Taking care of the elderly in rural Kansas communities is complicated by an already stressed environment challenged with a decreasing population and scarce resources.

Already stretched services are being pulled further to take care of people 65 years old and up who in 2012 made up nearly 14 percent of the country's population. That same population was responsible for 34 percent of health care-related spending in 2012, according to the Centers for Medicare and Medicaid. Personal health care spending per person for those 65 and older was $18,988 in 2012, which is more than five times higher than spending per child at $3,552 and about three times the spending per working-age person at $6,632.

Elder care isn't just about addressing health issues, although those become more extensive as people age. Brock Slabach, spokesman for the National Rural Health Association, said considering the needs of elderly citizens is part and parcel of the work his organization supports in rural communities.

"We like to say that rural communities are older, poorer and sicker," he said. "As you compare the average percentage of the elderly in rural areas against urban, we have a much higher percentage. One statistic I think that's fascinating is every day, more than 10,000 Americans turn 65 years old, and one in four of those American seniors live in small towns or rural areas."

An easy way to encapsulate the challenges meeting the needs and the challenges meeting those needs of the elderly in rural areas doesn't exist.

Rachel Monger, vice president of government affairs for LeadingAge Kansas, an organization that represents nonprofit aging service providers statewide, understands those problems well. Sixty percent of LeadingAge's members are in communities with populations below 4,000.

When asked if problems are at a critical stage, she was blunt.

"Frankly, unless we do something drastic very soon, yes it will be because it’s our rural parts of the state that are aging the most and the most rapidly," Monger said. "The staffing issues that we’re seeing, the closures that we’re seeing of nursing homes, all of those issues are accelerating and will continue to."

Some communities aren't well-fortified to address needs, Monger said. Nearly all LeadingAge members provide long-term care along with other services, such as assisted living, home care, meals and transportation. One way to address scarcity of services is to diversify and provide many of them through one organization, she said.

Slabach said NHRA breaks concerns about care into several categories. One of those is social isolation.

"Statistics show this can afflict up to 43 percent of older adults," he said. "This is also directly linked to obesity, and smoking, that often lead to heart disease, stroke, dementia and disability. Social isolation is one of those root causes, if you will, that can cascade into those other areas."

A second area is infrastructure, which speaks to a wide array of issues, including hospitals, safe and affordable housing, transportation and broadband internet.

"The lack of these things can make it difficult to remain at home," Slabach said. "A lot of elderly want to age in place. They don't want to leave their rural community. They don't want to have to move to Wichita or Topeka or Hutchinson.

"Deinstitutionalization has been a goal of many Medicaid and some Medicare programs now, which we understand in the long run may be cheaper than putting people in a nursing home," he said.

The structure in place to care for seniors and others in a rural county is of critical importance to Lincoln County Hospital CEO Steve Granzow. Lincoln County, with a population of about 3,000 people, he said, faces the typical challenges of rural areas. It does, however, have a good infrastructure with support for the elderly, including a Meals on Wheels component, a long-term care facility and transportation options, he said. 

Granzow serves on a task force that includes others focused on health in the county, and the members have been working to identify needs and coordinate care.

Both long-term care and in-home support services are critical in Lincoln. The city's leaders currently are working to support the long-term care facility in their town, including efforts to make management more local. An out-of-state owner currently manages the facility, which is owned by the county. It's a resource they don't want to lose, he said.

"If we can't care for them here, then they may have to put them in a home 30, 50, 60 miles away," Slabach said. "They don't have that old safety net that they had before because it makes it more difficult for family to visit on a regular basis."

The concept of aging in place can be especially challenging in rural areas, Monger said.

"With the business model and reimbursement, it's harder to do the home and community-based service part," she said. "People are so much more spread out. Staffing is a really big challenge."

But on the other hand, the movement to provide services to let the elderly age in place is one of the bright spots Slabach sees in what's happening, including incentivizing those changes through Medicare, a larger payer for aging services.

The next area of concern is health care and social services, of which that important in-home support is a large part, he said.

So is access to specialists, such as cardiologists and pulmonologists, which seniors need to treat typical aging health issues. Included also is access to mental health care, Monger said, which is an extremely tough issue everywhere.

Slabach said the providing access to mental health care is one of the top two most challenging issues that rural communities face. The second is emergency medical services.

Nutrition services are the next "big bucket" the NRHA considers, he said.

"Rural seniors lack fresh access to food, and they have difficulty preparing those food items at home," Slabach said. "Meals on Wheels is not available in many rural communities, as well."

Kansas is not unique in the challenges seniors face in rural areas, Monger said. Movement is being made to beef up telemedicine services, which can get access to remote areas and can include psychiatric services, along with physical health services.

But no one, she said, has found that silver bullet that offers answers for struggling rural communities.

Solutions, Slabach said, will come through collaborations and partnerships.