Amanda Flener and her military veteran husband, John, survived hurricane Helene without a scratch. Their routine access to Veterans Affairs healthcare for John's medical conditions didn't fare so well.
Four days after the storm passed over their town of Fitzgerald, population 8,900, in south Georgia, Flener and her husband were busy rescheduling appointments with the Veterans Health Administration. With power outages affecting hospitals around Georgia, the Fleners couldn't risk driving 30 to 70 miles for appointments that might be canceled, especially with gas so scarce.
"We had been driving 30 miles just to get gas to power our generator this week, and we were fortunate to be able to do that," Amanda Flener told the Daily Yonder. "But [the healthcare providers] can't guarantee they'll have power tomorrow."
Flener is the primary caretaker for her husband, John, who was wounded in Iraq during his fourth deployment in 2006. His armored vehicle was hit by an improvised explosive device, or IED, which left him with a traumatic brain injury and other wounds.
"We have a gamut of physical and mental health issues," said Flener, from seizures, migraines, and balance issues to back and knee pain, PTSD, anxiety, and depression.
For almost 20 years, Flener has coordinated her husband's extensive care, which at times has required near-daily medical and therapeutic appointments. Because there are no Veterans Affairs health services in Fitzgerald or Ben Hill County, the Fleners have to drive as long as three hours to reach their appointments, which can be as far as Augusta, Georgia, or Gainesville, Florida. In the two years since she bought her new car, Flener has racked up nearly 72,000 miles, about twice as much as the average Georgian drove in that same time frame.
There are an estimated 14.3 million military and veteran caregivers across the United States, according to a new study conducted by the RAND Corporation and commissioned by the Elizabeth Dole Foundation, which supports military and veterans caregivers. About a quarter of the nation's 19 million veterans live in Census-defined rural areas, according to the VA.
The report included a chapter analyzing differences in demographics and outcomes for rural and urban military and veteran caregivers. One notable finding was that those caring for veterans under the age of 60 were more likely to live in rural areas than those caring for older veterans. The U.S. Department of Veterans Affairs (VA) reports that there are 4.4 million rural veterans, 46% of whom are under the age of 65.
Many of these veterans, like John Flener, were deployed after 9/11. According to the Pew Research Center, post-9/11 veterans are more likely to "have been deployed, seen combat, experienced emotional trauma" than pre-9/11 veterans. Post-9/11 veterans are also more likely to struggle with readjusting to civilian life.
The RAND study also found that nearly a quarter of rural military and veteran caregivers did not have access to reliable broadband internet. This means that some solutions for rural healthcare access, like telehealth appointments, are not viable for some of the people who could most benefit from them.
Amanda Flener says telehealth appointments can help fill coverage gaps, for which she is grateful. But she says even with the most expensive internet plan available in her county, the signal isn't always strong enough for telehealth appointments.
Telehealth care is "progress, for sure," Flener said. "So we pay for the best wifi we can get in our area, but it isn't always reliable enough to take the video calls from the VA."
Transportation and Access Gaps
Fitzgerald, Georgia, where the Fleners live, is designated a primary care, dental, and mental health professional shortage area according to the U.S. Department of Health and Human Services. This lack of healthcare resources is one of the reasons the Fleners spend so many hours on the road. But transportation to and from a continuous stream of appointments is a challenge for millions of veterans and their caregivers in the VA system, including those in suburban and urban counties.
Tara Plybon and her husband, Todd, live in Taylor, Texas, a small town outside of Austin in suburban Williamson County. Despite their proximity to a major city, Plybon spends at least four hours each week driving her husband to and from appointments.
"My husband, like a lot of other veterans, has a brain injury and can't stay awake to drive," Plybon told the Daily Yonder. "So one of the biggest challenges of caregiving is driving him all over God's green earth to get him to his appointments."
According to the RAND study, just under half of military and veteran caregivers live in a county without a VA facility, and nearly half live in a primary care provider shortage area. The Department of Veterans Affairs does provide some transportation to health services for rural veterans through their Highly Rural Transportation Grants program, but this option is currently only available in counties with fewer than 7 people per square mile. This limits the reach of the program to just 227 counties across 14 states. That's less than 12% of the U.S. counties that are nonmetropolitan under the federal Metropolitan Statistical Area classification system, and an even smaller percentage of counties where at least half the population lives in rural areas using the U.S. Census rural definition.
There have also been attempts to organize transportation help by non-government organizations, such as the charity Disabled American Veterans (DAV). For a while, the Fleners had access to a van service run by local DAV chapters, but it hasn't run in their area since the Covid-19 pandemic.
In February, a bipartisan group of congressional legislators introduced the Rural Veterans Transportation to Care Act, which would expand transportation access to more rural veterans.
"This bipartisan bill would improve how VA measures rurality, helping more veterans living in rural areas get transportation to VA or VA-authorized health care facilities," according to the website of Representative Marie Glusenkamp Perez (D–Washington–3rd), who co-sponsored the bill. The act was co-introduced in the Senate by John Ossoff (D) of Georgia, where 3 in 10 veterans live in rural communities like the Fleners, according to the VA.
No Shortage of Shortages
Transportation and access to healthcare services are two of the biggest challenges facing rural veterans and their caregivers, but they are far from the only things that set them apart from their urban counterparts.
In 2016, Amanda Flener was nominated as a Dole Caregiver Fellow, which the Elizabeth Dole Foundation describes as "an immersive multi-year leadership experience, focused on building community and support across all 50 states."
Flener said she has been profoundly affected by the connections she's made with other caregivers around the country, who offer support and share resources. But it has also opened her eyes to the difference geography can make in the lives of wounded veterans and their caregivers.
Unlike some other fellows, Flener and her husband have no access to treatments like equine therapy, which can help with conditions like PTSD and depression as well as improve balance, physical strength, and mobility.
And options some of her peers take for granted to alleviate the caregiving load, like hiring a cleaner or using an online delivery service for occasional dinners and emergency shopping, isn't practicable in her small town, Flener said.
"Amazon next day delivery, that's not really a thing for us. And just things like somebody saying, ‘oh, hire a cleaning service.' There is literally not a cleaning service in our town."
But despite these difficulties, the Fleners have no plans to move to a more urban location. Amanda Flener says rural communities offer veterans like her husband a calmer place to heal, away from crowds.
"If [wounded veterans] can get away to a quieter place where they can hunt or fish, or just find solitude in nature, it goes a long way to help their mental health," Flener said.
This article first appeared on The Daily Yonder and is republished here under a Creative Commons license.
