Where to turn? Long-term care of the elderly challenging in rural areas

Posted 6/30/22

At the Powell Valley Healthcare emergency department, it’s not uncommon to have fatigued caregivers bring their elderly loved ones in late in the evening, hoping to get them into the Powell …

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Where to turn? Long-term care of the elderly challenging in rural areas


At the Powell Valley Healthcare emergency department, it’s not uncommon to have fatigued caregivers bring their elderly loved ones in late in the evening, hoping to get them into the Powell Valley Care Center. What they find is that long-term care for the elderly is not so easy to find. 

“A lot of folks wait too long. They’re absolutely exhausted. We see it a lot with married couples, especially cases involving dementia,” said Karen Parker, director of The Heartland, an assisted living facility on the Powell Valley Healthcare campus. 

There are a number of options the elderly and their caregivers can pursue, but the system of services for the elderly is stressed. 

Lack of funding, which has always been a problem, remains a barrier, but staffing shortages have come to the forefront of the issue recently. 

Rural communities offer fewer amenities, such as shopping opportunities, and the jobs aren’t always offering competitive salaries — all of which makes recruitment and retention of employees difficult. 

Careers in health care are “not easy jobs,” said  Kim Deti, public information officer for the Wyoming Department of Health. “They can be very rewarding, because you’re helping the people who really need to be helped. But they’re not always high paying jobs. And there’s a lot of competition for those people.” 


Acute problem

Wyoming’s population is getting older. In the decade between 2010 and 2020, the state’s senior population grew by over 44%, which was the second highest in the country, according to research from AginginPlace.org, an online resource for communities and services for seniors. 

The demand for senior services is growing, and the staffing shortages are limiting Wyoming’s capacity to serve them. 

“It’s not enough to have the beds. You need to have the people to care for the patients and clients,” Deti said. 

Staffing issues are nothing new in health care, but the problem could be getting “more acute” lately, she said.

Powell Valley Care Center has been relying on a lot of traveling nurses to fill open positions at its care center. These are nurses contracted to work temporarily in the area. They are much more expensive than permanent staff, and many health care professionals choose to work as travelers for the higher salaries. Those contract labor costs, however, are a big drain on a hospital’s budget. 

Unable to recruit more staff or pay for more travelers, the care center has had to limit the number of residents it can take in. 

Michelle Petrich, Powell Valley Care Center administrator, said the center assesses patients who apply to determine if it is the best option for their needs. Priority is given to those who don’t have other safe alternatives — something Petrich calls a “triage system.” 

For those who can’t be admitted into the care center, Petrich said PVHC has case workers who help the patients and their caregivers find options. 

In-home care providers are an option, and since most people want to stay at home as long as possible, it’s often an appealing one. 

Deti points out those businesses struggle with the same staffing issues as all providers in health care do. 

“Families face some tough situations,” Deti said. 

Some in-home providers have contracts with Medicare, but others don’t. This puts in-home care options out of reach for many seniors. 

“How do our seniors pay for that?” asked Linda Dalton, director of the Powell Senior Center. 

Dalton told the story of one client of the center who wanted in-home care for his dying wife. She wanted to be at home when she passed, and he wanted to be with her when she did. Unable to find in-home care for her that they could afford, she had to go to hospice in Cody. The husband wasn’t able to drive to Cody every day to see her. 


Planning for options

People working in elderly care say one of the biggest mistakes people make is waiting until there’s a crisis situation before coming up with a plan for long term care needs. 

“Retirement doesn’t always turn out the way you expected. Your health may fail, or other circumstances change,” Parker said. 

Many communities, including Powell and Cody, have active senior centers. While they aren’t qualified to provide medical care, they provide meals and social activities. 

“It makes the family feel better because their loved ones aren’t sitting alone at home,” Dalton said. 

Senior centers also have a wealth of resources to help the elderly and their families make plans for the future when independent living might cease being an option. They provide transportation assistance, client advocacy services and preventative wellness education. 

Assisted living facilities — like The Heartland — are another option. Unlike the care center, assisted living facilities provide support for elderly residents who might need more assistance in daily needs but don’t need full-time custodial care.  These facilities have private apartments, and they provide meals and activities. 

The Heartland also coordinates with the Powell Senior Center for social activities, classes and other resources.  

“You don’t have to give up your total independence to get the assistance you might need,” Parker said. 

Medicare won’t cover assisted living expenses, so residents of The Heartland are self-pay or have private insurance. 

However, Parker said, it’s an option that can take a lot of the strain off caregivers, the stress of which can be detrimental to the caregivers’ health as well. 

The Heartland recently conducted a survey of its residents, Parker said, and found that 100% of the residents would recommend the facility. 

Sometimes assisted living facilities provide temporary care. For example, a person who breaks her hip might have trouble taking care of herself while she recovers from surgery. 

“They’re not quite ready to go home and do the things they were used to doing,” Parker said. 

She said the option is also good for getting someone used to a lifestyle change.

“It’s an opportunity to dispel some of the fear,” she said. 

An assisted living facility is also good for caregivers, as it takes the pressure off of them. 

The Heartland is planning to hold respite care events to which caregivers can bring their elderly loved ones to socialize for the day with other seniors, which will give the families some time off. 

There are many challenges to providing long-term care for the elderly in the Big Horn Basin, as with any rural community, and some of those issues aren’t going to go away. 

Sparse populations don’t generate the kinds of revenues that would support the opening of many more facilities that pay competitive wages. Even if the labor market were to improve, recruiting and retaining employees to rural Wyoming isn’t likely to ever be an easy task. 

For all the difficulties, at least there are options, and some early planning can make it a lot easier to navigate them.