Up North, isolation impedes health care for seniors

For some of the elderly in northern Michigan, their medical home may be far from their real one.

In dealing with the needs of an aging populace, one issue rises above all: health care. And yet northern Michigan, which is filled with seniors, falls short in providing for them.

That’s to be expected in any rural, sparsely populated area. But northeast lower Michigan is particularly vulnerable.

“If you think of concentric circles, you do pretty well on the outskirts,” said John Barnas, executive director of the Michigan Center for Rural Health at Michigan State University.

There are hospitals in Alpena, Tawas City, Standish, Grayling and Gaylord – along the Lake Huron coastline and up I-75. Turn into the interior, though, “and you get problems.”

The obstacles to quality care include transportation, distance from healthcare facilities, and one that has something common with the greater population:

“The population is aging in the medical workforce, too,” Barnas said.

Rural Michigan life has unique challenges, and so do its doctors. It’s harder to attract young physicians to live in far-flung areas. Barnas believes one solution is to recruit and train natives of the region to get their credentials, even if they have to leave Michigan, and then return to the area for practice. A program at Michigan State’s College of Osteopathic Medicine, called OsteoCHAMPS, targets students when they’re still in high school, and is aimed at eventually placing healthcare professionals in underserved areas, including rural Michigan.

Academic coaching and a summer enrichment program seek to guide students considering healthcare professions. Barnas said a recent graduate of Grand Valley State, who went through the program, is enrolling in the MSU osteopathy school and intends to practice in Newberry, in the Upper Peninsula, where every doctor counts.

The federal government offers loan repayment programs for doctors willing to work in underserved areas, and the state has similar help as well, Barnas said.

Those professionals whose training doesn’t end in a D.O. or M.D. degree are important parts of the solution, too. Nurse practitioners and physician assistants provide front-line primary care in a cost-effective, time-efficient manner. The U.S. Department of Health and Human Services certifies rural health clinics that have these professionals, as well as certified nurse midwives, calling them mid-level providers, a term Barnas thinks doesn’t fit the quality of work they do.

“They provide excellent care, but we just need more of them,” Barnas said.

Planning for a health-care home

Convenience and access are obstacles in any rural region, said Tim Size, executive director of the Rural Wisconsin Health Cooperative in Sauk Center, northwest of Madison.

“By and large, people in rural communities are provided good health care,” Size said. “But the challenges are different.”

In Wisconsin, the idea of managed care is nothing new, Size said, and integrated health systems seek to make primary and secondary care as seamless and cost-efficient as possible. It’s worth distinguishing between the recently retired residents in a rural community, who are more likely to be in good health and may not suffer from living in geographical isolation, and the “frail elderly,” for whom inevitable declines are beginning to accelerate. But the former will eventually become the latter, and both they and their doctors should be prepared for it.

“Managing the whole continuum of care is less new here than elsewhere,” he said.

It’s easier to get state-of-the-art care at an academic medical center in frozen Wisconsin or Michigan than in many sunnier states, Size said, adding that it’s interesting so many people seek warmer climates as they age or retire, but fewer consider the care they will need there.

Part of the solution may lie in what Robert McNulty, president of Partners for Livable Communities in Washington D.C., calls “intergenerational relationships of value.” That is, the elderly residents partnering with younger people for mutual benefit. Younger volunteers can drive older patients to medical appointments in return for using the former’s car for a time.

Still, some realities are stubborn, and certain procedures simply must be done in larger hospitals, usually in urban areas.

“I have friends who have (retired and) moved away,” said Size, who lives in Madison, home to the University of Wisconsin and other health systems, and reverse-commutes to work in smaller Sauk City. “But a lot of them come back (to Madison) for care.”