4 min read
By Lisa Naegele, FNP, Signify Health on 11/16/22 6:17 PM
Nearly one in five Americans live in a rural community. That’s 60 million Americans – myself included – who live, work, and play in small towns, farming communities, tribal lands, and sparsely populated frontier areas across the country. Though they manifest in ways that are unique to our geography, rural communities like mine in West Virginia often struggle with many of the same healthcare challenges as people who live in suburban and urban communities.
Every third Thursday in November, the nation takes a day to recognize those distinct challenges rural communities face such as access to quality care in communities where the nearest healthcare facility can be many miles away. This is also a time to come together as a health community to share knowledge and ideas for how best to bridge the medical, behavior, and social care gaps that we see every day.
I worked as a registered nurse for more than two decades. I have observed the ways in which these barriers impact the health and well-being of people living in marginalized and underserved communities. In fact, it’s what motivated me to become a Family Nurse Practitioner. For the past 19 years, I’ve been working in rural and remote communities and doing my part to improve health equity for the people who live there by meeting them where they are – in their homes.
In the rural communities I serve, getting to a member’s home to conduct an in-home health evaluation can often be a challenge unto itself. That often means driving across rickety bridges and unpaved paths.
Simply being in the home of a patient or member, however, is an enormous privilege for a clinician. In the home, I am able to observe the clinical, social, financial, and environmental factors that impact a person’s health – insights that may be otherwise undetectable in a traditional clinical setting – and connect members directly to the community and clinical resources they need to overcome those obstacles to good health.
On a recent home visit, I visited an 85-year-old member who was living alone in her home with limited support. The night before my visit, the temperature dropped to 34 degrees. The member did not have a functional furnace; her home was so cold, I wore my jacket throughout the visit. The member’s COPD prevented her from using her kerosene stove, and when I asked about her electric heater, she told me she could not afford it – when she’d used it previously, the power bill was exorbitant. As a Signify Health clinician, I was able to spend the time necessary to not only uncover a major problem in this member’s home but provide a referral to a local agency to address it.
I visited another member recently with similar clinical conditions and no support whose home was needing attention. This member was renting her home, and when I asked if she had informed her landlord of the problems, she told me he would swing by to attend to the home. When I asked her where she went when her landlord was treating the property, my heart sank as she told me she doesn’t go anywhere due to mobility challenges. I filed an urgent care management referral and shared information on the local food bank and Catholic community services in her area.
I’ve seen roofs in shambles, black mold running rampant, and broken stairs with no handrails. Environmental challenges like this are, unfortunately, all too common in many of the homes I visit. Just as common are members who do not have a primary care provider (PCP). Whether it’s because they’re relying on specialists to provide the majority of their care or because they simply cannot make the trek to see a primary care physician, many of the members I visit are missing a critical component in their healthcare journey. As a Signify Health clinician, the ability to connect members back to the healthcare system and re-introduce them to preventive care is one of the most powerful tools in my toolbox. I use it frequently.
Another important tool is education. In addition to a comprehensive health risk assessment, the visit includes a comprehensive medication review. During this assessment, I look for medication interactions and safety issues. I have found expired medications, members not taking their medications as prescribed, and prescriptions that were never refilled. So a big part of this process is providing education on how to take the medications they have been prescribed and the side effects to watch out for. Some members have lab results and bring questions to our visit. They love having someone to help explain what the tests are and what the results mean. They often have questions about their health and treatment, many of which I can answer. I help the member formulate these questions or concerns for their PCP so they can get all of the information they need from the physician who knows them best.
As the nation celebrates National Rural Health Day, it’s my hope that folks will keep in mind the unique challenges and health disparities thousands of clinicians like me are working to address every day. Whether they exist in a city or a small town, the solution to overcoming many of these obstacles is the same: there is no substitute for meeting people where they are.