|
Older Americans in Rural Counties
| Largest Population of 65+ |
% |
| McIntosh County, N.D. |
34.2 |
| Kalawao County, Hawaii |
32.0 |
| Llano County, Texas |
30.7 |
| McPherson County, S.D. |
29.6 |
| Divide County, N.D. |
29.5 |
| Largest Population of 85+ |
% |
| McIntosh County, N.D. |
6.6 |
| Hooker County, Neb. |
6.3 |
| Divide County, N.D. |
5.7 |
| Smith County, Kan. |
5.5 |
| Osborne County, Kan. |
5.3 |
|
The definition of rural used here is the Office of Management of Budget's definition of outside core based statistical areas. For more on this designation, see "Census Bureau to Track Both Metro and 'Micropolitan' Areas."
Fallout From Aging Economies
What is the effect of aging on rural areas? That depends on whether they are the kind that retirees seek or the kind that frail elders return to. The latter places are the ones hurt by aging. In these rural locations, typically places without natural amenities whose economies have been weakened by the loss of agricultural or mining industries, most older people stay where they are from retirement on. Like others in the towns, they tend to have low incomes. They rely on Social Security and Supplemental Security Income and, with more physical ailments than older people in urban areas, on Medicaid and Medicare.
Health care then becomes an important industry for these towns, and the Medicare dollars that older people dispose of become a major source of economic activity. Medicare accounts for anywhere from 40 percent to 90 percent of rural hospitals' revenue, according to Judith Stallmann, professor of agricultural economics and rural sociology at the University of Missouri. As the oldest people in small towns die, the flow of outside medical dollars into the community declines, in some cases rendering rural hospitals unviable. What this does, said Stallmann, is decrease services, not only for the elderly in that county but for everyone, and decrease jobs. "So it's not just an elderly issue," she emphasized.
Cutbacks also ensue in local government. Old people in rural areas have high rates of home ownership. When they die, there are rarely newcomers to buy their houses. Houses remain vacant, deteriorate, and lose value, driving down property taxes. The purchases that the older people made — groceries, drugs, toiletries, and clothing — cease, causing sales taxes to decline. Yet the fixed costs of offering basic public services that towns must continue to provide do not decline.
"The only way you can cut your costs with street lights is to turn them off at 3 a.m. or turn them off in some sections of town. What's the chance that all the elderly who died lived in the same place? And do you really want to turn your street lights off at 3 a.m.?" asked Stallmann, summarizing public officials' limited options.
Strategies
Small towns with large but declining populations of older people have some options. Rathge's suggestion is one: Recruit more older people, but appeal to the younger, healthier, and wealthier among them. Research by Stallmann and her colleagues shows a net benefit to communities that do this. She suggests marketing at high school reunions. People who came from the area, she said, know the lifestyle and might go back.
Another option is innovation — using creative approaches and technology to solve problems. Towns can develop what Stallmann terms "regional retirement centers," which attract retirees from the small towns in their own and surrounding counties. These towns have hospitals and a few doctors and some shopping, "so they're getting a critical mass."
Rathge too endorsed the regional approach. Rural areas, he pointed out, are already confronting the facilities problem with school consolidation. Among the technological innovations he cited that make regional health facilities viable are telemedicine, whereby medical specialists located in urban areas review digital images of X-rays and other patient records and discuss follow-up and treatment of patients with paraprofessionals in rural hospitals or clinics. Closed heart surgery performed by the daVinci robot but guided by an off-site surgeon is another such medical advance.
But while he feels that facilities — from nursing homes to basic care units to congregate living facilities — should be regional, Rathge advocates expansion of home-based services. "Seniors want to live in their own homes. And when they need help and assistance because of mobility issues, they still want to have those services provided to them in their homes," he said. "Most policymakers haven't caught on to that."
Breaking Out of the Older Mindset
The most promising economic strategy for aging, shrinking rural areas would seem to be a combination of recruitment, creative thinking, and technological advances. The obstacle is conceptual: It boils down to changing the way people think about older people and recognizing the differences between the current generation of healthier, well-educated older people and previous generations. "Policymakers see seniors as an economic drain as opposed to an asset," said Rathge.
"We're not talking about the Depression generation anymore, and the disposable income of these folks is pretty impressive." But, he said, the refrain from lawmakers is familiar: "The first thing they start thinking is 'We'd have to build facilities, and we'd have to do this and that.' And what's interesting is, when you entice a new industry, you have to do exactly the same thing."
Allison Tarmann is a senior editor at PRB.