Alternative care is a common practice in rural regions as a lack of access to hospitals has prevented many families from obtaining healthcare. Families within rural regions, with a focus on North Carolina for this essay, practice various types of alternative care for numerous reasons such as a lack of resources, or, what this essay will mainly focus on, the desire to treat families in the home even as access to healthcare facilities has increased in rural regions. This willingness to treat families within the home can be partly attributed to the substandard care that is available to families within this region. Combined with a history of a lack of access to healthcare facilities, a culture within families has developed of treating the ill, furthering the effects by introducing healthcare avoidance. This causes families who once had no access to still rely on traditions of alternative care in an attempt to achieve health despite more physical access to hospitals.
The use of alternative care can be found in rural regions where a lack of access has prevented families from being able to obtain care. Some common forms of a lack of access can include; a lack of health insurance, lack of physical access to hospitals, lack of resources to see a doctor, etc. As a result, families are left to look for alternative methods to treat the very same illnesses. Here in North Carolina, a research study was conducted, “Home Remedy Use among African American and White Older Adults.” This study examined 62 adults over the age of 65 who lived in rural regions of North Carolina. This study viewed both food and non-food remedies and how they were used by each individual participant. The study gathered their data through oral histories and survey data. From these, they were able to conclude a trend among some alternative methods with many members from diverse rural backgrounds generating some of the same answers. Part of their conclusion stated, “Remedies was frequently passed on to the respondents when they were children. Several respondents indicated that although they were required to use certain home remedies as a child (e.g. castor oil), they decided to use different treatments as adults” (Quandt et al). As these alternative methods are passed down through familial tradition, people chose whether to use those same remedies or switch to new ones. However, it is through alternative care that families have hope for a treatment that they cannot access.
One reason that families in rural regions still lack access to hospitals relates to the quality of hospitals located in these areas. In 2021, a research review was conducted in America that compared urban and rural hospitals. This review looked at the Centers for Medicare & Medicaid Service (CMS) rating system of hospitals throughout America. One of their key findings states, “…patients may perceive the lack of a star rating as a signal of lower quality of care and consequently avoid care at hospitals without a star rating (that is, they may misinterpret “no rating” as “zero stars”) (Bozovich et al). Their findings also found that rural hospitals were more likely to be unrated than urban hospitals, and almost all unrated rural hospitals were Critical Access Hospitals (CAHs) (Bozovich et al). A lack of a CMS rating is a deterrent for people seeking access to hospitals, especially within rural areas as they are more likely to have unrated hospitals. The purpose of CAH was to provide rural regions with access to this critical care, yet the implications of a rating system negatively impact these same critical hospitals. Patients deem no rating to be equivalent to a bad rating, which in turn causes fewer to seek access to these hospitals. However, CAHs are the only hospitals that offer emergency care to people within these regions. Families in rural regions especially those with CAHs, are left with few options, go to the unrated hospital or seek alternative methods to meet this gap in care.
A culmination of factors that decrease access also causes avoidance of healthcare facilities in rural regions for families. One report from a nationally representative survey discussed what they called a delay or avoidance of healthcare. Their finding state that rural residents as 1.7x more likely to report behaviors of avoidance in comparison to metropolitan residents (Spleen et al). Some of the factors that the report discusses as contributing to healthcare avoidance among people in rural regions include the lack of healthcare infrastructure, limited healthcare access, and high healthcare costs. The report also highlights the role of cultural beliefs, stigma, and mistrust in healthcare providers as factors that may discourage rural residents from seeking care. Additionally, the study notes that individuals who are uninsured or have lower incomes are more likely to delay or avoid healthcare, which are all factors that are more common in rural populations.
One example of healthcare avoidance in rural regions is the fact that many families choose to care for their loved ones at home despite how difficult it can be to achieve. This happens because families feel responsible to care for their loved ones. This is why the perception of the quality of healthcare facilities is so important when addressing the issue of healthcare avoidance and its roots within families. For example, Carla Norwood discusses her family’s choice to take care of her great-grandmother at home after she had been diagnosed with Alzheimer’s. Norwood stated,
“…vast majority of the time, it was someone in the family because we didn’t think it was right to put her somewhere else and she should be at home. And I tend to still believe that, despite the fact that it was really hard. I would not put her in a nursing home.” [0:23:17.7, 0:23:53.2]
Norwood used the word ‘right’ to describe how she and her family felt about keeping their great-grandmother at home instead of placing her in a nursing home. The decision was based on their values of family and care, which they felt it was their responsibility to provide her with the best care possible. While this sentiment is shared by many families who choose to take care of their loved ones at home, even when it is difficult. It also demonstrates how healthcare systems are seen in rural regions, specifically nursing homes, which often insight a negative connotation that can affect how families are then choosing to treat their loved ones. When facilities receive a negative connotation of not being able to provide quality care then the issue of healthcare avoidance is thus exacerbated.
Another example of avoidance in health care perpetrated by the family unit was discussed by an interviewee named Chasity Hargrove, who is a resident of Dunn, North Carolina. When asked what she does when she is sick, she said, “Suck it up. Yeah. I’m the type, like, I would never call into work.” [00:28:52, 00:29:00] Hargrove then goes on to say,
“So, I’m kind of that way with my children. I’m like, “You’re fine. You’re fine. Are you bleeding? No? You’re fine.” My papa had a saying, “If you ain’t tough, get tough.” You know, kind of like, life could be a lot worse. It’s going to be okay. So that’s kind of what I’ve adopted with them.” [00:29:00, 00:29:32]
This is an example of the type of sentiment that has developed within rural regions, the ‘get tough’ attitude reinforces patients to overcome illnesses without the help of biomedicine, thus avoiding having to go to the doctor. It is indicative of the resilience and self-reliance that are often valued in rural regions. The idea of “sucking it up” and not calling in sick to work is a reflection of this type of care where patients don’t seek out treatment for illness. This idea is then translated through generations as they too are taught the ‘get tough’ attitude. The ‘get tough’ attitude in combination with the ‘life could be a lot worse’ sentiment have a combined effect on families that promote avoidance behaviors from a young age.
In conclusion, families within rural regions use alternative care to fulfill the needs not met by their healthcare facilities. However, healthcare avoidance has developed within rural regions due to factors such as the perception of low-quality facilities and attitudes of ‘get tough’ or ‘suck it up’. These factors influence the use of alternative care within families, as families continue to rely on these methods in the form of healthcare avoidance. Yet alternative care is still a necessity for families who cannot access hospitals due to a lack of resources, physical access, or a lack of insurance in rural regions. It is through alternative care that families can access the treatment they need. As the issue of healthcare avoidance in rural regions continues to affect families, it is important to understand the complex factors that contribute to the lack of healthcare access and availability, as well as the role of alternative care in addressing these issues.
References
Bozovich, Laura, et al. “2021 CMS Hospital Quality Star Ratings of Rural Hospitals.” The Cecil G. Sheps Center for Health Services Research, NC Rural Health Research Program, October 2021, https://www.shepscenter.unc.edu/programs-projects/rural-health/publications/. Accessed 20 February 2023.
Hargrove, Chastity. Interview with Shelby Smith. 15 July 2019 (Y-101). Southern Oral History Program Collection (#4007), Southern Historical Collection, Wilson Library, University of North Carolina at Chapel Hill.
Norwood, Carla. Interview with Darius Scott. 8 August 2018 (Y-0041). Southern Oral History Program Collection (#4007), Southern Historical Collection, Wilson Library, University of North Carolina at Chapel Hill.
Spleen, Angela M et al. “Health care avoidance among rural populations: results from a nationally representative survey.” The Journal of rural health: official journal of the American Rural Health Association and the National Rural Health Care Association vol. 30,1 (2014): 79-88. doi:10.1111/jrh.12032
Quandt, Sara A., PhD., et al. “Home Remedy use among African American and White Older Adults.” Journal of the National Medical Association, vol. 107, no. 2, 2015, pp. 121-129. ProQuest, http://libproxy.lib.unc.edu/login?url=https://www.proquest.com/scholarly-journals/home\remedy-use-among-african-american-white/docview/1695019477/se-2. Accessed 20 February 2023.