“We’re All Sitting at the Same Table”: Challenges and Strengths in Service Delivery in Two Rural New England Counties

Identification of Functional, Social, and Health Needs of Older Residents in Nonurban Settings: A Community Risk Assessment

“…Thus, the particular measures that inform cluster development were derived from minimally intrusive questions. Using minimally intrusive questions is critical, especially when working with individuals living in rural areas, as there are unique privacy and confidentiality concerns (Carson & Mattingly, 2018). Although using information about income would be preferable, individuals are more likely to provide invalid responses (e.g., "do not know" or "prefer not to answer") to questions about income (Bee & Mitchell, 2017).…”

“…Individuals residing in rural areas are disproportionately older, poorer, and less healthy (Hash et al, 2015) than individuals living in urban areas. Rural-dwelling individuals are also typically characterized as being independent, maintaining close relationships with family and friends (Cohen, 2013), and, thus, often hesitant to ask for or accept help from others (Carson & Mattingly, 2018). In rural regions of the United States, issues with accessing LTSS, continuity of care, and efficiency of healthcare delivery (Menec et al, 2015) can also exacerbate health disparities.…”

Challenges of Delivering Regional and Remote Human Services and Supports

“…Many communities were seen to be distrusting of service staff and the government in general. Inadequate education and employment opportunities further constrains people's willingness to pay for, or demand, services delivered in these areas (Carson and Mattingly 2018).…”

“…A consensus generated in extant literature is that policy criteria often fail to accurately reflect the essential components of service delivery, as well as the unique human, geographic, and other characteristics of remote regions. Policy document analyses conducted in Australia, the USA, and the UK (see -Atterton 2008;Carson and Mattingly 2018;Dew et al 2014) evidence this disconnect between the broader policy objectives and metropolitan-centric operational content. Often, these policy and practice documents fail to acknowledge the barriers to the provision of services impacting workers and participants, partly due to assuming costings and circumstances consistent with urban areas.…”

“…Further, funding timelines reflect serviced hours rather than considering the resources impacts of the precursory relational and cultural needs present in many R&R communities (Massey et al 2013). Scholars lay much of this tension on the funding trade-off between impact and demand as determined by population size (Carson and Mattingly 2018;Weinhold and Gurtner 2014). As such, standard cost/benefit analyses disadvantage rural areas as demand is considered in the context of population density not its severity.…”