Long-term care in rural West Virginia: managed care and future roles for the aging network

The managed care movement emphasizes the rationalization of health care delivery through fixed price or capitation of service and the utilization of a preferred physician or health gatekeeper. These features are advanced as measures of cost control in health care delivery. This approach presents the aging network, established under the Older Americans Act, with a number of daunting challenges which are particularly acute to service providers in rural areas. How this network responds will determine its future efficacy in the delivery of health and long-term care services. This article examines these concerns among eight rurally based senior centers and two Area Agencies on Aging in Southern West Virginia. Issues of management capacity, present and future positioning, and receptivity to managed care are emphasized. These providers stand on the strengths of a long tradition of serving clients, knowledge of their needs and face-to-face interactions with them--capabilities managed care organizations do not have. However, little outreach to managed care in these areas has occurred.