CAVALIER, N.D.—Bev and Roger Jaster, both in their 80s, live in this rural town in the house they built. They raised their three children here, the oldest now in Oklahoma, the middle in South Carolina and the youngest in Canada.
Mr. Jaster still drives but only in town and during the day. Volunteers take his wife to weekly dialysis treatments in Grand Forks, N.D., an 180-mile round trip. “I probably wouldn’t be here without them,” Mrs. Jaster says of the volunteers in the local group Faith in Action.
Michelle Murray, who runs the group, says her volunteer drivers have logged around 89,000 miles this year, up from 76,000 miles a year ago, bringing older adults to doctors, dentists, the grocery store and hair appointments. “We’re an aging community,” she says.
The strains and limits on the country’s caregiving system are especially acute in rural and non-metropolitan areas, where one out of four Americans 65 and older live—some 10 million people. Around 65% of areas short of health professionals are rural or partially rural, according to September figures from the Health Resources and Services Administration. Many adult children have moved away from Cavalier and towns like it. The percentage of family caregivers—unpaid relatives or friends—living in rural areas fell to 16% in 2015 from 31% in 2009, according to reports by the National Alliance for Caregiving and AARP Public Policy Institute.
Many residents grew up in their small towns and never left. Others moved in, drawn by a slower pace and beautiful landscape. They may live miles from the nearest city, which is part of the appeal for some, but becomes a problem when they can’t drive, health fails and they can’t get to doctors or grocery stores, some of which are an hour away. About 40% of rural residents live in counties with no public transportation services, according to a 2011 report from Transportation for America, a Washington, D.C.-based alliance of public and private transportation advocates. But moving often isn’t an easy option.
Tim Putnam, a paramedic and chief executive of Margaret Mary Health, a small hospital in Batesville, Ind., says he gets 911 calls from older adults who live in isolated areas and have fallen. “They have no one else to turn to,” he says. In rural areas, more than 120 hospitals, many similar to his own, have closed since 2005, according to researchers at the University of North Carolina at Chapel Hill.
In about 2,000 U.S. rural communities, the pharmacist is the only local health-care provider, according to Grantmakers in Aging, an organization of philanthropies.
Rural areas also have fewer non-medical support services, says Carrie Henning-Smith, a University of Minnesota professor who specializes in rural health and aging. In the course of interviews for a 2018 report that she co-authored, she found that some caregivers took loved ones who couldn’t be left alone along with them to the fields to sit in a truck while they worked. “It’s a huge struggle if there isn’t a care center to go to,” she says.
Patti Jo Baker, 67, lives with her husband Larry on a 23-acre ranch in central Wyoming, about 25 miles from the nearest town with a grocery store and pharmacy. Her husband, 69, who worked as a diesel mechanic, was diagnosed with early onset Alzheimer’s nine years ago after he could no longer remember how to put engines back together.
Mrs. Baker drove her husband 5½ hours to Salt Lake City, Utah for a diagnosis. Later they found a neurologist in Jackson, Wyo., 2½ hours away, who sees her husband twice a year.
Peg Palmer, who runs Frontier Home Health and Hospice in Lander, Wyo., 33 miles away, sends an aide out once a week for four hours, giving Mrs. Baker time to run errands. “We try to reduce the stress or burden on the caregiver,” Ms. Palmer says. With her husband’s condition worsening, Mrs. Baker asked her two daughters, one 35 miles away and the other, 22 miles, to take turns sitting with their dad for a few hours on the weekend. Her grandson, Bailey, decided not to return to the University of Wyoming in Laramie, so he could help with the ranch and care for his grandfather. “Even though I want Bailey to continue with his education, he really is a Godsend for us at this time,” Mrs. Baker says.
One daughter asked her why she didn’t move. “I can’t do that,” Mrs. Baker says. She worries the change would make things worse for her husband, who already is losing his way around the house. He loves their 23 acres. When he gets agitated, she takes him for a drive in their pickup truck so he can hunt for rocks.
Older adults in rural areas have deep ties to their land and communities, no matter how small, which makes it difficult to move to areas with more services, says Kristina Hash, a social-work professor who teaches classes on rural gerontology at West Virginia University. “They live on land owned by their grandparents and built their own homes,” she says.
The Jasters’ lives and memories are rooted in Cavalier, a town in the middle of corn, wheat and sugar-beet fields, with one stoplight, two restaurants and nine churches. Mr. Jaster, born and raised here, played linebacker for the Cavalier High School Tornadoes. He owned the local furniture store, was chief of the fire department, and has been a Mason for 57 years. Mrs. Jaster grew up in the nearby town of Glasston and remembers taking the train to go roller skating. She was Pembina County treasurer for 28 years.
Cavalier’s population fell to 1,204 in 2016, from 1,537 in 2000. Now, nearly 28% of its residents are 65 and older, up from less than 25% in 2000. Many adult children have moved away.
The Jasters’ youngest daughter, Holly Giesbrecht, 50, lives in Altona Canada. She visits every Thursday to cook, clean and do the grocery shopping. She is only 30 miles away, but is busy raising 15-year-old triplets. She tries to get to Cavalier whenever there is an emergency, but the border crossing closes at 10 p.m., and that isn’t always possible. One night she got a late call that her mother had been taken to Grand Forks hospital with blood clots. “I worry all the time,” Mrs. Giesbrecht says.
Her parents were in relatively good health until the last 10 years or so. Now, her father has prostate and colon cancer and has had several back surgeries and eight hip surgeries, the last in Fargo, N.D., a 425-mile round trip. He sees oncologists who come to town on a rotating basis.
Mrs. Jaster has been on dialysis since 2015 and Janine Moris, a retired postmaster living on a farm 22 miles away, takes her to Grand Forks weekly for treatment. Mrs. Moris recalls how grateful she was when the community rallied around their family when her daughter needed a liver transplant. “I just wanted to do something to give back,” says Mrs. Moris, who began volunteering with Faith in Action.
Demand for transportation is growing, says Faith in Action’s head, Mrs. Murray. Her non-profit organization relies on donors, a local tax and six fundraisers throughout the year, including an annual bingo night that recently generated $1,300. With those funds, she is able to pay her volunteers 0.505 cents a mile if they travel more than 20 miles.
She has 46 regular volunteers, most in their mid-60s. “They’re getting older, too,” she says, and she doesn’t know who will take their places.
Across the country, communities, organizations, non-profit agencies, and foundations are coming up with ways to try to meet rural caregiving needs by delivering meals, arranging transportation, and providing companionship.
In rural Vermont, older adults can offer their services—tutoring, sewing, baking—in exchange for someone shoveling their drive through the Onion River Exchange. In Wickenburg, Ariz,. the Freedom Express leases two vans to provide free rides to residents 60 and older five days a week. It is funded by foundations, the state lottery and the Salvation Army Red Kettle campaign. In Houlton, Maine, the farm cooperative Friends of Aroostook harvests food and provides firewood for seniors in the rural area. Telemedicine, a two-way, real-time interactive communication between a patient and caregiver and a doctor or specialist at a distant site, offers promise to people living in remote areas.
Partnerships are important, says John Feather, CEO of Grantmakers in Aging, an association of foundations seeking ways to improve the experience of aging in America. In Tennessee, he says, Meals on Wheels drivers alert the local Habitat for Humanity office when they see an older adult living in a home that isn’t safe or needs repairs. Such local efforts that can be replicated help foundations and other organizations see what is possible.
The Alzheimer’s Association has a 24-hour hotline that fields about 310,000 calls a year, and telephone support groups help those who live too far away from community support groups. Calls range from people wanting to know the difference between Alzheimer’s and dementia to those who don’t know what to do when their parent no longer recognizes them, says Ruth Drew, director of information and support services for the Alzheimer’s Association.
In North Dakota—among the states one report published in 2017 called a “dementia neurology desert” because of its shortage of neurologists—the Alzheimer’s Association worked with the state to develop a dementia-care services program. Beth Olson, a care consultant with the program, covers 15 counties—a 17,000 square mile territory—meeting with families to answer questions and direct them to resources such as the National Family Caregiver Support Program, which offers free respite care for a limited number of hours a week. Given the shortage of neurologists, especially in rural areas, the association is also developing tools to help primary care-physicians diagnose and treat Alzheimer’s.
Write to Clare Ansberry at firstname.lastname@example.org