward, 1998), and may feel like they have to “go it alone.”
The second A is for Access. The tendency to utilize formal aging-related resources has been historically lower among rural compared to urban older adults, despite documented higher rates of chronic illness and daily care needs among rural elders (Schulenburg & Coward, 1998).
The third A is for Availability. Many aging-related resources exist, including programs, services, tools, technologies, agencies and professionals that can be used to assist with changing needs and challenges. Resources may help to support instrumental tasks (e.g., daily activities such as bathing and dressing); emotional needs (such as stress reduction, comfort and reassurance, companionship, and connection); and family needs (caregiver support and information; family communication and involvement). Resources may be free, subsidized, or for-pay. They may be offered by government agencies, private organizations, local non-profits, or other entities. Below are a few examples of common aging-related resources:
- An evidence-based falls prevention program or a caregiver skills-building course, typically offered at the local senior center (program).
- An in-home caregiving company (services).
- A printable checklist to help family caregivers manage care tasks (tool).
- An online application to help families communicate around the care and well-being of a loved one (technology).
- Area Agencies on Aging (AAA) offices located in every state with knowledgeable staff to advise about available local resources (agency + professionals).
Working to ensure that people are aware of potential resources in their area — and that they would feel comfortable accessing them — has great potential to help alleviate burden and stress on families as they adapt and manage aging-related changes of a loved one.
Increasing the availability of resources in rural areas is a complex challenge which requires the cooperation of key stakeholders in a given community to develop solutions to support residents’ goals (National Conference of State Legislatures, 2017) — including residents themselves.
One example of such a cooperative effort is the recent creation of the North Forty Food Pantry in the Red Feather Lakes area in northern Larimer County. The North 40 Mountain Alliance was established a few years ago as a trusted entity to disseminate information to residents during emergencies, such as wildfire evacuations. Having that essential infrastructure in place — combined with a culture of neighbors helping neighbors — turned out to be pivotal during the COVID-19 pandemic. Within a month of the onset of the pandemic, the Red Feather Lakes community was able to create a weekly food pantry, with the help of a little seed money.
Community members were willing to take on specific tasks, including driving down the hill to the food bank, hauling truckloads of food to a church basement, sorting and distributing. Now a year later, the North Forty Food Pantry has received grants to be sustainable and become a source of food, information, and community engagement.
Local Survey Results
The listening process is an important first step to identify the types of resources that may support aging in place, and strategies for connecting residents to those resources. Therefore, we recently conducted a study involving 210 individuals in rural Northern Colorado.
Through surveys and listening sessions, we found that being able to age in one’s home and community was a strong value endorsed by almost all participants. Interestingly, the aspects of aging in place that residents were most hopeful about were also the things that they were concerned about losing, especially with regard to health and independence. The study also found that many people were not aware of resources that could be supports for their ability to age in place, outside of their informal networks of family and neighbors.
Addressing the Resource-Access Gap: SAP of Colorado
Addressing resource access gap has been a primary goal of the Senior Access Points team since its inception in 2016. Senior Access Points has been working to build awareness, to break down barriers to resource access, and to partner with communities to develop newly available resources. Our university-community partnership has included multiple strategies to get the word out about aging resources in Larimer county, including an informational website, a cadre of trained volunteers, presentations to community agencies, and coalition-building efforts. Now in our fifth year, 2021 efforts include an overhaul and redesign of the SAP website, as well as a move toward state-wide expansion through the CSU Extension network system.
Seeking Community Input
All Colorado residents are invited to provide input on the current survey to let the team know what types of resources would be helpful to know about in your community. We would especially love to hear from our rural neighbors across the state!
Senior Access Points is grateful to its funding partners: the Next Fifty Initiative, Department of Human Development and Family Studies (HDFS) at CSU, CSU Extension, and AARP.
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ABOUT THE AUTHORS
Allyson Brothers, PhD, Assistant Professor, CSU Department of Human Development and Family Studies
Sue Schneider, PhD, Extension Agent, Larimer County Extension
Cheryl Noble, SAP Project Coordinator, Larimer County Extension; Outreach and Volunteer Coordinator, Partnership for Age Friendly Communities
Jessy Jiao, MS, Intern, CSU Department of Human Development and Family Studies
References
Anarde, S. (2019) Home sweet home: Aging in place in rural America. Generations: Journal of the American Society on Aging 43(2), 17-23. https://www.ingentaconnect.com/content/asag/gen/2019/00000043/00000002
Crosby, R. A., Wendel, M. L., Vanderpool, R. C., & Casey, B. R. (2012). Rural populations and health: Determinants, disparities, and solutions (1st ed.). Jossey-Bass.
Greenlee, K. (2019). Why people choose the rural life. Generations, 43(2), 6-8. https://www.ingentaconnect.com/content/asag/gen/2019/00000043/00000002
Magilvy, J. K., & Congdon, J. G. (2000). The crisis nature of health care transitions for rural older adults. Public Health Nursing, 17(5), 336-345. https://doi.org/10.1046/j.1525-1446.2000.00336.x
National Conference of State Legislatures (2011). Home and community-based services: meeting the long-term care needs of rural seniors. www.ncsl.org/research/health/home-and-community-based-services-meeting-the-lon.aspx
Scheibl, F., Farquhar, M., Buck, J., Barclay, S., Brayne, C., Fleming, J., on behalf of the Cambridge City over-75s Cohort Study Collaboration (2019). When frail older people relocate in very old age, who makes the decision? Innovation in Aging, 3(4). https://doi.org/10.1093/geroni/igz030
Schulenburg, N. E., & Coward. R. T. (1998). Residential differences in attitudes about barriers to using community-based services among older adults. The Journal of Rural Health 14(4): 295-304. doi: 10.1111/j.1748-0361.1998.tb00635.x
Singh, G. K., & Siahpush, M. (2013). Widening rural–urban disparities in all-cause mortality and mortality from major causes of death in the USA, 1969–2009. Journal of Urban Health, 91(2), 272–292. https://doi.org/10.1007/s11524-013-9847-2
Skoufalos, A., Clarke, J. L., Ellis, D. R., Shepard, V. L., & Rula, E. Y. (2017). Rural aging in America: Proceedings of the 2017 Connectivity Summit. Population Health Management, 20(S2), S-1. https://doi.org/10.1089/pop.2017.0177
Sörensen, S., & Pinquart, M. (2001). Developing a measure of older adults’ preparation for future care needs. The International Journal of Aging and Human Development, 53(2), 137-165. https://doi.org/10.2190/1r0d-30tc-f4k1-f0dw
The United States Census Bureau. (2019). The Older Population in Rural America: 2012–2016. https://www.census.gov/library/stories/2019/10/older-population-in-rural-america.html
Weirich, M., & Benson, W. (2019, //). Rural America: Secure in a local safety net? Generations, 43(2), 40-45. https://www.ingentaconnect.com/content/asag/gen/2019/00000043/00000002/art00007
