Examining Barriers to

Healthcare for West Virginia’s

Rural Elderly
R. Turner Goins, Ph.D.
Sara Jane Gainor, MBA
 BACKGROUND
• During the 20th century, the number of persons in
the U.S. under 65 years has tripled while those
65+ have increased by a factor of 11.
• Today, 1 in 8 Americans is 65 years or older.

• By 2020, the ratio will be 1 in 6.

• Those 85 years or over are the most rapidly

growing age group.
 BACKGROUND
• 25% of all Americans live in rural areas.

• Of those 65+, 26% live in rural areas and 24% live in

urban areas.

• In 2000, 15.6% of West Virginia’s population was 65

years or older (2nd highest).
• In 2025, 24.9% of West Virginia’s population will be 65
years or older.

• 56% of West Virginia’s elderly population live in rural

areas.
Percentage of the population age 65 and older, by state, 2000

Less than 10%

10% - 12.9%
13% - 14.9%
15% or more
 BACKGROUND
Rural elderly populations have often been viewed as
especially vulnerable with respect to healthcare access…

 High chronic illness and disability

 Lower socio-economic status
 Poorly developed/fragile infrastructures
 Distance/terrain
 Availability of transportation
 Limited trained labor pool
 Rural culture
 STUDY OBJECTIVES
To understand among community-dwelling
rural elderly:

 What are the barriers to healthcare

access?
 How do they cope with prescription
medication costs?
 What are some solutions to addressing
these barriers?
 % 65 Median
Total years or % % household
  HPSA population older female white money income

Grant No 11,299 15.3 50.6 98.3 $27,808

Pendleton Yes 8,196 17.8 49.7 96.3 $27,366

Monroe Yes 14,583 15.4 55.6 92.7 $26,592

Summers Yes 12,999 19.9 51.1 96.6 $21,664

Roane Yes 15,446 14.8 50.5 98.6 $23,846

Jackson Yes 28,000 15.3 51.3 98.7 $30,739

West Virginia     1,801,916 15.3 51.4 95.0 $27,432

Source: US Census Bureau 2001. Profiles of general demographic characteristics: 2000 Census of the
Population and Housing, West Virginia
 METHODS
DATA
– During spring 2001, 13 x 90 minute focus groups with 101
elderly were held and tape recorded
– Trained facilitator conducted the focus groups
– Trained research assistant took observational notes
– Self-administered survey

RECRUITMENT
– Local radio, news stations, printed information in
newspapers, church bulletins, senior centers, and grocery
stores
 FOCUS GROUP QUESTIONS
• Do you believe your healthcare needs are being
met? If no, why not?
• What kind of help do you need to address these
problems?
• What are the barriers/problems that you experience
in getting the care you need?
• How do you cope with the cost of prescription
medication?
• What are the solutions to these barriers/problems?
 Data Analysis
• Audiotapes transcribed and cross-checked
• Text reduced to specific thematic categories
• Coding dictionary constructed containing key words that
represented topics
• Transcription and coding dictionary inserted into QSR N5
software
• Text coded according to the agreed coding system
• Tables created to list main themes, sub-themes, and all related
quotes to each sub-theme
Demographic characteristics of
focus group participants

Frequency Percent
Age
61-70 30 31.6
71-80 41 43.2
81 or older 24 25.3
Gender
Male 21 22.1
Female 74 77.9
Race
White 93 97.9
American Indian 1 1.1
African American 1 1.1
 Demographic characteristics of
focus group participants
Frequency Percent
Marital Status
Currently married 31 33.3
Widowed 51 54.8
Never married, divorced, separated 11 11.8
Educational Attainment
Grades 1-8 22 23.4
Grades 9-11 7 7.4
High school graduate or GED 44 46.8
Beyond high school 21 22.3
Annual Household Income
Less than $10,000 24 29.3
$10,000-$14,999 19 23.2
$15,000-$24,5000 19 23.2
$25,000 or greater 20 24.4
BARRIERS TO HEALTH CARE

(1) Limited Healthcare Supply

(2) Lack of Quality Care
(3) Transportation Difficulties
(4) Social Isolation
(5) Financial Constraints
 LIMITED HEALTHCARE
SUPPLY
• Need for more doctors
– Recruitment, retention, aging of local
doctors, and limited choices

• Resistance to international medical

school graduates
• Limited long-term care options
• Out-migration of younger people
 LIMITED HEALTHCARE
SUPPLY
“It’s like we say, we would like to see more
doctors, more specialists, in our area. Like
we all think, they’re going to the bigger
cities where they make more and their
children go to schools that are better or
something for their children.”
 LIMITED HEALTHCARE
SUPPLY
“They’re not supposed to see a PA
continuously year after year and that’s what a
lot of people are doing. I think that’s the
barrier to getting better healthcare
because your doctors don’t know what’s
going on…I don’t feel like seeing a PA every
time you go in is a good way to go.”
 LACK OF QUALITY CARE
• Inaccurate diagnoses
• Lack of trust
• Not taking enough interest
• Lack of sensitivity
• Poor communication
• Difficulty getting an appointment/long
waiting time
 LACK OF QUALITY CARE
“I’ve just surrendered to travel out-of-town
and spend the money to get to it where I
think I have confidence in the care. At
home they was treating me for heart
problems and I got to the Mayo Clinic and
I don’t have heart problems. I’ve got
prostate cancer, serious, and they fixed
it.”
 LACK OF QUALITY CARE
“When I have my stroke, it took me 2 days
to convince my doctor that I was having a
stroke. I drove into town and asked him, ‘is
there anyway that you can tell?’ He said,
‘well, no. I don’t see any symptoms that
you are describing to me.’ So, I had to go
home.
The next day I saw that my mouth was
drooped and my speech as slurred, I got
back in the car and drove into town and
showed him. Then, he (doctor) said, ‘ok, go
across the mountain and I’ll have a
neurologist meet you because we don’t have
a neurologist here.’ … it’s just one of those
situations where because we choose to live
where we do we have to make certain
choices and one of those is the healthcare
providers that are here.”
 TRANSPORTATION
DIFFICULTIES
• Travel out-of-town for specialty care
• Distance
• Terrain/weather
• Poorly marked roads
• Limited public transportation
• Roads in poor condition
• Unable to drive
 TRANSPORTATION
DIFFICULTIES
“I feel like the biggest need in this county
is transportation. We have so many
seniors here who are not able to get to the
doctor for medical things without
transportation. Transportation is really a
problem in this county. It’s rural.”
 TRANSPORTATION
DIFFICULTIES

“On account of the snow they close the

mountain down, they close the road and
then you have to call Medivac or whatever
and they come with helicopters and take
you out.”
 SOCIAL ISOLATION

• Pride/reluctance to ask for help

• No telephone
• Not aware of programs/services
• Too frail/physically isolated
 SOCIAL ISOLATION

“Some people need telephones and

don’t have them. If there was some
way that they could get in touch with
people who might help them.”
 SOCIAL ISOLATION

“Most of the people just don’t want to

ask for help or too shy to ask for help.”
 FINANCIAL CONSTRAINTS

• Services too costly

• Inadequate health care coverage

– Medicare not enough
– Not poor enough to qualify for Medicaid

• Too much paperwork

• Prescription medications too costly

 FINANCIAL CONSTRAINTS
“Well, what do you do when you’re just in the
middle?”

“…if you income falls between the cracks you

can’t afford to pay it…we’ve got the middle
zone of people. Got too much and can’t get
the help for free and don’t have enough to pay
for the help.”
 FINANCIAL CONSTRAINTS

“Just like when I came from the hospital. I

believe, it was $200 my medicine was, just so
many prescriptions. I mean, I have so many
prescriptions. I think there ought to be some
laws made for the senior citizens, especially
people who takes a lot of medicine.”
 COPING WITH COST OF
PRESCRIPTION MEDICATIONS
 Reduce dosage or do without
 Reduce food expenditures, do without
heat, or late on rent
 Family assistance
 Use of supplements
 Shop around for cheapest prices
 Use of the VA
 Physician assistance/assistance
programs
 COPING WITH COST OF
PRESCRIPTION MEDICATIONS
“Sometimes they do without and sometimes they pay
out for medicine they think they need and do without
something else and it makes it really hard in the
wintertime when they have fuel and food and then
they have to have medicine. I’ve heard a lot of people
say it is either food or medicine and they’ll do
without one or the other. Most of the time they do
without food to buy their medicine.”
 COPING WITH COST OF
PRESCRIPTION MEDICATIONS

Sister A: “The difference between us though is she

has to pay for her medication and I’m…”

Sister B: “She’s on Medicaid.”

Sister A: “…I’m on Medicaid along with my

Medicare and I just have a co-pay. So it’s easier
for me to get the medications and give it to her.”
 SOLUTIONS OFFERED

 Develop foundation for physician retention

 Better support of local hospital
 More involvement from community
 Better informed physicians
 More screenings/health fairs
 SOLUTIONS OFFERED
 Reduce social isolation by helping others

 Encourage churches to help more

 Become a more educated consumer

 Expand current bus routes

 Well-placed road signs

 CONCLUSIONS
• Rural elders cite financial constraints as the most
dominant barrier to accessing needed health care

• They are using unique strategies to cope with the

cost of prescription drugs.
• Access to health care can be subjective and can
vary from state-to-state, region-to-region, and
county-to-county.

• Qualitative methods can inform the study of rural

health by capturing an individual’s interpretation of
health care access.
 Acknowledgements

 Claude Worthington Benedum

Foundation of Pittsburgh, PA
 Study participants
Contact information:
R. Turner Goins, PhD
WVU Center on Aging
Medical Center Annex
PO Box 9127
Morgantown, WV 26506-9127
Email: rgoins@hsc.wvu.edu
Phone: (304) 293-2081