Aging in Appalachia

Poverty isn’t new, particularly in Appalachia. As recently as 2015 the Appalachian Regional Commission reported that more than 25 percent of residents in Eastern Kentucky live below the poverty line. And sadly, the rate of senior poverty in the state, at 11.2 percent, is the third highest in the nation. Christian Appalachian Project (CAP) works every day to transform the lives of these seniors.

“The average income of the majority of our participants is about $750 per month. That is the income for individuals that receive supplemental social security income,” said Teresa Gullett, manager of elderly services and elderly housing in Johnson, Martin, Floyd, Knott, and Magoffin Counties. “They often struggle with having funds for food, utilities, home repairs, transportation, and medical supplies.”

Healthcare costs naturally increase with age. Chronic conditions are more prevalent in seniors, while costs for treatments, medications, and health insurance continue to rise. Seniors in rural areas such as Eastern Kentucky face additional challenges. Often, rural areas lack high quality and specialized health services, and seniors may have no access to reliable transportation to local healthcare facilities, much less to more specialized and advanced treatment options not located in the community.

“We provide transports to various agencies which gives our participants a better chance of being able to stay in their own home and maintain an increased quality of health,” Gullett said. “But sometimes their health issues limit their mobility and that is when our housing staff steps in to build accessible ramps or to make other needed repairs to the home. These repairs provide our participants with homes that are safe, warm, and dry so that they can enjoy their homes with reduced concerns of injuries.”

Housing is one of the most concerning issues for seniors in Eastern Kentucky, and the issue isn’t always about affording the rent or mortgage, but rather the financial strains ofhome repairs and upkeep as well as modifications for disabilities.

“Our participants are connected to Appalachia because it is where they were born and raised. It’s where they raised their own families,” said Carolyn Lindsey, manager of elderly services in Rockcastle, Jackson, and Mc- Creary Counties. “Many own their homes and land and they will not leave it. Their spouse may be buried there and they will not leave them either. There are memories there. So we meet them where they are.”

Mike Wallace manages all of the housing projects, including home repairs for seniors in the same service areas as Lindsey. He feels a special burden to get homes repaired because for every elderly participant that is helped, there is another senior in need waiting to be added to the home repair list.

“I know it may sound worn, but our goal really is to make sure homes are safe, warm, and dry,” Wallace said. “We have a waiting list for home repair assistance. We have supplies and funds available, but we need more skilled volunteers to help lead these projects. If we dedicated all of our labor resources to repair the homes of our elderly participants, it would be 2021 before all of them on the currentwaiting list would be served. And still there are new calls to our office every day inquiring for the first time about getting on the wait list. There is a great need.”

CAP is meeting those needs, not just in the housing program, but in a variety of areas. The Elderly Services Program provides home visits, transportation for errands and doctor visits, home repairs, and advocates for special circumstances that may arise. While some seniors are living without family nearby, many others are in the position of caring for family members, including adult children with health issues or grandchildren.

“Seniors face a variety of challenges in addition to housing,” said Lindsey, who has managed elderly services in her community for 19 years. “Sometimes it’s a lack of services or it could be loneliness. At other times, it might be financial issues due to health challenges or caring for loved ones.”

Lindsey concedes that these issues would be similar for any person growing older in America, but they seem particularly impactful for seniors in Appalachia.

“I think these challenges are more exaggerated in Appalachia because of the geography. It is hard to live in the mountains,” she said. “There is a lack of transportation and access to services are even more of an issue in Appalachia due to isolation. It seems like many of our elderly participants outlive their families or their families have moved away in search of better jobs.”

Gullett agrees and sees, like Lindsey, that the issues facing CAP’s elderly participants are inter-related. Declining health and lack of transportation can lead to social isolation, which can in turn have an additional negative effect on health.

“An important thing that we do is to just sit and listen,” said Gullett, who, like Lindsey, has served seniors in Appalachia through CAP’s services for nearly two decades. “But we work to build those relationships. Some seniors might not see anyone other than us more than once a month. We make them feel loved, which some may have lacked for years. And at the end of a long day, seeing the accomplishments we have helped them achieve and the smiles on their faces is worth more than money.”

Those interrelated issues continue when you consider that lack of transportation not only contributes to isolation, but impacts seniors when it comes to food security as well. Food insecurity is another serious issue that seniors face. Feeding America reports that more than 5 million seniors in the U.S. ages 60 and over struggle with hunger. Many rural areas lack adequate or affordable food retailers. As a result, nearly 15 percent of rural households are food insecure, meaning they lack reliable access to a sufficient quantity of affordable, nutritious food. Seniors can be hampered from reaching available food, even in food pantries, by lack of transportation.

The Kentucky Association of Food Banks reports that Kentuckians ages 60 and over make up 20 percent of weekly food pantry visitors throughout the state, but could be increased if transportation barriers did not exist. Additionally, nearly 43 percent of seniors in Central and Eastern Kentucky who are eligible to receive Supplemental Nutrition Assistance Program (SNAP) benefits do not participate in the program due to enrollment barriers, making assistance with the enrollment process an increasingly valuable service. The United States Department of Agriculture’s Commodity Supplemental Food Program (CSFP) supports many seniors by providing staples on a monthly basis, but many seniors, just as with the SNAP program, either do not know how to navigate the enrollment process or are resistant to accepting these benefits.

Lindsey knows that meeting the needs of elderly participants in Appalachia like healthcare, housing, and hunger is built on the foundation of trust gained by developing meaningful relationships.

“I truly believe that you cannot assist someone with their needs if you don’t first form a relationship with them by listening to their stories and being committed to being in their lives,” Lindsey said. “The companionship and relationships that are formed with our caseworkers is what makes CAP’s work life-changing. Honestly, the most rewarding thing about serving our participants is the look on their faces when caseworkers arrive for visits – huge smiles that show that they know they have someone to visit with and talk to. Our participants consider our caseworkers part of their family and the amount of trust they have in them is uplifting.”

Gullett shared a story that demonstrates just how elderly services truly does transform lives. One of her greatest memories is of an 85-year-old participant who received a warm, safe, and dry home for the first time in his life.

He had been assisted by CAP’s Elderly Services Program for many years. He had no children and lived in an old barn that had been converted into a dwelling after his childhood home had caved in. It took years for a CAP team to gain his trust because there were so many that had taken advantage of him in the past because of his limited education and some disabilities.

He had always worked on his parents’ farm and rarely went into the community, so he was very shy and withdrawn when they met him, but his blue eyes and his smile could melt anyone’s heart. As he allowed CAP to become more active in his life, they learned that he had once played the banjo, but at some point, it was taken from the home.

When CAP moved him into what he called his “mansion here on earth,” the employees and volunteers gave him the first birthday party he had ever had. A volunteer purchased a banjo for him and he entertained everyone at his party. It was a truly memorable day.

“This is how we provide our services,” Lindsey summarized. “It’s how we build those relationships, how we go above and beyond. This is what we do.”