Seniors who live in rural areas a number of difficult challenges when it comes to accessing healt and planning surgeries compared to non-rural seniors.

Rural seniors must deal with hospital closures and drivi long distances to reach health care and medicin Seniors who need surgery will require the assistance of f friends and even strangers who may live miles away.

And aft rural seniors face a host of dif that can make their recovery jou very challenging and even danger Please join us as we show how rural seniors and their fami can plan their surgeries and get they need to live their best possible live after surgery.

We've created this program so th members will share this informat with their fellow Grangers and t they know in their community.

This program was partially funded through a Patient Centered Outcomes Rese Institute, Eugene Washington PCORI Engageme and the National Grange.

So for most of us who've enjoyed living in rural communities, there are lots of benefits.

But one of the challenges when y recovering or have been in the h is that your access to services is more challenging.

Doctor Laurie Anne Ferguson is the form dean and professor of the Emory and Henry College School of Nurs located in the Appalachia Highlands of southwest Virginia.

Both the school and Doctor Fergu are extremely familiar with the problems of rural senio It may be that you have to drive miles and to get to follow up care, whether it's your specialty appo whether it's picking up medicati from the pharmacy, food at the grocery store, it might require a lot of travel Rural hospitals are closing at an unprecedented rate since 2005, a total of 195 rural hospitals have shut down more than 600 rural hospitals na or at risk of closing in the nea which is 30% of all rural hospitals in the U.S.

These closures mean rural seniors must often tr many miles and hours to reach any type of health care One of our closest friends has to drive four hours tomorrow to go to an eye surgeon for his for their childr just because they don't have the specialists where they We do see a lot of driving and and hardships trying to get the for our families possible.

We are lucky right now.

Our closest hospital is within 25 to 30 minutes of us and that hasn't always been the Samantha and her family returned to rural San Antonio, Texas, to become caregivers for her aging parents.

So we've had new hospitals in re built closer to us.

I have family members that it's an hour or so to get to a hospit So it's definitely plays into a lot of scary times someti how do we prepare for getting to a hospital, getti you know, health care needs take in an emergency situation.

As a firefighter and EMT for over 28 years, I have seen firsthand too many s who could have had better medical outcomes had they been better prepared.

Do they have and wear an alert s Is there a hide-a-key so first responders, neighbors, or family can gain access if nec These are just a few of the thin that are super important to talk as our loved ones age.

Another difficult problem to ove is the independent nature of most rural residents.

The proud frontier qualities that enable them to thrive in re means they often find it difficult to ask for hel for the adult children of rural this means they must make an ext to talk to their senior parents.

The first step that strangers ne is well before any medical proce or surgery.

You've got to have some difficul or tough conversations with your loved ones and caretak The time to plan is before you need any type of medical hel before you face surgery.

And before you even talk to your health care provider.

When Mom and Dad have gotten old we've definitely started talking about how they want to live and what's important to them.

And it's not an easy talk, like you never want your parents to g like they should be young and helping us raise their grand and hopefully their great great grandchildren.

Since conversations with independently minded senior may be a challenge, a question prompt list will help guide everyone in making these vitally importan decisions.

I'm Joan Smith on the program manager on this e for trying to reach rural senior about their health care.

Very proud to be part of this pr by the National Grange.

Because personally it affects us Joan Smith and her team at the National Grange put toget these question prompt lists to h with pre and postsurgical plan It covers topics such as should I have surgery?

And what happens if things go wrong after surgery So I have done all those documen that they urge you to do.

Your directives, your authorizat for making medical decisions for The Question Prompt List made us about how we were going to find a place for Kathy to sle she had surgery.

How we can get around the house, talking about how we're going to be more and more mobile, assistance with walkers or whate she's going to need to be able to be able to get around the hou for the first few weeks.

It's good to have a prompt list.

Start thinking about it prior to A Question Prompt List is a real to help remind us about the important things we want to ask that we might for In the urgency of the moment, or the nervousness of seeing our health care provider, or the of even thinking about having su So having the questions written ahead of time is really importan to both cover everything we want to ask, as we as prompting us to ask those que when we have the opportunity.

Many rural residents live in are with limited internet connectivi and even no internet access.

There are non-internet ways to distribute these pre-surgical and post-surgical q prompt lists.

We know there's many seniors, many people in rural areas that still don't have access to We encourage those who do have a to take an unserved person under their w to print out materials that they may receive by email, and share them at the Grange mee or outside of the meeting with those who who don't have ac so that all of our members can receive this valuable materi about preparing for surgery.

Make copies of it and take it to your church.

What about your Kiwanis Club and your Rotary?

Take it to your women's club or your Masons.

Any place that you can distribute these two documents that we've put together on questions to ask your surgeon and then planning your life span before and after surgery.

What about those county fairs or that bazaar, or that dinner you could place it right on the when you have a local community for the neighborhood to raise fu I think that the the questionnaire is helpful in that there sometimes things you don't think about growing up that you have to talk to your pa about, as well as your kids abou Dave Roberts and his family are for his 91 year old mother, Debb David relocated his family from to rural Connecticut to care for both his parents.

We joke with our kids that they' to have to change our diapers, l change their, They don't like to hear that.

The question prompt lists were funded through the Patient Centered Outcomes Research Institute, and are available on the National Grange website.

You never want them to be old, b because we've had these conversa I know that I'm doing what they and I don't have to second guess what I'm doing because I know this is their wis The question prompt list is going to be a fantastic tool my age and older to utilize in o to have conversations with their to make preparations for surgery for healthcare needs Rural folks can be a little bit and so sometimes tough love comes into play and say, no, this is what we've got to do This is how it's going to be.

I think the questionnaire is goo because it's important to understand, like, who should we be talking to?

What should we be focused on?

What are their wishes?

The most important conversation seniors need to have is with the Modern medicine can certainly prolong life, but will this be a life that seniors want to live?

I think it's important for senio to ask their surgeon and themsel will this surgery offer me a better quality of life?

Because for some patients, as we get older, the focus is on quality of life, not necessarily just living long And this is an important and very personal distinction to and to discuss with your doctors and your family.

The greatest thing that a patien can have going into and out of s or any serious condition, is a c medical advocacy that will look out for the best of this person's in Most of us don't think about a living will.

A, medical power of attorney, or about asking someone close to or someone in our family to be our medical advocate for u A living will is a legal documen that spells out the medical trea that you would and would not wan used to keep you alive.

It also lists your preferences for other medical decisions, such as pain management and organ donation.

Do you have somebody that will h you make your medical decisions if you are unable to communicate This is that important document called the Advanced Health Care or a Living Will.

Please make sure that you have your preferences communicated very clearly to the people aroun and it needs to be in writing.

As a personal example, my husband and I have recently m for end of life cremation services for the both That way, we and our family know what we w and everything is ready to go when the time comes.

Probably the hardest conversatio to have with your surrogate or your patient, your advocate, your loved one is being thinking through what if things don't go as plann A vital part of advocating for y is finding a surrogate.

This is a health care proxy, someone who can make decisions if you, as a patient, are incapa and unable to make decisions.

This can be a family member, a loved one, or a close friend.

It is really important that you choose someone who can articulate for y that you trust, and that you talk through the di decisions that might happen in terms of what your wishes are Do you want to be on a ventilato Do you want CPR?

Do you want life prolonging care Or do you want comfort care, to be kept clean and pain free?

If you don't plan for this and make your expectations clear surgery, then your family will e making a crisis decision afterwa This might not be in your best i and it also increases the stress on your family member or loved ones.

To make decisions during a moment of crisis when Mom and Dad have gotten old we've definitely started talking about how they want to live and what's important to them.

Is it moving houses?

Is it getting closer to, their health care and their doct And what do they want that's mos important to them in their next Shared decision making is at the core of all the conver that seniors and their children need to have with each other.

It's a big part of this is commu with your caregivers and your fa on what it is that your desires are for your f Shared decision making is import so that you think through what i that you're personal.

Preferences are for care.

Should you not be able to commun to your loved ones or caregiver So thinking about ahead of time what matters?

Do you want life prolonging care Do you want to be on a ventilato with I.V.

drips?

Would you like to have supportiv care to help cure and restore you to the best level of health?

Would you like to have comfort c Make sure you're clean and comfo but not have any other invasive medical procedures.

Some of the questions that you'll need to consider.

Would you be willing to receive feeding through a tube, even if it's just for a short ti after surgery?

Or if you have trouble waking up after surgery?

Would you be willing to have a m breathe for you?

And if so, how long would you be to stay on a breathing machine?

Please make sure that your famil what your preferences are.

And that's a very, very personal After surgery, you're going to need a responsib to drive you home and to stay wi for at least a day or two.

Most people would prefer that that support comes from a family After surgery, you'll need to as can I prepare my own meals?

Or will you need to rely on a family mem to help you with your food prepa And if you have drains or tubes or bandages after surge will you be able to take care of yourself?

Or will you need to have one of family members come to help you And if so, they need to be train how to do that safely until you're able to do it on yo Once you've had those important conversations between surgical s and their caregivers, the next steps are far more conc and vital to a safe recovery fro Another question to ask is, how long will anesthesia Depending on the procedure, it could take days or weeks for the effects of anesthesia or paralysis to finally wear off Will you be able to walk?

Will you need a wheelchair or a Should you prepare a bed in your living room or prepare to sleep on the couch on the first floor near a bathroom, rather than trying to navigate t Will you need a wheelchair ramp Will you need a social worker or home health care aide to help Will you need rehabilitation or physical therapy?

Can that be done?

Outpatient?

Does that need to be done in a physical therapy office?

Or does that need to happen in your own home?

Or can physical therapy be provided in your home?

Does their home still work for t Can they safely fix meals?

Can they access the shower or ba Can they get themselves up off t or out of chairs?

Do they need a grab bar?

Is there enough room to move about with a walker?

Study after study.

Now, the medical community over the last decade is patients recovery is so much better at ho Plan for it.

Do you have the right resources and enough resources to stay hom Do you have help available?

You can call on so you can stay I became a caregiver to my mothe in 2020.

One of the challenges that we initially faced was not knowing the amount of assistance that she was going to need on a daily basis.

She does have her own bathroom, It has a tub and it's not a walk-in shower.

So we have a shower chair that we transport into our bathr because we have a walk-in shower and we can put the shower chair in the shower, and then she can to sit on and bathe herself.

Some of the resources for staying safely at home after may require a few simple but necessary changes.

I think we make sure that we hav handrails on stairways, and I don't yet, but I really want to have those bars in showers and bathtubs I think those are so important.

And I just think that aides like are necessary for older people, because you just never know when you're going to slip.

One of the things we're looking is changing homes and getting in where we don't have stairs to cl which will help mitigate that an you know, we realize that we're becoming a little bit more unstable, and we do take steps to be able to manage as we move and so that we don't fall.

And we're very cognizant of the opportunity to fall.

And so we hold on to things and and use assistance as we nee Falls are the leading cause of d from injury among people age 65 Every year, more than 3 million seniors over are treated in emergency rooms for injuries related to falling.

The most common injuries due to are hip fractures and head injur I know several people today that are in the advanced age timeframe that are basically the that the biggest issue is fallin My own mother, passed away just a few days after she fell, and, basically crumbled her hip joint and pelvis.

One thing you might consider getting is that many watches hav detection ability, so that if yo down, it'll ask you, are you oka Do you need to call 911 and it will help you communicate if you're lying on the floor and can't get to the phone.

I had to think about my home.

Do I have rails in my shower?

I do now, I didnt when I first into my house in Florida, but I do now and I feel much saf Do I have a rail to go down from my home into the garage?

I do because I thought about it prior to this project even, but most of us don't.

Every time a senior comes into o we talk to them about how to prevent falls.

And are they at risk for falls because that could be devastatin to a senior for them to fall and potentially have a fracture.

And then we're dealing with a bi that they didn't have time to pr So make sure that your balance and your coordination and your strength is where it ne so you can best recover.

Preventing falls is so important in order to be able to maintain our independence and our ability to live on our o We're learning more and more about how best to prevent falls, and one of the big issues is looking through your home and looking for obvious trip haz So rugs that are not tacked down or smal rugs or thinking about, oh, I've got to hurriedly get to the that maybe we want to have a bed commode where you're during your so that even the bathroom is not a long, trip We didn't have to move too many out of the way.

She does have a rug in her own b which is what she wanted.

What we did wind up having to do is put double sided tape on the just to keep it stationary.

So there's a lift up on the edge and she trip over it.

Looking at your bathroom is a really important piece in terms of encouraging or helping you to live independe So considering having handrails in the shower, what are the rugs in the bathroo Avoiding slip or trip hazards?

Is the floor particularly slippe if there becomes moisture on the Having assistive plumbing device so that the handles are not diff to turn on or turn off.

Having well-lit and open surface so that you can have your suppli or everything you need to take c of yourself with ready accessibi I think one of the challenges, if you live by yourself, is to recognize when you can't do it.

Many rural seniors live alone.

They may be widowed or live mile from family and friends.

Seniors who live alone, without access t and friends can reach out to state and local assistance pr to find someone who can help after their surgery Personally, I reached out to fellow Grangers when I had that gallbladder situation in March.

I asked one to come and stay wit for a time, just for 3 or 4 days after surgery, not knowing, at my age, if I was going to be to get in and out of the bed on without assistance, up and down or out of a chair to bring the ice packs, etc.

I encourage our younger Grange m to reach out to those older memb in their Grange.

They may not have family near th Our younger members should not h to reach out to those older memb and and, befriend them and just to help in any way possible.

That would be so appreciated by the older members, even if th willing to ask for help.

And that's one of the hardest th for any of us to sort of recognize and admit that I need some help and that it's really important that you think through ahead of It may be the best choice for you to go into an extended stay rehab center as you recover until you're strong enough to live and be able to care for independently.

So for seniors that live alone and don't have nearby children or grandchildren, communicate with other Grangers in the area.

They'll be glad to help you as well as your senior citizens All those folks that your senior sent during your church.

Many of them are in the same sit So some seniors that may not have close friends to help them after surgery, they may need to look in other p Make sure that your doctor and the nurses at the clinic know what some of your limitatio And if you don't have someone to at home, ask them to help you get set up with a chore work a home health worker, or maybe even a nursing home following your surgery.

They're confident in their livin However, once in a while, we all need help.

So reach out to them.

It's communication, and that communication can happe with your family, your caregiver, or just that fol you say hello to in church or at a club meeting on Tuesday Don't be afraid.

You must communicate.

If you nee It's really important for our grandparents to be aroun so you can have fun and help the There are many resources for seniors, no matter their rural living situation.

One of the oldest rural farm soc organizations is the National Gr with more than 150,000 members across 1500 chapters in 37 state The Grange often plays a huge comprehensive role in rural comm The Grange is the social hub.

The Grange conducts necessary community service.

The Grange in many cases satisfi both immediate needs, like meals and home maintenance, term needs like emotional well-b The Grange strengthens bonds between neighbors.

The Grange reduces isolation through its meetings and events.

I think it's the camaraderie with other members of the Grange working in the community, doing community service projects and then just being with other G who are all great people and really diverse and truly enjoy being with them.

And you make lifelong friends.

Well, I would have to say that I being Granger for same reason fr You're never feeling alone.

You always have someone you can if you want to do something or n I encourage all our Grange leade to present this program in their Grange Hall, to share with other so that we can keep those older active in their communities, keep them at home and attending meetings and events so that they don't have to spend in a hospital or nursing home.

We want to keep them with us as we get older, and my husband and I prepare for, you know, our that allows my kids to know, hey this is how we're going to take care of Mom and hopefully a couple of them o the four are going to be willing right up and help take care of Mom and Dad as we a Grangers across this nation since 1867 have been helping eac and have been helping their comm in many, many ways.

We're all strong Grange communit and you can help your own commun and those in need.

Ask for help and give help.

That's what Grangers do.

For information on the National Grange, visit NationalGrange.org For information on services for seniors age 60 and older, co your State Unit on Aging and your state's Department of Human Services.

This program was partially funde through a Patient Centered Outco Research Institute Eugene Washington PCORI Engageme The content does not necessarily the views of the Patient Centere Outcomes Research Institute.