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September/October 2004

Inside This Issue:


Rural Elderly and Caregivers Benefit from Adult Day Services
The graying of America is showing its roots in rural Pennsylvania. According to the 2000 Census, Pennsylvania’s rural elderly population, which includes those aged 65 and over, increased by about 9 percent since 1990, and it is projected to increase by 27 percent over the next 20 years.

As this population continues to grow, so too will its need for health care. Physically, the rural elderly are more likely than their urban counterparts to have self-care deficits with “activities of daily living,” such as eating, dressing, and walking. The rural elderly also have an increased risk of developing a dementing illness, further limiting their abilities for self-care.

Over the years, considerable federal, state and local dollars have been spent to create a complex continuum of care for the elderly. Since keeping elderly adults in the community is more cost effective than institutionalization, community-based services, including Adult Day Service, have been developed over time to meet the care, assistance, socialization, and supervision needs of older Americans.

Adult Day Service (ADS) is a structured, comprehensive community-based program that provides a variety of health, social, and related support services in a protected setting during any part of the day, but less than 24-hours.

Research on ADS supports positive outcomes for the elderly and their family caregivers. For example, it provides more socially and behaviorally oriented care for the elderly, emphasizes preventing harm to the elderly, offers pleasurable activities and promotes friendships.

It benefits caregivers by allowing them to pursue work and leisure activities, and it helps them to better deal with emotional stress. Of the existing studies on ADS however, few have included rural populations.

To address this research gap, in 2003, the Center for Rural Pennsylvania contracted with Dr. Janet Melnick of Penn State's Worthington Scranton Campus to review Adult Day Services in rural Pennsylvania. Other members of the research team were Dr. Heather Shanks-McElroy of Keystone College and Dr. Doris Chectotka-McQuade of Marywood University.

Research methodology
The research project covered Pennsylvania’s rural counties as defined by the Center for Rural Pennsylvania. A list of multiple elder care stakeholders, including the Pennsylvania Departments of Aging and Public Welfare, Area Agencies on Aging, AARP, county Human Development Agencies, local chapters of the Alzheimer’s Association, and others, was developed, resulting in the identification of 128 ADS programs in Pennsylvania. Of that total, 32 responded to a request to participate in a telephone interview. Additionally, the researchers reviewed several state-of-the-art rural ADS programs in the U.S. and Canada and used those programs to help inform their policy consideration process. The Robert Wood Johnson Foundation also provided input on high quality programs, and the research team visited two Pennsylvania ADS programs to gain further insight into the supply and demand for rural adult day services. Finally, focus group sessions were held in Stroudsburg, Harrisburg, Williamsport, Uniontown, and DuBois with elder care stakeholders and program providers to explore issues of funding and other strengths and weaknesses of the current ADS network.

Availability of services
Overwhelmingly, rural ADS centers throughout Pennsylvania rural counties are operated in conjunction with other services, with only 6.3 percent of participating centers housed in independent, freestanding structures. Nearly 91 percent of participating centers are operated as non-profit entities that focus on providing socialization programs. On average, ADS programs were licensed for 29.38 clients per day and were providing services to 12.72 clients per day; clearly an under use of available services. Waiting lists were almost nonexistent for most of the ADS centers in the study sample. During 2003, a total of 105 rural constituents were on a waiting list, but for less than three days on average. Center directors, who are primarily responsible for marketing and recruitment, reported that word of mouth is their primary and best form of referral. However, many cited the lack of referrals from doctors, who may not regard socialization programs like ADS as viable alternatives for their patients. Along the same lines, the failure of aging and mental health networks to refer clients to ADS early enough for dementia patients’ caregivers to fully benefit from participation negatively impacts recruitment.

Types of services
Depending on the client needs, a wide variety of services are provided including entertainment, personal care, recreation, transportation, family support, education, and physical therapy. During the research project, which ran from January through December 2003, the 32 rural participating ADS centers provided services to 954 unduplicated clients, two-thirds of whom were female. Sixty-eight percent of both males and females were at least 80 years old. Sixty percent of the participants exhibited moderate-to-severe cognitive impairment and 75 percent experienced mild-to-severe communications impairments.

The majority of centers reported limited hours of operation from about 6:30 a.m. to 4:30 p.m. Directors overwhelmingly would like to expand hours, thinking this would help with recruitment, but are not able to justify the staffing expense without the patients.

Staffing and funding
The respondents reported 429 staff positions; 320 paid and 109 volunteer. Of the paid positions, just over 100 were full-time. Staff consisted of nurses, aides, case managers, social workers, professional therapists, dietary personnel, and administrators.

There are numerous funding sources to help with the costs of ADS. Topping the list is private pay revenue, which was reported by 56 percent of the rural ADS centers. Other sources include the state Departments of Aging and Public Welfare, Area Agencies on Aging, county funding, the federal Veteran’s Administration, local agencies, and private donations. Cost sharing measures were adopted by the state for community-based services in 2002-2003.

Geriatric centers reported mixed outcomes. Many centers reported a loss in clients and client days, while others reported that clients and families made up the cost differential. The Robert Wood Johnson Foundation’s Partners in Caregiving Program views this cost sharing as a positive occurrence, resulting in the centers developing more stable sources of revenue and allowing centers to expand and provide for additional services, regardless of the governmental fiscal outlook. However, unlike clients at child day care centers, ADS clients are not routinely charged for missed days. The focus group session’s participants noted that a significant reduction of client hours resulted from the state’s cost sharing initiatives. Participants reported that the losses were not recouped either through revenues generated by the waiver program or private pay funds. These centers reported the loss of client days resulted in a reduction of either service hours and/or staff. These centers were located in the more remote areas of rural Pennsylvania and relied more heavily on state funding.

Best practice considerations
In reviewing best practices and models of ADS, several key elements emerged. The first is the role of community support for developing and sustaining a program. The community from which clients will be drawn must not only see the need for ADS, but also be part of the planning and resource pool. This necessitates the cooperation of multiple localities, and possibly counties and professional service providers in the aging and mental health networks.

An effective and reliable transportation network that prioritizes ADS equally with medical appointments and that trains drivers to assist ADS clients appropriately is also needed.

A third key element is consistent annual funding, not tied to a monthly head count. And finally, the lead person or center director must be knowledgeable of the client population, possess programming expertise, and have the requisite financial and marketing skills to successfully energize an interdisciplinary team of staff.

Full report available
For a copy of the full report, Adult Day Services in Rural Pennsylvania, call the Center for Rural Pennsylvania at (717) 787-9555 or email


Chairman’s Message
As a member of the baby boom generation, whose members are quickly approaching retirement age, I can understand the concerns of our health care industry. As it prepares for this large population group to age, it is trying to identify services and treatments that will help these and present-day seniors lead more productive lives, preferably at home.

Our cover story on adult day services presents the results of research on this health care option as it relates to Pennsylvania’s rural elderly. Faculty from Penn State’s Worthington Scranton Campus, Keystone College in La Plume, and Marywood University in Scranton conducted the research. The researchers found that this service is a benefit to both seniors and their caregivers. Adult Day Service offers more care to seniors and helps keep them socially engaged. It also gives family and other caregivers the opportunity to pursue other activities and better deal with the stress that often accompanies such care.

In addition to providing baseline information on the availability and use of these services, the researchers offer some basic considerations on how to improve these services, specifically touching on the elements of community, transportation and funding. For the complete report, contact the Center for Rural Pennsylvania.

This issue of Rural Perspectives also features the results of a survey conducted by the Center for Rural Pennsylvania and the Pennsylvania Downtown Center. The survey was a follow up to a 1999 survey of downtown revitalization organizations to learn more about the organizations and their programs. The results of the 2004 survey delivered good news, since it appears that many Pennsylvania downtowns are starting to rebound from a period of economic decline. Downtown revitalization efforts need to continue, however, since many organizations are still faced with organizational challenges and limited tourism readiness. To read more about the survey and the results, call or email the Center for a copy of the report, Progress in Pennsylvania Downtowns.

On page 6, we have some good news to announce about the federal Summer Food Service Program, which was a part of the federal Child Nutrition and WIC Reauthorization Act. Pennsylvania has been selected to conduct a pilot program that may help in feeding more rural school children over the summer months of 2005 and 2006. The details of the program are still being worked out by the state Department of Education, but we’ll be sure to provide more information as it becomes available.

We also have some information to report on job opportunities in the dairy industry and the potential to coordinate and integrate public rural transportation systems on page 4.

As the active fall season rushes in, there are always a whole host of special events and conferences on the horizon. Check out the Conferences section on page 7 for upcoming workshops, seminars and events. Just the Facts on page 7 also features some good information about voter participation rates in rural Pennsylvania.

And the Resources section on page 8 has some grant news and technical information to take into consideration.

Enjoy the cool days to come.

Representative Sheila Miller


Help Wanted: Dairy Industry
Dairy farms serve up more than just milk to Pennsylvania communities. The dairy industry represents nearly 40 percent of the state’s agricultural revenue, and in 1997, the economic impact of dairy farms and milk production on other businesses and local communities was estimated at nearly $950 billion.

The dairy industry is also a major employer, providing nearly 45,000 jobs to people in Pennsylvania’s rural communities from both on-farm and service and supply sectors. Milk processing and dairy products further multiply the total number of jobs within the overall dairy industry.

While this large and diverse industry adds so much to the state’s economy, it is currently facing a shortage of qualified employees. The pool of applicants that are choosing to enter the dairy workforce is simply too small, and not enough training opportunities exist at present.

To learn more about the workforce needs of this industry and identify gaps in competencies of current production level, middle manager and senior manager dairy positions, the Center for Rural Pennsylvania sponsored a one-year research project in 2003, conducted by Lisa Holden, Jeffrey Hyde, Richard Stup, and Kathy Brasier of Pennsylvania State University.

The researchers found that for entry-level employees, the needs are greatest in basic work skills and technical areas of milking and reproduction. For middle managers, areas of greatest need are in the areas of reproductive and youngstock management as well as information management. For senior managers and dairy owners, training needs included sales and marketing, and financial planning. Overall, the training needs for all management positions included human resource management and public relations. Compensation rates of on-farm dairy jobs ranged from $16,400 to $34,800. When combined with various added benefits, such as paid vacation, sick leave, health insurance, and vehicle use, the total compensation package was estimated to range from $21,300 to $45,400 for a variety of entry level and middle manager positions. The total employee wage and benefits packages offered by dairies are competitive with other small businesses in rural communities. The researchers noted, however, that the perception of the dairy industry – among a group that includes agricultural education teachers – is still one of long hours, poor pay, and no benefits. More than one quarter of the career counselors who responded to a survey indicated that the rate of pay for most dairy jobs was below average. Nearly three-quarters of the survey respondents indicated that most dairy jobs required long hours; however, dairies in the survey indicated that the average work week for entry level workers and managers ranged between 40 and 50 hours per week for most positions.

The researchers concluded that if the dairy industry is going to continue to generate the much needed revenues for the Commonwealth, then the shortage of labor must be addressed through targeted training opportunities and increasing the awareness of the potential career opportunities available.

For a copy of the research results, Building on Our Strengths: Workforce Development for the Pennsylvania Dairy Industry, call the Center for Rural Pennsylvania at (717) 787-9555 or email


Research Reveals Potential for Coordinating, Integrating Rural Public Transportation Services
Public transportation providers face many unique challenges in rural Pennsylvania due to its low population density and large geographic area. In spite of these significant challenges, public transportation provides a valuable service to the rural communities in which they operate. However, most of the Commonwealth’s rural counties are not served by public transportation systems today, and those in operation require public funding because they cannot be supported though farebox revenues alone.

Integration and coordination of public transportation providers in rural areas is one method that could potentially expand the availability and reduce the expense of this service. To determine the potential for public transportation integration and coordination in rural areas, the Center for Rural Pennsylvania sponsored a study by Dr. Bridget M. Jeffery of Edinboro University in 2002. The researcher interviewed administrators and employees from eight of the 21 providers of public transportation that operate in rural areas. These providers were selected because of their attempts to integrate or coordinate their transportation service and to compare regional differences.

From the interviews, Jeffery produced a snapshot of several public transit organizations operating in rural Pennsylvania, their approach to the common challenges unique to rural areas, and improvements that may help provide better service to these underserved areas in the future. Notably, the researchers found no legal barrier to the integration and coordination of rural transportation services at the state and federal level.

For a copy of the report, Coordination and Integration of Rural Public Transportation Services in Pennsylvania, call the Center for Rural Pennsylvania at (717) 787-9555 or email


For Pennsylvania Downtowns, Hard Work Is Paying Off
Thanks to the hard work of local downtown revitalization groups, many Pennsylvania downtowns are rebounding from a period of economic decline and are once again attracting new businesses, gaining employment and rebuilding the local infrastructure, according to a survey conducted by the Center for Rural Pennsylvania and the Pennsylvania Downtown Center.

The survey also found that, while many of the revitalization programs have been successful, some programs continue to suffer from organizational difficulties, including the lack of leadership and financial concerns.

Studying downtowns
In February 2004, the Center for Rural Pennsylvania mailed a survey to 257 downtown revitalization organizations to learn more about the organizations and their programs. Seventy-nine usable surveys were returned, for a response rate of 31 percent. Where possible, the responses were compared to a similar study conducted in 1999.

For the survey analysis, respondents were divided into three groups, based on the total number of establishments in the downtown. The groups were “small downtowns,” which had less than 53 establishments, “mid-size downtowns,” which had between 53 and 106 establishments, and “large downtowns,” which had more than 106 establishments.

Typical downtown establishments
In the typical Pennsylvania downtown, there are 82 establishments. Retail businesses, such as restaurants, furniture stores and florists, comprise 43 percent of establishments, followed by service establishments, such as doctors, dry cleaners, and theaters, with 35 percent. Educational and non-profit organizations make up 14 percent of the downtown establishments, and government offices, such as post offices, employment offices and county offices, make up 4 percent. The remaining 3 percent are other establishments, such as manufacturing and telemarketing.

About 400 people work within the typical downtown. The average establishment has about five employees. One exception is downtowns with business district authorities or business improvement districts. Among these downtowns, median employment is 11,000.

Thirty-two percent of respondents reported an increase in the total number of persons employed within the downtown between March 2003 and March 2004. Twelve percent said there was a decline in the number of downtown jobs, and 57 percent said that the number of jobs were about the same.

Revitalization projects and business development
Forty-six percent of respondents said a downtown revitalization project was completed within their downtown between March 2003 and March 2004. A total of 300 projects were completed costing $93.6 million, or an average of $312,200 per project.

Mid-size downtowns typically had more projects while large downtowns had higher cost projects. Forty-five percent of all revitalization projects occurred in mid-size downtowns. The average cost per project in large downtowns was $694,000. Small downtowns had fewer projects (13 percent) and less expensive projects; the average cost per project was $18,500.

Eighty-one percent of respondents said their downtown organization provided or coordinated business development and promotional activities. This percentage is up from the 1999 survey, when 75 percent of respondents reported such activities.

Attracting tourists to the downtown is a challenge for the majority of respondents. Eighty percent reported that some to very few outside visitors came to their downtown on a typical weekday. Twenty percent, however, reported that their downtown has had many to very many visitors.

Issues Facing the Downtown
The top three issues that significantly impact downtowns are absentee property owners (44 percent), superstores/big box retailers moving into the market (25 percent), and broadband access (22 percent).
Respondents also identified the following as the top three issues that significantly impacted their organizations: long-term viability of the downtown organization (63 percent), organizational leadership (55 percent), and board participation (50 percent).

The three organizational issues that had moderate or no significant impact were staff turnover (56 percent), management of the organization (54 percent), and cooperation among property owners (54 percent).

Overall, the survey found that conditions in Pennsylvania downtowns have improved since the 1999 survey. For example, more businesses and people are working in the downtown and there has been an increase in the number of revitalization projects and a decrease in the number of storefront vacancies.
Downtown revitalization efforts, however, are still plagued by organizational difficulties and limited tourism readiness.

More survey results
For a copy of the survey results, Progress in Pennsylvania Downtowns, call the Center for Rural Pennsylvania at (717) 787-9555 or email


PA Summer Food Pilot Set to Begin in 2005
Good news for rural school children. The federal Summer Food Service Program (SFSP) has been reauthorized as part of the Child Nutrition and WIC Reauthorization Act, which was signed into law on June 30, 2004. The law includes a new summer food pilot for Pennsylvania. The pilot program lowers the area eligibility threshold in rural areas from 50 percent low-income families to 40 percent low-income families for 2005 and 2006.

According to the Pennsylvania Hunger Action Center, which analyzed October 2003 school data, 134 school buildings in rural counties met the 50 percent threshold and qualified for open enrollment in the summer food program. The new 40 percent threshold will allow an additional 208 school buildings to qualify for the program.

The act also provides grants for rural transportation for SFSP sponsors and expands the farm-to-cafeteria pilots to three more states. While Pennsylvania has not been identified as a qualifying state for either of these programs as yet, the U.S. Department of Agriculture is working out the details of these and other programs included in the act and will provide more information in the coming months.

Currently, the state Department of Education (PDE) is working on the details of the SFSP pilot and is eager to meet with rural schools and organizations that are looking to develop a summer food program for 2005. For more information on SFSP, call Susan Still, with PDE, at (717) 772-3529.

In the coming months, the Center for Rural Pennsylvania will provide more information about the child nutrition programs that affect Pennsylvania rural school children as it becomes available.


Rural Internet Use Still Lags Behind Urban, Suburban Use
While Internet use in rural areas has increased over the past few years, rural communities still lag behind other areas, according to a report released by the Pew Internet & American Life Project. The report, Rural Areas and the Internet, which is based on the findings of a 2003 survey, notes that despite national growth for all areas in Internet use, rural Internet use rates have remained about 10 percentage points behind the national average for each of the past four years.

In 2000, the Pew project found that 41 percent of rural residents used the Internet; this figure increased to 52 percent in the 2003 survey. Also in 2003, low-income rural residents were less likely to use the Internet than low-income residents of either urban or suburban areas. Interestingly, the survey found that the type of community a person lives in is not a significant predictor of Internet use.

The report notes that demographic differences are factors that contribute to the gap in Internet use. Residents who are older, less wealthy, and have lower levels of educational attainment tend to use the Internet less frequently. The lower population density of rural areas was also cited as an explanation for the divide.

In the survey, rural residents said they had fewer Internet Service Providers (ISPs) to choose from than urban and suburban areas. A larger percentage of broadband users live in urban and suburban areas than in rural sections of the country. Rural users were more likely than their urban or suburban counterparts to depend on a connection at a place other than their home or workplace, such as a library. The report also notes that rural residents were more likely to look for religious or spiritual information and less likely to perform commercial transactions in comparison to other Internet users. Finally, the report concluded that even though new rural users were “wary” of the Internet, experienced users were quite comfortable with the technology.

The text of the report is available online at


Did You Know . . .
For every 1,000 residents in rural Pennsylvania, there are . . .
60.20 Elected and appointed municipal officialsA
26.08 Motorcycles registered with the Pennsylvania Department of TransportationB
47.78 Mobile home unitsC
2,201 Library books and other catalogued itemsD

Sources: (A) Pennsylvania Center for Local Government Services, 2003; (B) Pennsylvania Department of Transportation, 2002; (C) U.S Census Bureau Census 2000; (D) Pennsylvania Department of Education, 2001.


Just the Facts: Get Out the Vote
Rural voters are notorious for voting. Historically, rural voters have showed up at the polls more often than their urban counterparts and the nation as a whole.

To identify factors that are highly correlated with rural voter participation rates, the Center for Rural Pennsylvania analyzed municipal voter participation rates from the last two presidential elections (1996 and 2000.) Data for the analysis came from the U.S. Census Bureau and the Pennsylvania Bureau of Commissions, Elections and Legislation.

In the last two elections, rural voter turnout averaged 68 percent. In comparison, urban voter turnout averaged 64 percent and national turnout averaged 67 percent.

Rural areas had a higher turnout despite a relatively lower voter registration rate. In 2000, 76 percent of the rural age-eligible population (18 years old and older) were registered to vote. In urban areas, 86 percent of the age-eligible population were registered to vote.

The factors that are statistically associated with high rural voter participation rates are income related. Voters in rural communities with higher incomes are more likely to vote than those living in lower income communities. For example, among rural communities with voter participation rates greater than 70 percent, the average household income was $6,700 higher than rural communities with participation rates of 65 percent or less. The same pattern is evident in other factors that are strongly correlated with income, such as housing values and the percent of the labor force employed in professional or managerial occupations.

Voter participation rates are also significantly higher in rural communities with a high percentage of baby boomers, those with a high percentage of married couples without children, and those with higher homeownership rates. Rural communities with a higher percentage of adults with college degrees also have higher voter participation rates.

Rural communities in which residents have a long commute to work have lower voter participation rates, as do communities with high unemployment rates and single person households.