Rural healthcare initiatives in spinal cord injury - Spinal Cord Injury, Part 3

American Rehabilitation,  Spring, 1997  by Kristofer Hagglund,  Daniel L. Clay

• E-mail
• Print
• Link

For a variety of reasons, people with spinal cord injuries (SCI) in rural areas have been underserved by the healthcare system.

Not only are there fewer healthcare providers -- particularly providers trained in rehabilitation or spinal cord injury -- family practitioners and other generalists in rural areas often have less experience with medical management f spinal cord injuries than do their urban counterparts; this lack of experience is due to the fact that people with SCI previously remained close to tertiary care centers to receive essential medical care following injury.

Similarly, behavioral healthcare has been fragmented and inconsistent. Few mental or behavioral health providers in rural areas are familiar with the unique challenges of spinal cord injury. In failing to recognize these challenges during diagnostic evaluation and treatment planning, persons with SCI have been treated ineffectively and/or inappropriately.

Other impediments to quality healthcare include transportation limitations, physical/architectural barriers, attitudinal restraints, and lack of knowledge about the specific needs of people with SCI in rural America. In spite of these obstacles, individuals with SCI and other disabilities are exercising their right to choose where to live and, increasingly, they are choosing rural communities.

Accurate estimates of the number of rural dwellers with spinal cord injury are not available, but perhaps as many as 13 million rural Americans have permanent disability of some form. The Breaking New Ground Resource Center (BNGRC) estimates that there are approximately 4,500-6,500 farm/ranch families with a member with SCI.[1] Although the healthcare delivery system has been slow to respond to the unique needs of this population, programs that may improve the quantity and quality of healthcare for persons with SCI in rural areas are being developed. These programs are not typically specific to the needs of persons with SCI, but are usually designed for individuals with a variety of disabilities.

Most rural healthcare initiatives operate on a state and/or local level (sometimes with financial support from federal agencies) and the reader is encouraged to contact local resources (e.g., Center for Independent Living, library, county commission) to identify available rural healthcare programs.

Barriers to Quality Care in Rural America

The major healthcare concern for persons with SCI in rural areas is access to high quality, least restrictive care. Lack of access to knowledgeable providers and adequately staffed and equipped facilities increases the potential for unnecessarily compromised quality of life, including reductions in independent functioning, productivity, and life satisfaction.

The obstacles to healthcare access in rural areas have been well documented.[2] Local, state, and federal government agencies have begun to focus on overcoming these barriers to provide more comprehensive and effective services.[3] This task has been enormous, however, given the disproportionate number of rural people who are poor[4] and the lack of financial resources in rural areas. The difficulties the general population experiences in accessing quality healthcare are compounded by the challenges associated with a disability. A previous needs assessment in rural Arkansas, for example, revealed the most significant problems encountered by persons with disabilities included economic limitations, unemployment and underemployment, restricted transportation, and healthcare shortages.[5] A survey by the Breaking New Ground Resource Center revealed that more than 30 percent of farmers and ranchers with SCI purchased and obtained service on their wheelchairs and other mobility aids more than 100 miles away from their homes. Additionally, approximately 34 percent lived more than 51 miles from rehabilitation services.[1]

Passage of the Americans with Disabilities Act (ADA) in 1990 is facilitating removal of barriers to healthcare, employment, transportation, and other important domains of life, but application of ADA to rural areas is slow and will take many more years before full compliance is obtained. There is sparse empirical data about the extent or impact of physical, educational, financial, attitudinal, and other barriers for persons with SCI in rural America. Nevertheless, anyone who lives in or travels to small towns in rural America will see that wheelchair accessible housing, shopping, recreational facilities, and public facilities are uncommon. The BNGRC study found that farmers and ranchers with spinal cord injuries were frequently unable to participate in previously enjoyed social and community activities, such as church or agricultural organizations, because facilities were physically inaccessible.[1] Furthermore, the continuing economic crisis in rural America has left many main streets with empty buildings. With the migration to urban centers, there is an increasing scarcity of resources for implementing changes to accommodate persons with SCI.