Reaching Out to Aging Veterans in Rural Areas: Innovative Use of Telehealth and Care Coordination

n 85-year-old veteran of World War II, “Bill,” lives in a small community in northern Nevada. After the war, he married his high school sweetheart, “June,” raised a family, and operated a 2,000-acre cattle ranch. Although retired now, Bill enjoys helping his son manage the family ranch. As Bill and June age, they’ve faced the challenges of living with chronic health conditions. Bill’s health issues include diabetes and congestive heart failure (CHF), while June has severe arthritis and hypertension. Additionally, over the past year, June has noted a progressive decline in Bill’s memory—to the point where he now has difficulty remembering how to get home after a day on the range. He feels he is burdening June and voices feelings of worthlessness. He no longer wishes to visit with his family or help with the ranch. Bill has been to the emergency department (ED) twice for symptoms of CHF but has found it difficult to get to the nearest VA medical center, which is in Salt Lake City, UT, more than 250 miles from his home, for follow-up with his primary care provider (PCP). He has canceled two appointments because he felt too fatigued to make the three-hour trip. Bill is not alone. An estimated 38% of veterans older than age 70 live in rural areas, and a 2004 AARP survey found that almost 20% of rural patients and nearly 15% of rural caregivers were veterans. 1 Studies have shown that rural veterans are more likely to live in poverty, to be in poor health, and to have limited transportation than veterans living in urban centers. Rural veterans also may have fewer younger people in their communities to assist them and fewer options for both VA and non-VA health care and social services. 2