EFFINGHAM, Ill. — When Gustie Unkraut was banned from driving at age 90, it changed his life.
“I’ve driven all my life. It makes a difference,” she said.
She usually went to mass every day at 6:30 a.m., played cards with friends, and was active in the Effingham community. Now she couldn’t drive because of a change in her vision.
“I thought they put me in jail,” she laughed. “Fortunately, they didn’t throw away the key.”
She got her ‘get out of jail free’ card by buying a house in Effingham within walking distance of St Anthony of Padua Church.
This meant selling his farm in 2019 to buy his new home in town. It was hard to leave the farm where she and her husband had raised their seven daughters and where she had lived for 65 years.
She was active on the farm when she was young and said she probably misses driving a tractor the most. She still owns farmland.
“I watch the markets. I’m interested. You can’t give up everything,” she said. “I go ahead and do what I can.”
Last week, the 93-year-old cooked for a church picnic.
“I’m capable and it’s a way to give back,” said the 16-year-old grandmother and 15-year-old great-grandmother.
She misses her huge garden on the farm and the wide open spaces, but she loves the advantages of being independent.
“I haven’t changed my lifestyle too much,” she says.
“It was good for her,” said her granddaughter, Chelsey Byers.
Sadly, Byers sees the issues seniors and their caregivers face in rural areas through her work as a family life educator at the University of Illinois.
Byers, who is based in Champaign, Ford, Iroquois and Vermilion counties, has also worked with veterans receiving care for Alzheimer’s disease and leads workshops for caregivers and seniors on a variety of topics she sees. so the first-hand difficulties.
One of the biggest problems for older people in rural areas is finding the right living situation, especially with special needs like memory care.
“There may be smaller units and longer waiting lists,” Byers said, or the opening may be in a town further away from friends and family.
Families may also have more limited choices due to their financial situation. There may be fewer spaces available for those on Medicaid, Byers said.
Eldercare Locator is a government service that helps caregivers start knowing what facilities are options in their postcode, she said.
“Fallouts” of closures
The pandemic has made difficult situations worse for nursing home residents as their advocates were not allowed into the facilities, said long-term care ombudsman Angela Van Pelt.
She and six of her staff hear complaints and advocate for residents at 900 facilities in Iowa, authorized by federal law on senior citizens.
“We’ve seen fallout,” she said.
Some issues were related to visits during the pandemic, others to toileting and basic resident care during a time of staff shortages.
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The big problem now is facility closures. A nursing home may not get the funding it needs or may not have enough staff, so it closes. They are required to give notice to residents and their families, but often time is short and finding new accommodation is difficult.
“We will see that this will continue. We are only at the beginning,” said Van Pelt. In the first half of this year, 29 nursing homes closed in Iowa alone.
Recently, more and more ‘involuntary dismissal’ letters are being sent to residents at a time when staff turnover means they don’t know people individually either. Sometimes it’s for behavior or payment. Payment may be delayed by Medicare. People may not realize they can appeal those letters, said Van Pelt, whose office also helps with that.
The Ombudsman team also helps connect families with resources and information about their rights.
“Every obstacle you encounter becomes another frustration,” she said.
Sometimes the ombudsman helps with small things that make a big difference. She gives the example of a resident who wanted to bring her pet to her new home. At first, the facility was hesitant to help, but agreed when a lawyer argued the case. People may not realize that they can appeal such decisions.
“It also warmed the hearts of the staff,” Van Pelt said.
Such stories strike a chord with Van Pelt. When her parents were unable to care for themselves in rural Madison County, Iowa, she moved them into her home for more than two years and worked hard to access the services they needed. She was able to see how “complex” the system is. Even with her upbringing and background, she found the process frustrating at times.
“That experience fueled my passion for where I am now,” she said.
And Van Pelt said efforts are being made to help people stay in their homes and communities longer.
Transport and health
As Unkraut experienced in rural southern Illinois, transportation is “a real challenge” for many elderly residents of Knox County, Missouri.
The county, the third-smallest in the state, has no regular public transportation, no taxis and very little bus service, said Lori Moots-Clair, director of the Knox County Health Department. At the same time, many services needed by older residents require transportation to get there.
It’s especially difficult for older people who need specialist doctors, with the closest being 100 miles away in Columbia or 50 miles away in Quincy, Illinois, she said.
The county has a few health care options, including two nurse practitioners and a blood draw clinic.
County residents can access physical therapy, speech therapy, and occupational therapy as a nonprofit service. Services are also offered at home in rural areas.
Moots-Clair’s budget must pay therapists from out of county at a higher rate and cover transportation costs that strain their resources. Some therapists have to drive 60 miles to reach those in need here. Moots-Clair, who is also a registered nurse, said she fears she won’t be able to keep the program if they continue to lose $60,000 to $80,000 a year.
Discounted prepared meals are also available to Knox County residents, both at meeting centers and with select volunteer deliveries. But there are not enough volunteers to deliver meals to people in the most rural areas.
Here, too, retirement home closures and understaffing are “major public health concerns”, she said. A retirement home in a neighboring county recently closed, which is concerning as there is only one retirement home in Knox County. When the Knox County Nursing Home, which is “usually full,” needs to find a home for someone, it will be a neighboring county.
There are a few seniors’ accommodations here, although they may need updating. Hospice is offered, but there are fewer volunteers for additional services than in the past.
Knox County does not have any assisted living spaces or memory care nursing units in the county, Moots-Clair said.
“There are no in-between housing options,” she said.
Here, at least 22% of the population is over 65 and 14.2% of all residents live in poverty.
Even though rural communities have issues with isolation and transportation, the benefits of living here often outweigh them.
“We seem to come together and take care of people,” Moots-Clair said.
The usual tips for aging better — including eating well, moving more and managing stress — are good ideas for all of us, Byers said.
“But you can’t ignore having a purpose and a social commitment,” she said, giving the example of her grandmother’s active social life with her church and community.
“People took a hit during the pandemic when they weren’t allowed to go out and move around. We are social beings,” Byers said.
Her grandmother learned to use Facetime to talk and see her grandchildren and great-grandchildren.
“Sometimes it was a forced learning curve,” Byers said.