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Headshot of Kendra KuehnSurviving the Service Desert

by Kendra Kuehn, National Adult Protective Services Association

Many APS workers may find the following scenario familiar: you have investigated the allegations of maltreatment, worked hard to gain the trust of your client, and now you are working with them to determine how to assist them with their needs. However, you quickly realize that your local community does not have the services your client needs to be independent and safe. It may be that the client lives in a “service desert.”

What is a Service Desert?

Building off of the term food deserts, which describe a community with little access to nutritious food options, the term service desert describes lack of options. A service desert is an area facing a lack of necessary services that are accessible and affordable. Accessibility may not just be, for example, transportation challenges but also navigation and coordination between services1. Service deserts may have a lack of home health care providers or specialized services. A study of South Carolina found that most counties had home health services, but rural counties often only had one provider for the entire county2. The National Association of Area Agencies on Aging notes that rural Area Agencies on Aging (AAAs) have less staff but may have greater resource needs from challenges like greater transportation needs. They are less likely to provide adult day care, care transition services, money management, and options counseling. Additionally, victim services in low population areas tailored to APS populations can be challenging.
Living in a service desert impacts supports for clients and can be frustrating for workers. The Rural Monitor discusses impacts like healthcare offices not having expertise to provide counseling or rural pastors who may see needs beyond their churches’ capabilities. Service deserts can create challenges, but agencies are rising to meet these challenges and resources are out there, if you know where to look.

Meeting the Challenge

A Rural State Addresses Their Service Deserts

As a rural/frontier state, the Montana APS program faces service deserts on a daily basis. One strategy they use is embracing technology both within the agency and in working with clients. You can read more on Montana Adult Protective Services’ use of technology with staff in the APS TARC Interview with Experts – APS in Rural Areas. Workers also use telehealth practices with clients to address a lack of available health services and improve access for investigations. They are equipped with cell phones, laptops, and mobile internet hotspots, which enables them to set up video conversations between doctors and clients when needed. To facilitate this, the worker will plan a visit to the client’s house at a time when the doctor will be available. At the planned meeting, the worker connects the client and medical professional for any advice or assessments needed.
Coordination and relationship building have also been key to addressing service deserts. Governor Steve Bullock of Montana recently began the Eastern Montana Elder Justice Coalition. The Coalition has a range of participants including prosecutors, health care professionals, and representatives from financial institutions. State government officials, including Montana’s APS director, are ex officio members. The coalition has helped expand services in smaller, rural counties by sharing expertise. For example, some counties only have part-time prosecutors who cover all cases and multiple counties. The prosecutors felt they did not have the resources or expertise to bring some cases to the criminal level. The Coalition has created the ability to pool knowledge and reach out to state experts. State ex officio members encourage participants to reach out for assistance. Experts like the Attorney General’s office have been able to walk prosecutors through challenging cases and areas they are not familiar with or have questions on. By leveraging expertise greater services are provided in the counties.

An Urban Program Addresses Their Service Deserts

Service deserts do not just occur in rural areas. Availability and accessibility challenges exist in urban communities when services are concentrated in one area or transportation is limited. Just as in rural areas, relationships and community building are key. One urban APS director did monthly community outreach event and connected with leaders of each district and their staffs to learn about needs. This helped inform efforts to identify gaps in each district that contribute to service deserts.
One gap identified was financial exploitation resources. Exploitation was one of their most frequent allegations and had high losses to the victim but there were challenges in addressing victims that needed support with financial decision-making. The director built a partnership with the city’s attorney to expand support services and have regular meetings on areas missing services.
A second gap identified was that clients in certain districts did not have access to primary care physicians because of affordability or lack of accessible transportation. There was a community program that did house calls, but it only covered a few zip codes. The director worked with a family care doctor who was willing to help expand the program and perform house calls. The program expansion made healthcare accessible to those who did not have transportation elsewhere in the city. Both programs demonstrated that creative thinking is key.


Below are a few resources to transform your service desert. Something missing? Share on a peer to peer call or let us know!
National Advisory Committee on Rural Health and Human Services. (2019). Supportive services and caregiving for older rural adults: Policy brief and recommendations to the Secretary. U.S. Department of Health and Human Services. Retrieved from

Probst, J., Towne, S., Mitchell, J., Bennett, K., & Chen, R. (2014). Home health care agency availability in rural counties. South Carolina Rural Health Research Center. Retrieved from

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