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Giving voice to rural elders on health care 

Graduate student Rebecca Wells helps elders be heard on dwindling health care choices in rural South Carolina

When Bamberg County’s only hospital closed in mid-2012, residents realized that they would have to travel longer for care, risking higher odds that a minor mishap could turn fatal.

Rebecca Wells, a third-year student in the dual master’s program with the College of Social Work and the School of Public Health, lent a greater voice to their concerns through a series of interviews earlier this year. Her study highlights the flip side of metropolitan growth: Those remaining in rural areas perceive that their isolation has created greater risks. Health problems are likely to cost them more time and money, and delays in reaching a hospital can mean a more severe outcome or an avoidable death.

Wells presented her findings at the Gerontological Society of America’s annual meeting in New Orleans in November of 2013.

According to the American Hospital Association, rural hospitals have been struggling with the high cost of replacing old medical equipment and retaining qualified personnel. They also tend to serve older populations, who provide lower reimbursement rates via Medicare.

The Bamberg County Hospital and the Barnwell County Hospital, 23 miles apart, both went into bankruptcy after attempts failed to form a regional hospital system. Bamberg’s hospital closed and Barnwell’s was later bought by an Atlanta company.

Bamberg County is among the state’s poorest counties. About 31 percent of its residents were below the poverty line in 2011, nearly twice the poverty rate for the state, according the U.S. Census Bureau. The gap was especially wide for older residents: About 28 percent of those aged 65 or older were in poverty in Bamberg County, compared with 11 percent of elders statewide. In a county where 61 percent of residents are African American, the poverty rate for blacks was 38 percent, compared with 17 percent for whites.

Those demographics led Wells to interview 14 African American women who were age 65 or older. The interviews were conducted last spring at a senior citizen center.

“The problems they discussed were not just confined to older people,” Wells said. “It’s children, middle-aged people, people with disabilities.”

She asked them general questions about how they used the health care system, including how often and under what circumstances they had gone to the local hospital. She asked them how the hospital’s closing affected them personally and the community as a whole. She found the hospital had been a primary location for certain tests, such as mammograms and colonoscopies, and emergency care. Those interviewed typically lived within 15 minutes of the former hospital in Bamberg, while a trip to Orangeburg was 30 minutes.

Meanwhile, gestures of common courtesy among neighbors had become fraught with unseen costs.

One woman, 73, found a diabetic neighbor who had collapsed from insulin shock in his home around 4 p.m. She called 911 and followed the ambulance to Orangeburg so he could have a ride home if the hospital decided to release him. She waited in the emergency room. When doctors decided to keep him overnight, she was faced with starting a half-hour drive home at 11 p.m.

Residents lucky enough to have minor medical emergencies occur during weekday business hours can visit their local doctor or clinic. Otherwise, they have to drive to Barnwell, 23 miles southwest, or to Orangeburg, 22 miles to the northeast. And if they choose Barnwell, they might be transferred to the larger hospital in Orangeburg. Anything major requires a trip to a Columbia hospital, putting them 70 miles from home.

“All of that takes gas money,” Wells said. “A lot of families can’t afford to be running back and forth.”

Wells said her independent study project has strengthened her interest in rural health issues. She worked under the supervision of Dr. Mindi Spencer, a professor in the Department of Health Promotion, Education, and Behavior in the Arnold School of Public Health. Wells has also been helping to write a chapter with Dr. Spencer and Dr. Kristina Hash, a social work professor at West Virginia University. The book, Aging in Rural Places, will be published next year.

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