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New Models of Care Support Aging in Rural Communities

Medical Center

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Across the country, thousands of FQHCs serve millions of patients, many in rural areas, who would otherwise have limited access to health care.

The town of Transfer is an unincorporated community within Mercer County in western Pennsylvania, right on the border with Ohio. Life in rural places like Transfer can seem idyllic: clean air, lots of space, and friendly faces. But older, low-income people living in rural areas of the U.S. face significant challenges to staying healthy: lower availability of health care, lower access to healthy foods, and even higher rates of social isolation.

On a national level, this challenge is growing. The number of people in the U.S. over 65 is projected to double to more than 83 million by 2050, and as they get older people tend to move into rural communities in search of a higher quality of life. Since the 1990s the number of older adults living in rural areas has tripled, and could increase up to 30 percent more by 2020.  

In the face of this growing challenge, approaches like telemedicine, volunteer caregiving, and “hub-and-spoke” models of care are emerging and helping to meet the particular health needs of older, rural populations.

Among these approaches is a renewed focus on expanding Federally Qualified Health Centers (FQHCs) to better meet the needs of our rural aging population. FQHCs operate in government-designated Medically Underserved Areas (low primary care physician to population ratio, high percentage of population age 65 and over, high percentage of people living below the federal poverty level) and Medically Underserved Populations (low-income). Across the country, thousands of FQHCs serve millions of patients, many in rural areas, who would otherwise have limited access to health care. These centers provide primary and preventive out-patient care, and in some cases, offer more specialized care.

As part of their Age Strong initiative, AARP Foundation, Capital Impact Partners and Calvert Impact Capital invested $3 million in 2016 to expand and modernize an FQHC in Transfer. In addition to primary care, the health center provides patients with behavioral health care, urgent care, and a pharmacy that provides retail and drive-through services. Opened in January 2017, the facility is the second phase of a planned three-site medical campus that will ultimately include an elderly housing facility and other wraparound services. For the residents of Transfer — 40 percent of whom are older than 50 — the facility brings much-needed services, with the capacity to double the number of patient visits from the old facility.

Finding investment capital to fund FQHCs can be tricky. Rural communities tend be lower-income and more reliant on Medicaid, or simply uninsured. Health care centers and programs struggle to manage costs because of low reimbursement rates and patients who are unable to pay costs. For investors, that adds to the perceived risk of financing such projects.

But in the face of uncertain public funding for health facilities, it is imperative that philanthropy and private capital find a way to close the funding gap. AARP Foundation, Capital Impact Partners, and Calvert Impact Capital launched Age Strong in 2015 to do just that — find creative ways to leverage philanthropic capital and private capital to invest in projects that support healthy aging across the U.S. We hope to demonstrate that investing to meet the needs of our elders is not only high impact, but also financially sustainable. Through our innovative approach, called “impact investing,” we aim to make $70 million in loans to organizations that provide critical services for people 50 and older.

Learn more about Age Strong at



The Cecil G. Sheps Center for Health Services Research

Center for Medicare and Medicaid Services (2017)

National Association of Community Health Centers (2011)

National Conference of State Legislatures (2011)

Rural Health Information Hub

U.S. Census (2014)

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Initiative to invest in critical services and programs for struggling adults 50-plus.