How Community Health Workers Transform Lives for Older Americans in Rural Areas

On a recent Monday, Sandy Guzman, a community health worker in rural Oregon, drove to visit a patient in her 60s in The Dalles. The patient lived alone and struggled with severe social isolation, Guzman said. After a serious fall and subsequent surgery, the woman was wheelchair-bound and confided that she wanted to attend services at a nearby church but lacked transportation and feared being a burden.

“We called the pastor to see if there was someone who could pick her up on Sundays,” Guzman said. And there was.

The next day, Guzman visited a woman with heart failure who required constant oxygen. She lived in substandard housing, with no kitchen and only a plug-in heater for warmth. “We were trying to figure out if she qualifies for HUD housing or assisted living,” Guzman said, referring to the federal Department of Housing and Urban Development. “We spent a lot of time talking about the options and came up with a game plan.”

Wednesday’s schedule included a 20-mile drive to Hood River to see an 81-year-old woman whose partner of nearly 40 years was battling advanced cancer. Guzman, who speaks Spanish, found her distraught at the possibility of losing him. Guzman had arranged for the woman to begin seeing a therapist to help her through the crisis — no minor achievement. But on this visit, “I just handed her tissues and tried to give words of comfort,” she said. “Honestly, sometimes just sitting and listening is the best response.”

Who Are Community Health Workers?

A community healthcare worker, according to the American Public Health Association, is a “trusted member” of a local community or someone with “an unusually close understanding” of it. This role enables them to serve as intermediaries between patients and the healthcare system. These workers have been active since the 1960s, particularly in rural and low-income areas, and their numbers are growing today.

The Bureau of Labor Statistics reports about 65,000 community health workers, though the National Association of Community Health Workers notes this is likely an underestimate. The discrepancy stems from the variety of titles these workers hold — such as community health educators, outreach specialists, or promotores de salud — and the differing state regulations governing their roles, which sometimes require no licensure or certification.

What unites them is their ability to “talk like the people they work with,” said Sam Cotton, who directs the curriculum for several such programs at the University of Louisville in Kentucky. With a shortage of healthcare professionals and an aging population, “there’s a lot of momentum for this,” she added.

Training and Impact in the Pacific Northwest

In Oregon, five rural clinics employ community health workers who become state-certified after completing 90 hours of online training through a program called Connected Care for Older Adults. A sixth clinic in neighboring Washington also employs a community health worker.

Many of their frail patients face overwhelming challenges. “They can’t drive, so they can’t get to