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May/June 2020

Inside This Issue:

Hospice Use, Availability in Rural Pennsylvania

Hospice is a form of palliative care that optimizes quality of life by anticipating, preventing, and treating suffering, and is typically delivered within the last six months of life. Research has shown that hospice positively impacts patients’ quality of life, and also mitigates the cost of care at patients’ end of life. Despite these reported benefits, hospice remains underused, with substantial geographic variation in hospice availability and use rates. As there was limited information about hospice availability and use in rural Pennsylvania, Dr. Lisa Kitko, Dr. Joel Segel and Elizabeth Thiede of Penn State University, through a grant from the Center for Rural Pennsylvania, analyzed data from the Centers for Medicare and Medicaid to describe the availability and use of hospice care throughout Pennsylvania. The research was conducted in 2019.

Specifically, the researchers: analyzed the distribution of hospice providers and the number of hospices providing care to rural Pennsylvania counties compared to urban counties; developed a descriptive profile of rural Pennsylvania’s hospice users and drew comparisons between rural and urban Pennsylvania counties; analyzed patient use information to project the number of future hospice users in Pennsylvania counties; and analyzed information collected from interviews with hospice and palliative care providers and administrators to understand the challenges and opportunities for those providing hospice and palliative care.

The research included the following results:

For a copy of the report, Availability of Hospice in Rural Pennsylvania, click here.


Chairman’s Message

Over the past several weeks, together we have faced an unprecedented and truly challenging situation with the onslaught of COVID-19. We’ve all had to adjust our daily habits to deal with a public health pandemic that continues to affect the way we work, learn, interact, and live.

As I write this message, we are five weeks into the now Pennsylvania-wide, stay-at-home order. We’re anticipating that coronavirus infections will decrease in the coming weeks, but we must remain vigilant to the threats of this devastating virus. While some have said that it may be somewhat easier for our rural counties to adapt to and maintain social distancing, as we have lower population densities in our rural counties than our urban counties, we know our rural communities are not immune to this virus and its effects.

Right now, the virus has infected residents in every Pennsylvania county. And several rural counties are showing dramatic increases in unemployment in vital industry clusters.

Before this health crisis spread throughout our commonwealth, the Center for Rural Pennsylvania was sharing research and data on matters of importance to our rural communities. The COVID-19 pandemic has clearly proven how critical these issues are to rural Pennsylvania. Our 2019 report, Broadband Availability and Access in Rural Pennsylvania, documented how the lack of broadband has posed challenges for many communities, such as limiting work and learning at home, and limiting telemedicine capabilities for health care providers and home health service providers. Our research, Examination of Community Health Workers, Exploring Healthcare Alliances in Rural Pennsylvania, and Telehealth in Rural Pennsylvania, have all documented the various challenges of providing health care in rural Pennsylvania, from the limited number of health care providers to the limited number of health care facilities. And, with our extensive database, we have continued to show the trend toward an ever aging population, which we know is more susceptible to virus-related fatalities.

As the limitations of the stay-at-home order are lifted, and we return to what will most likely be an adjusted normal, we know it may be harder for our rural areas to bounce back economically. We’re basing this on our analysis of the rural economy after the 2008 recession, Nine Years and Counting: Rural Pennsylvania’s Economy After the Great Recession.

These data and research results all help to keep a necessary focus on our rural communities, and the resources they need to return to the new normal.

We know that the coming weeks and months will be a difficult time for our commonwealth, and our nation. Stay healthy and safe, and remember to follow the advice of the Centers for Disease Control and Prevention, and the Pennsylvania Department of Health.

Senator Gene Yaw


Results: Attitudinal Survey of Pennsylvanians

In 2019, Penn State University researchers, with a grant from the Center for Rural Pennsylvania, conducted an attitudinal survey of rural and urban Pennsylvanians on a variety of issues. The results of the survey indicated that most respondents in both rural and urban communities had similar attitudes about issues in their local communities, communities across Pennsylvania, and the performance of the government. The following attitudes were most common among both rural and urban residents:

Several differences were observed in rural and urban attitudes. One key difference was that rural respondents identified the availability of jobs as the most important issue while urban respondents identified maintenance of roads and bridges as the most important issue.

Also, rural and urban residents disagreed on how to best address the opioid crisis. Rural respondents supported stricter enforcement of criminal penalties, while urban respondents supported increased funding for programs to treat and prevent addiction. Urban respondents supported the expanded availability of methadone clinics, and rural respondents were split as to whether they supported or opposed expanded availability.

Finally, while relatively few respondents identified expanding broadband internet access as needing to receive a “higher priority” from state government, the proportion who said this nearly doubled in comparison to a similar survey in 2008, so its importance has increased among respondents. Furthermore, access to the internet was significantly related to attitudes on many issues. Those without internet access at home felt that their communities were less desirable, were less satisfied with the way things are going in Pennsylvania today, and had less trust in government officials and institutions.

For a copy of the full results, Attitudinal Survey of Pennsylvanians, 2019, click here.


Rural Snapshot: Coal Mining – Production and Employment

Coal Mines by Location and Employment, 20181
Pennsylvania Map Showing Coal Mines by Location and Employment, 2018

Coal Production in PA and U.S., 2001 to 20181
(In million tons, graph not to scale)
Graph Showing Coal Production in PA and U.S., 2001 to 2018

Average Annual Employment in Pennsylvania by Type of Mine, 20181
Chart Showing Average Annual Employment in Pennsylvania by Type of Mine, 2018

Average Annual Coal Mine Employment in Pennsylvania, 2010 to 20181
Graph Showing Average Annual Coal Mine Employment in Pennsylvania, 2010 to 2018

Energy Sources Used to Produce Electricity in Pennsylvania, 1990 to 20182
Graph Showing Energy Sources Used to Produce Electricity in Pennsylvania, 1990 to 2018

Infographic Showing Top 5 Coal Producing States, 2018

Number of Pennsylvania Homes Using Coal or Coke for Heat, 1970 to 20183
Infographic Showing Number of Pennsylvania Homes Using Coal or Coke for Heat, 1970 to 2018

Note: All ton production is measured in short tons (2,000 pounds). 1. Data source: U.S. Energy Information Administration. 2. Other includes hydroelectric, renewable sources, petroleum and other sources. All sources measured in generation megawatt hours. Data source: U.S. Energy Information Administration. 3. Data sources: IPUMS NHGIS, University of Minnesota, and the 2010 and 2018, 5-year Average, American Community Survey, U.S. Census Bureau.


What is Rural?

What is the definition of rural?
There is no one definition of rural. At the federal level, there are no fewer than seven definitions of rural and urban. Each definition is accurate, but each measures different aspects of rural and urban. Most federal definitions begin by defining what is urban; everything else is then considered rural.

What are some of the common federal definitions of rural?
The two most commonly used federal definitions are from the Office of Management and Budget (OMB) and the Census Bureau. OMB’s definition defines Core Base Statistical Areas as cities and counties that are comprised of Metropolitan Areas (50,000 or more residents) and Micropolitan Areas (10,000 to 49,999 residents). Everything else is often referred to as Non-Metro Areas. The Census Bureau uses the terms Urbanized Areas (Census Blocks that are joined together and have a combined population of 50,000 or more), and Urban Clusters (Census Blocks joined together that have a population of 2,500 to 49,999): everything else is rural.

How does the Center for Rural Pennsylvania define rural?
In 2003, the Center’s board adopted a population density model to identify rural and urban counties, school districts, and municipalities. Population density is the population divided by the number of square land miles. According to the 2010 Census, Pennsylvania had a total population of about 12.7 million residents, and 44,743 square land miles, making its population density 284 people per square mile. Counties and school districts that have population densities below this number are defined as rural. Those with population densities at or above this number are defined as urban.

What about municipalities?
The municipal definition is a bit more complicated. The Center defines a municipality as rural when the population density within the municipality is less than the statewide average density of 284 people per square mile, or the total population is less than 2,500, unless more than 50 percent of the population lives in an urbanized area as defined by the U.S. Census Bureau. All other municipalities are considered urban.

What are the numbers of rural/urban counties, school districts, and municipalities?
There are 48 rural counties and 19 urban counties; 235 rural school districts and 265 urban school districts; and 1,592 rural municipalities and 970 urban municipalities.

Will the Center for Rural Pennsylvania update it definition?
Yes, when the results from the 2020 Census are released in 2021, the Center will re-calculate Pennsylvania’s population density, and then update its county, school district, and municipal rural/urban definitions.
Click here for more information.

Pennsylvania County Population Densities Per Square Mile
(Rural counties are in bold)

Adams                       196
Allegheny               1,676
Armstrong                106
Beaver                        392
Bedford                       49
Berks                          480
Blair                           242
Bradford                     55
Bucks                      1,035
Butler                         233
Cambria                    209
Cameron                     13
Carbon                      171
Centre                        139
Chester                       665
Clarion                        67
Clearfield                    71
Clinton                         44
Columbia                  139
Crawford                    88
Cumberland               432
Dauphin                     511
Delaware                3,041
Elk                                39
Erie                             351
Fayette                       173
Forest                           18
Franklin                    194
Fulton                          34
Greene                         67
Huntingdon                52
Indiana                      107
Jefferson                     69
Juniata                         63
Lackawanna              467
Lancaster                   550
Lawrence                  254
Lebanon                     369
Lehigh                     1,013
Luzerne                      360
Lycoming                    95
McKean                       44
Mercer                       173
Mifflin                       114
Monroe                      279
Montgomery          1,656
Montour                    140
Northampton             805
Northumberland    206
Perry                            83
Philadelphia         11,379
Pike                            105
Potter                           16
Schuylkill                  190
Snyder                       121
Somerset                     72
Sullivan                       14
Susquehanna              53
Tioga                            37
Union                         142
Venango                      82
Warren                        47
Washington              243
Wayne                          73
Westmoreland           355
Wyoming                    71
York                            481


Just the Facts: Elected Women Officials in PA Small Towns

Pennsylvania had more than 12,700 elected municipal officials in 2018. Less than one-fifth of these officials were women.

According to a 2018 survey of municipal officials conducted by the Center for Rural Pennsylvania, female elected officials were 61 years old, on average, and had been in office for 9 years. Their male counterparts were 62 years old, on average, and had been in office for 12 years.

A higher percentage of female officials had a bachelor’s degree or higher than male officials (38 percent and 26 percent, respectively.) Female officials were less likely to have attended a municipal training class in the previous 2 years (39 percent) than male officials (52 percent).

On the home front, both female and male officials had roughly the same number of people living in their households (average of 2.3) and about the same percentage had young children living in their households (15 percent). There was, however, a difference in the number of years they have lived in the municipality: 73 percent of female officials lived in their municipalities for 20 years or more, compared to 80 percent of male officials.

A slightly higher percentage of female officials (62 percent) were in the labor force than male officials (59 percent). In terms of income, there was no significant difference between females and males; 64 percent of female officials had incomes of $50,000 or more compared to 62 percent of male officials.

In addition to their municipal responsibilities, a higher percentage of female officials volunteered in their communities (81 percent) than male officials (72 percent). 

In their last election, 51 percent of female officials and 45 percent of male officials said another candidate ran against them. 

In the survey, municipal officials were asked why they initially ran for local office. For the most part, the motivation to run for local office did not vary by gender. The top three reasons why both female and male officials initially ran for office were: a desire to be active in the community, encouragement from others, and a desire to improve their local areas.

For the fact sheet, Elected Women Officials in Pennsylvania Small Municipalities, click here.

(Note: The survey was mailed to elected municipal officials in municipalities with fewer than 2,500 residents. The statewide survey was sent to a random sample of borough and township officials and had a response rate of 33 percent, with a margin of error of +/-2.6 percent.)


Fact Sheet Available on Pennsylvania Fire Company Capacity

The Center has released a fact sheet, Pennsylvania Fire Company Capacity, 2012 and 2019, which is available here. It is the second in a series based on a 2019 survey of Pennsylvania fire chiefs from volunteer fire companies and combination paid/volunteer companies. The Center conducted the survey in partnership with the Pennsylvania Fire and Emergency Services Institute (PFESI).

The Center compared the results of the 2019 survey with the results of a similar survey of fire chiefs conducted in 2012.

The 2019 survey results indicated that: