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Livable Appalachia: Access to Healthcare in Rural Areas


Adding to poverty, lack of adequate housing and transportation, and food insecurity, the rural areas of Appalachia face problems with access to adequate and appropriate health care. Efforts to combat those issues were highlighted recently in the continuing series—Livable Appalachia—hosted by AARP Virginia, AARP North Carolina, and AARP Tennessee.

Dr. Virginia Templeton, executive director of Memory Care based in Asheville, N.C., began the webinar by featuring a unique pilot program of providing foot care in conjunction with the memory care currently being offered to residents in rural areas.

Templeton explained that the stigma of seeking memory care is tempered by the foot care component.  Foot care, she said, gives health practitioners a window into other health issues such as arthritis, diabetes, and heart disease. Thus, they can make appropriate referrals for clients to get needed services.

The pilot program, which Templeton said she hopes can be extended, has opened lots of doors for education, services, and other kinds of collaboration.  Using their mobile unit, they are able to reach out into communities at hub sites such as churches and community centers to provide easy access.

Faith-based nursing was once known as parish nursing, but to be more inclusive of all faiths and spiritual practices the name was changed some years back.  Like Templeton’s program, this is another grassroots program, said Teresa Darnall, assistant professor and nursing curriculum coordinator at West Virginia Junior College. She described the faith-based nurse role as being “a lot nurse but a little bit social worker.”

Darnall explained that she is not a home health nurse, nor a hospice nurse or a public health nurse. In her role as a faith-based nurse, Darnall is routinely in people’s homes making sure there is food in the refrigerator and heating oil in the tank.  She makes sure they are connected with their federally qualified health centers or public health units in order to be able to get needed primary care. Her task is to keep people in their homes with the health care they need.

Darnell said faith nursing is a specialty practice with its own scope and standards.  While all nurses in training learn about the spiritual care of a client, they often end up focusing on the physiological aspects of care.  Faith-based nurses seek a more holistic approach keeping in mind psychological wellbeing, which can manifest into physical problems which interfere with the community.  So, it is integral, she said, to look after all aspects of the person.

Sam Rasoul, who represents the 11th district as the delegate to Virginia’s General Assembly, sits on the Joint Commission on Health Care and the Labor Health Commission. He has served as the vice chair of the Health Committee in the House of Delegates.  He has experience as a licensed nursing home administrator and still does consulting in that world.

Rasoul was instrumental in ushering in the PACE program—Program for All-inclusive Care for the Elderly—for individuals who are otherwise nursing home eligible but receive care in their home. 

Keeping people independent and as safe as possible in their homes has been the focus of a lot of work Rasoul has done focused on healthcare policy through his office in the past several years. One piece of legislation he has introduced is the caregiver tax credit, which passed out of committee but was not funded.  The valuation of the work that unpaid caregivers perform is in the billions of dollars, so he said he will continue efforts to get tax credit legislation passed.

Rasoul raised the point that political apathy is an opportunity for political activists.  He said so few people contact legislators about issues that constituents who do contact their lawmakers have a disproportionately greater opportunity than apathetic folks to influence legislators.

He encouraged people who contact their legislators to come prepared with a story—one that he can take back to the General Assembly as an example of how real people are impacted.  He strongly encouraged building broad coalitions to help make positive change happen.

Influencing public policy is central to meeting the needs and challenges of health care in these rural areas, said moderator Rose Hoban, editor of the North Carolina Health News. 

When asked how to most effectively advocate with legislators, Rasoul provided a concise set of suggestions:

  • Remember your legislators may be as intimidated by you as you are with them, so come in informed and confident.
  • Be brief—five minutes for you to speak, five minutes for a response, five minutes to “put our heads together.”
  • Make sure you have a nice summary of the issue.  A one-pager is best—simple and clear.
  • Show how the issue impacts their district, then focus on committee and subcommittee members of the committee that will deal with issue.
  • Come in with a solid close, thanking them for advocating for older Virginians. Close by asking, “How will you be voting on this?” Based on the response say, “I will follow up with you next week.”
  • Finally, treat the staff with respect.  They will largely determine where your issue falls in the stack of items to receive the legislator's attention.
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