Rural aging in place — the unique challenges of remote locations

This article is for informational purposes only and does not constitute medical, legal, or financial advice. Please consult appropriate professionals for guidance specific to your situation.

If your parent is aging in place in a rural area, you're solving a different puzzle than someone in the suburbs or the city. The bones of the problem are the same: how do you keep an aging person at home safely? But the infrastructure to support that is much sparser. The distances are greater. The options are fewer. The cost to solve problems is sometimes higher. And the isolation, if it happens, is absolute.

Rural aging in place works beautifully for people who have strong community connections, who have neighbors who know them and help them, who don't need complex medical care, and who have adult children living nearby. It's genuinely peaceful and wonderful in those situations. But many rural aging in place situations don't look like that. They look like older people living alone on land they've lived on for fifty years, increasingly cut off from services, increasingly dependent on adult children who live three hours away, dealing with medical problems that would be easier to manage in a place with more infrastructure.

The research on rural aging is clear about the challenges. Rural residents have less access to doctors, specialists, mental health services, and emergency services. They drive longer distances to get to almost everything. Services like home care, meal delivery, and public transportation are scarce or nonexistent. Housing stock in rural areas is often older and harder to modify for accessibility. The cost of services, when they exist, can be higher because providers have to travel farther. The social isolation can be even more pronounced because there are fewer activities, fewer opportunities to gather with others, fewer random interactions with neighbors and community members.

Rural Isolation Compounds Everything

The distance piece is deep. If your parent has a health crisis in a rural area, the nearest hospital might be forty minutes away by ambulance. That matters. If your parent needs to see a specialist, they might need to drive two hours each way. If they can't drive, someone has to take them, which means a six-hour day for a two-hour appointment. Some specialty care is simply not available rurally, which means your parent either doesn't get the care or has to relocate to get it.

The distance also means that if you live in the city, you can't easily pop over to help with a crisis. A health emergency might require you to drop everything and drive four hours to get there, or to hire an ambulance to bring your parent to you, both of which are expensive and disruptive. The visits you do make take an entire day just for driving. It's hard to maintain regular contact. It's hard to really monitor what's going on in your parent's daily life.

Rural areas have fewer services, period. Home care agencies might serve your parent's area but have limited availability. Some areas have no home care agencies at all. Meal delivery services often don't reach rural areas. Volunteer driver services might have one or two volunteers for a huge geographic area. Adult day programs don't exist. Senior centers might be forty minutes away. The services that help sustain aging in place in urban and suburban areas just aren't there.

The broadband situation matters too. If your parent is trying to use telehealth for doctor's appointments, the internet connection might not be reliable or fast enough. If you're trying to set up video calling with family or with a therapist, the technology might not work well. Some rural people are still on dial-up or have very limited data. This is changing slowly, but in many rural areas, relying on digital solutions for connection or healthcare creates challenges.

The social isolation is different in rural areas. In a city or suburb, your parent can go to a senior center or a coffee shop and see other people. In a rural area, if they're not driving and not regularly leaving the house, they might go weeks without seeing anyone. They know everyone in their community probably, but if they can't get to the places where people gather, the knowledge doesn't help. The relationships that do exist are often very strong, but they can be few in number.

Home Modification in Rural Areas

If your parent needs to age in place safely, modifications might be necessary: grab bars in the bathroom, a walk-in shower, ramps, improved lighting, accessibility improvements. These are expensive and require contractors. In rural areas, contractors are harder to find, might charge more because of travel time, might have longer waits because they serve a large geographic area, and might not have experience with accessibility modifications.

Finding materials can be harder. You can't just run to a big box store if the nearest one is an hour away. Shipping costs more, and delivery can take longer. Some specialized equipment or modifications might not be available locally at all.

The cost of modifications is often higher in rural areas. A ramp that would cost two thousand dollars in the city might cost three thousand in a rural area because the contractor has to travel far and materials have to be shipped. Repair services are more expensive. Plumbers and electricians charge more. Some rural areas have no specialists at all, so you're either doing it yourself or paying for someone to travel from far away.

Some older rural people have been modifying their own homes for years in creative ways. They've built their own additions, done their own repairs, solved problems through improvisation. This self-sufficiency is admirable, but it can also mean that modifications for accessibility don't happen because they're not thinking about aging. Or they happen in ways that might not be entirely safe.

The housing stock in rural areas is often older. Houses with multiple stairs, narrow doorways, small bathrooms, basements as the main living space. These are harder to modify than more recent suburban construction. Some older rural houses are no longer on public water and sewer, which affects both safety and the ability to modify for accessibility. Some are in such disrepair that you're fighting a losing battle trying to make them safe for aging.

Building a Support Network

The most resilient rural aging in place situations have one thing in common: a strong local support network. Your parent knows their neighbors and the neighbors know them. There's a reciprocal relationship of helping. The local pastor or rabbi or community leader knows about your parent and checks in. There are strong family ties. Someone local can help when needed.

But many rural aging in place situations don't have that anymore. Younger generations have moved away. The small town has lost population. Your parent's peers have mostly died or moved to be near their kids. The community that used to support elders has eroded.

In that situation, you need to be intentional about building support. Can you hire someone locally to check on your parent regularly? Can the local fire or police department do wellness checks? Can you connect your parent with the local senior center or community center even if it's far away, maybe arranging transportation? Can you identify one or two neighbors and gently cultivate a relationship with them, making sure they know your parent and know how to reach you if there's a problem?

Technology can help bridge the distance. If your parent is willing, setting up a webcam so you can see the inside of their house, video calls to stay connected, an alert system if they fall. Some of this technology requires reliable broadband, which might not exist. Some of it requires your parent to be willing and able to use it. But it can help with the feeling of being totally isolated and far away.

Your parent's doctor becomes more important in rural settings. A good doctor who knows your parent well, who you can communicate with, who will do proactive check-ins, can be a safety net. It's worth building that relationship and staying in regular contact.

Some rural aging in place situations require accepting that your parent is going to be more alone, more isolated, and more dependent on you or other family members than would be ideal. And some situations reach a point where aging in place in the rural home is no longer realistic and your parent needs to relocate to be near family or near more services. That's not failure. That's being honest about what's actually sustainable in that particular situation.

The thing about rural aging in place is that it can work, but only if you go in with eyes wide open about what that means. It means you might be their primary lifeline. It means crises will require you to drop everything and drive long distances. It means that the independence your parent values about living in their rural home might come at the cost of isolation and limited access to services. It means you need to be creative, resourceful, and willing to problem-solve in ways that families in more populated areas don't have to do. But it also means that your parent gets to stay in the place they love, in their community, for however long that's realistically possible. That matters to a lot of people, and sometimes that's worth the extra complexity.

How To Help Your Elders provides educational content for family caregivers. This is not a substitute for professional medical, legal, or financial advice. Every family situation is different ; what works for one may not work for another.