Tackling the challenges of rural Veterans

Veterans choose to live in rural areas for many reasons like lower cost of living, less crowded towns and schools, privacy, and more. These decisions to live farther from larger towns and cities raise the potential for serious drawbacks like access to mental and physical health care, homelessness, substance abuse, and isolation. 

VA continues to develop programs and services to improve the lives of rural Veterans to address these issues to ensure access to health care.  

What is a rural Veteran? 

VA uses the rural-urban commuting area code system (RUCA), developed by the Department of Agriculture and Department of Health and Human Services, to better understand rurality. This system considers those in an area and how linked a community is socio-economically to larger urban centers. 

“One way to thinking of a rural Veteran is someone who lives outside of a concentrated population center, and as it applies to health care it means they do not have the same access to care as their urban counterparts,” said Dr. Michael J. Ward, VA Tennessee Valley Healthcare System (TVHS) investigator. 

Utilizing RUCA and Ward’s description, Veterans who live in small towns or communities of 5,000 people that are located away from cities with hospitals and specialty care facilities would be considered rural Veterans. 

What is VA doing for rural Veterans in Tennessee and southern Kentucky 

Recently, Ward and Dr. Jo Ellen Wilson, another TVHS investigator, were selected by VA’s Office of Rural Health (ORH) to focus on improving mental health care needs of rural Veterans in Tennessee and southern Kentucky. 

“Our Veterans deserve the best mental health access and treatment so they can live their lives to the fullest,” said Wilson. “It is a privilege to play a small part in helping to expand access to acute mental health services for rural Veterans.” 

The ORH research funding, awarded to Wilson and Ward for one year, will be used to explore innovative strategies to deliver care, address unique health care challenges, and develop programs in rural communities to improve the overall health and well-being of Tennessee and southern Kentucky Veterans. 

“Our goal is to make it easier for rural Veterans to access mental health services. Whether it is when they present to the emergency department or urgent care clinic, or access [telehealth] from their home,” Ward said. 

According to ORH, more than 50% of Kentucky Veterans are considered rural Veterans compared to 45% of Tennessee Veterans. Ward and Wilson not only hope to make a significant difference in VA Tennessee Valley’s highly rural catchment area but are aspiring to make an impact to support rural Veterans nationally. 

Importance of focusing on rural Veterans 

It is estimated that there are 4.4 million rural Veterans across the country. One of the largest challenges for rural Veterans is the availability or proximity to mental and physical care. 

“80% of Veterans in rural settings have to access non-VA [locations] when they need emergency care,” Ward said. “As a result, particularly for mental health patients, they don’t get the same level of coordination that VA offers and are more likely to get what’s called ‘fragmented care’ or care that is spread out amongst a number of providers.” 

Fragmented care is health care that is scattered across a large number of providers with little coordination or cohesion for the patient’s care plan. Fragmented care is different from VA’s Patient Aligned Care Teams (PACT) which are supportive, patient-driven health care teams who help develop a whole-person care plan. Fragmented care could also mean that Veterans might have to travel to different locations to receive different elements of health care versus world-class connected care at a VA facility. 

In addition to providing comprehensive in-person care through PACT teams, TVHS has been expanding its telehealth program to support Veterans with remote care appointments to provide direct-access to providers.  

Supporting Veterans where they live 

VA Telehealth provides direct, real-time video support between a Veteran and a health care professional. This digital appointment allows providers the ability to schedule more consistent appointments with Veterans not interrupted by travel issues or weather.  

More than 93,000 mental health telehealth appointments were conducted at TVHS in fiscal year 2024. Telehealth first launched at TVHS in March 2020. 

However, telehealth requires access to the internet, which can be a barrier for some rural Veterans. 

“Rural Veterans don’t have the same level of broadband access that can be necessary to access telehealth services and to engage with VA, which potentially forces them to travel hours for in-person care,” said Ward. 

To overcome the issue of internet issues, TVHS has been establishing community partnerships with Tennessee County Veteran Service Officers and Veteran organizations to provide computer access for Veterans to attend their appointments. Telehealth spots provide rural Veterans with a local location to update their records, appointments, and stay in contact with their PACT team. 

Improving the lives of Veterans 

With the awarding of research funding from ORH, Ward and Wilson will have an opportunity to improve TVHS’ ability to provide world-class care to rural Veterans. 

“I think that TVHS is in a prime position to continue to creatively tackle this challenge,” Wilson said. “VA has been a leader in providing innovative solutions to expand timely access to acute mental health services for Veterans.”