home

Creating Support Systems for the Rural Elderly

Given the large number of elders in rural communities and the typical lack of formal health and human service options, one of the most important things that can be done to improve the quality of life for rural elders is to create stronger informal support systems and/or supportive relationships. Rural elders often exhibit a fierce sense of pride and independence, wanting to live their lives out in their own homes and communities. Yet, without supportive relationships, family, friends and confidants who befriend them, check in on them, and help meet their daily living needs (eating, bathing, taking medication, exercising, shopping)-they may end up frustrated and bored in a nursing home long before the time when skilled nursing care is required.

Korte (1990) emphasizes that the well-being of older adults is dependent on "the great triad" of health, financial security and social relationships or "health, wealth and friends." He goes on to emphasize that the state of informal, voluntary social ties is more critical to the well-being of elders than the more formalized organizational ties in rural communities. The informal social network-its size, the level of activity within it, and the level of satisfaction with the relationships-turns out to be predictive of well-being in older adults.

Weiss (1982) reminds us that multiple relationships are needed for positive well-being. Weiss identifies intimacy and sociability as two important needs: intimacy requires a confidant with whom important confidences and concerns can be shared; sociability requires the presence of and involvement with peers or a peer group. Thus, it can be most important for older adults to find ways of developing close, confidant-type relationships as well as getting linked with peers who simply share their interests and activities.

Linking peers who share interests and activities is considerably easier than establishing the close, confidant relationships which are so important to elders. Matthews (1986) points out that the significance of a relationship is in part a function of its duration. In other words, it may be difficult for a new-formed friendship to ever approach the significance of a friendship which formed years ago and evolved through a variety of experiences over time. Thus, it's not just a matter of bringing people together in situations and settings where they can interact with each other. It's not as easy as bringing able-bodied elders together with frail elders who need their help or bringing new elderly immigrants in the community together with old-timers who have lived out their lives in the community.

If it's not just a matter of bringing elders together, then what can rural communities do to strengthen the informal networks of older residents? Korte (1990) highlights three model efforts to strengthen support networks and enhance the well-being of elders in rural areas.

The Friendly Visitor Program. The Friendly Visitor Program is designed to supplement the social network of isolated elders by providing them with a weekly volunteer visitor. Emphasis is placed on meeting the intimacy needs (best met by confidants) and the sociability needs (best met by a peer group) of elders in the community. Volunteer visitors are trained to 1) assess each of these needs in the elders they serve, and 2) make a conscious effort to foster new contacts and relationships in the community. Initial evaluations of the program have shown greater improvement in a measure of need fulfillment on the part of clients and considerable enthusiasm for the program on the part of clients and volunteers.

Local Issues and History Forum. In North Carolina, a program was designed to bridge the gap between old-timers in the community and recent elderly immigrants. A local issues and history forum was offered for older adults in several small towns as well as some larger cities. The forum consists of a weekly series of programs on the history of the local area as well as the issues-political, social, economic, environmental-that face the local community. It involves old-timers as resources who know the town's history and it appeals the new comers who are eager to learn more about their new community. The program seems to have fostered significant social relationships between old-timers and newcomers in communities where it has been tried.

Social Linkages with Other Communities. Rural communities facing significant population declines experience unique challenges in terms of fostering social relations among the elderly. In small, dying towns of rural Kansas, elderly residents have responded to efforts that involved renewing relationships with elders in adjacent communities and increasing their identification with those other towns, thus expanding the geographical scope of their networks in response to the relationship losses occurring locally. A critical component of this type of program is that of providing transportation of elders between rural communities. Local churches or area agencies on aging might be most helpful in providing this transportation and fostering social relations among the elderly in small rural communities.

Newhouse, Ellis and Burton (1988) outline another effort to strengthen the support networks of rural elders, building on the extensive system of Extension Homemakers located in rural communities. Extension Homemakers from five rural Missouri counties were recruited and trained to be information providers to informal caregivers of older adults. Referred to as Volunteer Information Providers (VIPS), the Extension Homemakers participated in three, seven-hour training sessions addressing the following topics: normal and abnormal aging, communication and stress management, personal care, health care and community resource access. The VIPS then worked directly with hundreds of informal caregivers in the five Missouri communities. There were several positive outcomes: the program delayed institutionalization for some rural elders; it increased the self-esteem and sense of accomplishment in the volunteers; and it helped to allay the volunteers' fear of their own aging process. Most important, caregivers were more receptive to help offered by the VIP than from professionals in the community.