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Rural Vs. Urban Care Coordinators: Who Has it Harder?

Are you an Ontario care coordinator or case manager? If so, you’re a valuable resource to all of your clients—and probably a lifeline for many. No matter where you work in the province, you strive to ensure that all of the work you do is patient-centred.

These are characteristics you share with your fellow care coordinators and case managers. It goes without saying that you also encounter many of the same challenges on a regular basis. But there are differences, too. And these differences often depend on which type of region you work in—urban or rural.

The big question is, who has it harder? Do care coordinators in the country face bigger obstacles than those in the city, or vice versa? In this post, we’ll explore the role that geography plays.

Rural Coordination Challenges

Ask someone who doesn’t work in home care to imagine a day in the life of a care coordinator. More than likely, she won’t envision long drives to patient homes. She probably won’t consider the logistics of trying to organize care for a diabetic who lives nowhere near an endocrinologist.

Though rural health care challenges are the subject of many Canadian government reports, they’re still often overlooked in practice. But if you work in a rural area—let’s say, somewhere in the municipality of Chatham-Kent—you’ve seen many of these shortcomings firsthand.

An American organization known as the National Academy for State Health Policy points out one of the biggest general issues with rural care. In many rural communities, a single primary care physician (PCP) serves the entire population. As a result, patients may visit their PCP for all health issues that arise. Why? Because specialist care just isn’t accessible. The same is true in parts of rural Canada.

Access to care plays a huge role in patient health—and what care coordinators are able to do. Ensuring that various practitioners and experts are in sync when geographic distance is involved can take a lot of effort. And if you’re a care coordinator who works in a rural region, you personally know the burden of commuting to relatively isolated homes.

Of course, the many health problems that impact rural communities disproportionately—such as obesity and chronic disease—also impact care coordinators. Drawing from a limited pool of medical practitioners, coordinators are expected to facilitate top notch care for these conditions.

On the patient side, poor health literacy is a common issue. On top of everything else, it can make care planning, patient goal setting, and providing self care instructions seem like fruitless tasks.

Urban Coordination Challenges

Rural care coordination is challenging, and it’s no secret that there are obstacles to care delivery in these regions. Less has been said about the unique challenges that care coordinators face in urban environments.

In overcrowded neighbourhoods, there are numerous health risks. Substandard housing is one of them. In addition to affecting patient health, issues such as pest infestations and urban building decay can impact the safety of visiting care coordinators.

Cultural and language barriers also present major obstacles for coordinators working in cities. This, of course, is because the cultural makeup of urban centres tends to be far more diverse than it is in rural areas.

According to Statistics Canada, 96% of Canadians who belong to a visible minority group will be living in one of 33 metropolitan areas by 2031. The number of Allophones (people whose mother tongue is neither English nor French) is also rising quickly. Most of these Individuals live in cities.

These barriers can be especially difficult for care coordinators to deal with, given the patient-centred nature of their work.

Diversity comes into play in other ways, too. Many cities are stratified, encompassing both wealthy and very poor residents. The impacts of poverty show up in health-related data. Consider this example from a World Health Organization (WHO) report on urban health. In Glasgow (Scotland), life expectancy is just 54 for men in Carlton ward, and 82 for men in nearby Lenzie, East Dunbartonshire.

Sometimes the boundaries between impoverished and affluent neighbourhoods overlap. What happens when a care coordinator is responsible for clients within both camps?

The connection between socio-economic status and health is complex. And understanding the life experiences of patients from different backgrounds requires a lot of work—and emotional energy.

Care Coordination Solutions

It goes without saying that lifestyle and environment play a huge role in determining our health. For this reason, there are many different health challenges from region to region and on either side of the urban-rural divide.

That said, for those receiving care at home, there are a constants. One of them is carefully coordinated care. By synchronizing practitioners to help patients meet their health goals, care coordinators in every region are making life better for Ontario’s most complex patients.

But who has it harder, rural or urban care coordinators? You probably saw the answer coming: it depends. Each and every coordinator and case manager faces his own on-the-job challenges, which are as unique as the clients he serves.

Whether you’re a rural coordinator trying to link patients to providers across vast distances, or an urban case manager trying to understand a patient’s cultural attitudes toward health care, patient-centredness is key.

Given what you know about your client’s preferences, does one of the solutions your envisioning feel particularly frustrating? Few things are as important as listening to your client, regardless of which region you work in.

You might be talking to someone who lives in downtown Toronto. Perhaps you’re organizing the care of someone on the outskirts of Sioux Lookout. Either way, know her story. It sounds obvious. But as you almost certainly know, it takes a lot of work.

When it comes to meeting someone the biggest challenges, technology has an important role to play in both types of geographical areas.

As just one example, advanced telehealth systems can connect circles of care around patients who live in small, relatively isolated towns. But even in urban settings, where access to providers and specialists is better, communication can almost always be improved. In increasingly hectic work spaces, realtime, face-to-face connections are crucial.

Wherever you provide care coordination, a patient-centred attitude and a willingness to look at new and innovative solutions will serve your clients well.

Feature image courtesy of Robert Bell

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