This study investigated inpatient psychiatric units in small rural hospitals to determine their characteristics, the availability of community-based services after discharge, and the impact of the new Medicare payment system on these units. METHODS: Unit managers in all rural hospitals with fewer than 50 beds that had a psychiatric unit in 2006 (N=74) were surveyed on the telephone. RESULTS: On average these units had ten beds and 230 admissions per year. Medicare was the major payer (median of 84%). Typical staffing includes no more than one staff member from each category: psychiatrist, psychologist, social worker, counselor or therapist, and nurse practitioner. Common diagnoses reported were depression (74% of units), schizophrenia or other psychoses (42% of units), and dementia or Alzheimer's disease (57% of units). CONCLUSIONS: Hospital staff reported little difficulty obtaining postdischarge care, and most staff clinicians provided outpatient services locally. Thus mental health services infrastructure appears better in these communities than in most rural communities, but it may be weakened by recent closures reported by some units, caused, in part, by changes in Medicare reimbursement.
Over the past several decades, federal policy has made states and communities increasingly more responsible for providing long-term care for older adults. The Community Partnerships for Older Adults, a national program of The Robert Wood Johnson Foundation, saw this as an opportunity to explore new, sustainable ways to meet current and future needs for community-based longterm care. This initiative focuses on collaborative organizational partnerships, a distinctive philosophy of teaching and learning through the exchange of experience between communities, and program learning focusing on known factors promoting organizational sustainability. Using principles that emphasize the development of social capital and collective efficacy, the authors present a case study of the early experiences of this initiative to address the challenges inherent in meeting the growing supportive service needs of older adults. The implications of this multisite community intervention for social work education and practice in aging are discussed.
The pilot study was conducted to test the appropriateness of a nutrition and food security survey and estimate the prevalence of food security and its relationship with dietary intake habits among Somali refugees (n = 35) resettled in the United States. The other main objective was to estimate the association between acculturation and dietary intake habits. The interviews with the Somali mothers indicated that 72% of households were food insecure and, in comparison, the intake of fruits and green leafy vegetables was significantly lower among the food insecure households than among secure households (p < .05). Both of the acculturation indicators used in this survey, living in the United States for four years or more and having English language proficiency, were associated with a high intake of snack items among participants. Future studies examining the influence of food security and acculturation on health outcomes such as body weight are warranted among refugees in the United States.
Higher uninsured rates among rural compared to urban residents have been well documented, but do not adequately provide a full picture of coverage and access to care in rural areas. This study looks at the relative richness of coverage among privately insured rural residents, to determine their rate of ?underinsurance? and whether and how it differs from urban residents. The authors found that even with private health insurance coverage, a sizable portion of out-of-pocket costs is borne by the insured, particularly rural residents. Six percent of privately insured urban residents are underinsured compared with 10 percent of rural adjacent and 12 percent of rural nonadjacent residents. Policy implications for coverage expansion, for providers, and for small businesses are discussed.
People living in rural areas have the same incidence of mental illness but far less access to mental health services compared with people living in urban areas. This brief report describes the workforce of advanced-practice psychiatric nurses (APPNs) and explores their potential to ease the rural mental health workforce shortage. METHODS: National certification data were used to describe workforce characteristics and the rural distribution of APPNs. All nationally certified APPNs in 2003 were included (N=8,751). RESULTS: APPNs were more likely than psychiatrists to live in rural areas. The ratio of APPNs to state rural populations ranged from .06 to 14.9. The mean{+/-}SD ratio of APPNs per 100,000 in the rural population was 3.0{+/-}3.0. CONCLUSIONS: APPNs have great potential to be a solution to the rural mental health workforce shortage. Even so, the number of APPNs must increase and barriers to their full scope of practice must be removed. [Journal Abstract]
Introduction: Childhood obesity rates appear to be more pronounced among youth in rural areas of the USA. The availability of retail food outlets in rural communities that sell quality, affordable, nutritious foods may be an important factor for encouraging rural families to select a healthy diet and potentially reduce obesity rates. Researchers use the term 'food desert' to describe communities where access to healthy and affordable food is limited. Understanding the ways in which the food environment and food deserts impact childhood obesity may be a key component to designing interventions that increase the availability of healthy and affordable foods, thus improving the health of rural communities.
Methods: The food environment was investigated in 6 rural low-income Maine communities to assess how food environments affect eating behaviors and obesity rates of rural children enrolled in Medicaid/State Children
This article by Muskie School researchers assesses the impact of the rural food environment on the eating behaviors and BMI of rural low-income children, using a statewide (Maine, 2009) household survey of parents of children on Medicaid, oversampled in six rural communities, resulting in n=272 for six target communities. The food environment was measured using modified Nutrition Environment Measures Survey in Stores (NEMS-S) for 46 retail food outlets. Multi-variate analysis assessed factors affecting home food environment, child's eating behavior and BMI. Results: Home food behaviors (how often: family eats together, child eats breakfast, vegetables served) and parent food consumption were significantly associated with children's healthy eating behaviors. The only significant predictor of childhood obesity was parent eating behavior. We observed several alternative strategies such as hunting, gathering and buying from local farmers. Parents who drove over 20 miles to shop were found to shop at stores with higher NEMS scores as compared to parents who drove shorter distances. Conclusion: Defining and identifying "food deserts" is not a promising approach to measuring the rural food environment due to long distance trips, careful price shopping, and local, alternative strategies. Strategies to place healthier food in the home should be combined with interventions directed at parents' and families' eating behaviors.
Addressing substance abuse in rural America requires extending our understanding beyond urban-rural comparisons to how substance abuse varies across rural communities of different sizes. The authors address this gap by examining substance abuse prevalence across 4 geographic levels, focusing on youth (age 12-17 years) and young adults (age 18-25 years).
Findings: Rural youth have higher alcohol use and methamphetamine use than urban youth and the more rural the area, the higher the use. Rural young adults living in rural-large areas have higher rates of substance abuse than their urban peers; those living in the most rural areas have nearly twice the rate of methamphetamine use as urban young adults. Rural youth are more likely than urban youth to have engaged in the high-risk behavior of driving under the influence of alcohol or other illicit drugs.
Conclusions: Higher prevalence rates, coupled with high-risk behavior, place rural youth and young adults at risk of continued substance use and problems associated with this use. Rural community infrastructure should be enhanced to support substance abuse prevention and intervention for these populations.
Purpose: This article describes early efforts of four community partnerships in Boston, El Paso, Houston, and Milwaukee to address governance and management structures in ways that promote the sustainability of innovative community-based long-term care system improvements. The four communities are grantees of the Community Partnerships for Older Adults Program, a national initiative of the Robert Wood Johnson Foundation that fosters local partnerships to improve long-term care and supportive-services systems in order to meet the current and future needs of older adults. Design and Methods: We examined community partnership approaches to governance and management, as well as evidence of the partnerships' influence in their communities, by using the conceptual framework of the community health partnerships typology developed by Shannon M. Mitchell and Stephen Shortell. Results: Addressing governance and management issues was critical to the early evolution of community partnerships for older adults. Early partnership experiences, particularly with regard to local funders and media, provide evidence of emerging centrality (importance and influence in the community), which forecasts sustainability. Observation over a longer period is needed in order to see whether early successes will be sustained, particularly once original grant funding ends. Implications: Community partnerships for older adults can become influential positive forces but must invest in adequate governance and management structures early on.
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