L . , H: : _3_,+__:§ s. J wfim L i r: JERRY fiéchigan State U n?versity PLACE IN RETURN BOX to remove this checkout from your record. TO AVOID FINES return on or before date due. MAY BE RECALLED with earlier due date if requested. DATE DUE DATE DUE DATE DUE 2/05 «W15 A DISCUSSION OF DIFFERENCES IN URBAN AND RURAL SERVICE LEVELS AND TECHNIQUES ReIevant to P1anners and as Applied to the Genesee, Lapeer, Shiawassee County Area Sarah Ward Eubanks October, 1982 "PIan B" Paper a... A DISCUSSION OF DIFFERENCES IN URBAN AND RURAL SERVICE LEVELS AND TECHNIQUES TABLE OF CONTENTS II. III. IV. VI. VII. VIII. IX. XI. INTRODUCTION PROTECTIVE FACILITIES LOCAL GOVERNMENT PUBLIC FACILITIES HEALTH CARE FACILITIES SOCIAL WELFARE SERVICES LIBRARIES RECREATIONAL SERVICES EDUCATIONAL FACILITIES .CONCLUSION‘ APPLIED RESEARCH page 10 15 16 18 23 30 33 41 44 46 INTRODUCTION Study Focus: "Americans keep going back to the land. . .The land offers freedom, a chance to test your mettle against nature's challenges." "The pilgrimages began with our agriculturally-minded freedom-loving forebears of the 17th and 18th centuries. In waves since then--from the founding of community utOpias in the first half of the 19th century, to the homesteads of the later 1800's, to the flight of the unemployed from a collapsing economy of the 1930's--Americans have returned to the land. "Now the tide of Americans that swept to the cities after World War II has ebbed. The trend has reversed. People are populating the country- side faster than they are cities." So stated Bob Bergland, Secretary of Agriculture, in the foreword to The Yearbook of Agriculture 1978.1 The desire fer a detached single-family house on a few acres com- bined with the increasing availability of rural public and private home financing and with the ever improving state and interstate highway sys- tems have caused'Uwadepletion of prime agricultural land and wasteful residential sprawl. Another negative result of this migration is more subtle. It involves the urbanite leaving the city for country dreams complete with urban comforts. A person who moves from the city to the more remote areas could be in for a few unpleasant surprises if he/she feels that the country is merely a more spacious version of the city. As Bergland reminds us, "So I know that country life can push some people beyond their endurance, can shatter illusions with a heavy and indifferent hand, '0 3 and can press poverty upon the backs of the unlucky and the unprepared." The unwary urbanite can also harm his/her newfound community by demand- ing urban services from the already strapped rural service budgets. Unnecessary and unaffordable services not only mean financial ruin for the rural community, but could also damage community fabric by splitting the newcomers from the oldtimers into two warring camps. Another more subtle and often undetected result of this new migration is the use of urban techniques in rural areas. Persons who have lived and were educated in urban areas tend to bring urban problem solving techniques into the rural employment setting. Trying to fit a square peg in a round hole will often mean frustration for the new rural employee unless he/she is willing to adopt his/her methods to the new situation. Measuring the adequacy of community service levels has never been an easy task. Citizen satisfaction is difficult to quantify. Reliable standards applicable to a region are, for the most part, not available. Political perspectives often cloud the facts. The purposes of this paper are to: o alert the planner to the differences in urban and rural lifestyles, o to begin to explore the differences perceived to-date in appropriate urban and rural service levels and service techniques, and o to present a citizen opinion survey instrument appropriate for use in a rural community. To focus the discussion, existent service levels in the Genesee, Lapeer, and Shiawassee County area,as measured by the Genesee-Lapeer- Shiawassee (GLS) Region V Planning and Development Commission (PDC) in I 1979,are described. The theories discussed are applied in a public opinion questionnaire, prepared by the author for a rural community, Imlay City, which is also in the Region V area. - 2 - -5 D 0 Rural Lifestyles--Pluses, Minuses to Living in the Countgy The typesryfpeOple who move to the country vary considerably, and so do their reasons for owning a few acres. Their objectives range from merely enjoying a rural residence to trying to approach economic self-sufficiency. These objectives might, therefore, be to: 0 Use the acreage solely as a residence. 0 Pursue hobbies or recreational activities. 0 Reduce the family's food costs by gardening. 0 Provide an "alternative" lifestyle for meeting food and energy needs. 0 Provide an extra (part-time) source of income by selling produce from the acreage, or engaging in some other side- line. As the fable, The Country Mouse and the City Mouse, taught us when we were children, the pleasures of country living may not_outweigh the discomfortsfkn~some individuals. One should consider the tradeoffs before leaving the city. Often pastoral, romantic notions are formed on weekends or summer vacations in the country. The change of routine can make,what later becomes unbearable chores,seem delightful. Often it is fun to care for livestock in the spring, but those same animals also need care in cold, icy, and wet weather. A small garden may be fun after a hard day in the office, but perhaps not after a long commute and with a much larger plot to tend. A recent arrival may be trading industrial smoke and car fumes for animal waste odors, crop, and weed pollens. Also, a good sized lawn can mean longer mowing hours and less time for recreation. ’0 O Distances are often far between neighbors. This could result in lonely young mothers and other homebound individuals. Energy costs may not be less. A Michigan study of energy use by urban and rural families found that while energy use in the home was about the same, rural families used 42 percent more gasoline than did urban families.3 This additional gasoline was required for food shopping and driving the children to libraries, movies, and school-related events. With gas prices high, this ratio should be seriously considered. Home-grown food may be more expensive than store bought food. It also may not look picture perfect. Animals need care every day. Eating that pet hog that grew up in the backyard can make an awkward situation for some at the dinner table. While money can be made in part-time farming, money can also be lost. Some urban conveniences taken for granted may not exist in a rural area. In the city, a reliable supply of water flows from the faucet. In the country, the source of water becomes the homeowner's responsibility. When the pump fails, it is his/her task to get it repaired. Also, most rural residents are served by septic tanks which also need care when things go wrong. In the city, garbage is regularly picked up. In the country, the homeowner has to make his/her own arrangements for disposal. Schools in rural areas may be a considerable distance from a residence. Children sometimes meet the school bus before daylight and get home after dark. Sometimes they cannot participate in intramurals because of this. The neighborhood store may be several miles from home. In order not to waste time and gas, sh0pping habits will need to be changed. Dirt and gravel roads are typical in the country. They may be rough on the car, keep it dirty most of the time, and are often closed by snow or mud. '0 ‘3 A move to the country does not guarantee that theft and some other "city“ crimes will be left behind. Often emergency services may be miles away. This means increasing risk, which results in higher insurance rates. Adjustments are often difficult and often require time. Some people may experience increased loneliness or new financial stress. Sometimes a new car, equipment, and repairs are needed. Vacations must be carefully planned and timed to avoid the planting and harvesting seasons. Someone has to be found to care for domestic animals. In attempting a small scale farming operation, the romantic and uninformed notions of rural life can cause difficulty. Many pe0ple know nothing about or ignore animal and plant diseases, insect pests, and other production and marketing problems they may encounter. Often land is bought without a realistic plan for what to do with it. An important prerequisite to success is planning and allowing for unexpected changes. The rural environment is capricious. Catastrophies can come in the form of low prices, unfavorable weather, disease, pests, and vandalism. Also, all aspects concerning local restrictions (zoning, etc.) must be checked before engaging in a new enterprise. Finally, lower taxes in the country also mean fewer services. Many of the activities which are part of the urban community are not as acces- sible or abundant in rural areas. There are fewer choices available in rural areas for bowling, theater, restaurants, shOpping centers, grocery stores, repair shops, physicians, medical facilities, etc. Comparative sh0pping is unavailable. Fast food and all night drug stores are usually not found in rural communities. Radio and television signal reception may be relatively poorer. Fewer stations reduce choice. O ‘ Lifestyles tend to be slower. Patience is a must. What once appeared to be peace and tranquility during vacations could become boring. Being resourceful is important-~often repairs are done by the resident. Most rural residents know quite a lot about their neighbors. Some may find this openness to be a refreshing change, while others may deplore the loss of privacy. If it was relatively easy to find an "acre in the sun", it will be found by others also. What may be a quiet rural resi- dence could become crowded in a relatively short time. A rural planner may consider making these realities of rural living systematically known to a prospective urban transplant. Pamphlets placed in mortgage and realtor offices may be one opportunity for transmitting this information. Urban and Rural Defined: Defining the terms "urban" and "rural" has become increasingly difficult. This difficulty is due to the socio-demographic changes which occurred after World War II and which continue through to the present. During this time, the increased mobility both to and away from rural areas, and the greatly improved communication linkages due to technological advances in media, have blurred the sharp distinctions which existed previously. In fact, this "blurring" has progressed to the point where rural areas are falsely interpreted as mere miniaturized versions of cities and suburbs. Several criteria have, in the past, been used in an attempt to accurately define urban and rural areas. These criteria included: distance from major employment centers, total population, p0pulation density, migration patterns, predominant employment type, and service O ’0 areas. However, each of these criteria can be misleading when used alone. Alone, they no longer serve as accurate and universally accepted measures of what constitutes an urban as opposed to a rural area. Employ- ment criteria, in particular, can confuse the distinction. The continued decentralization of retail and wholesale trade, services, recreational facilities, and jobs has occurred since World War 11. Also, people are increasingly willing to drive longer distances to work to obtain the comforts of "country living." Because of these two factors, persons who now live in what would otherwise be termed as "rural areas" increasingly earn a living in professions other than those termed "rural" (agriculture and mining).4 Some criteria have become obsolete. For example, migration patterns no longer serve to accurately distinguish urban from rural. The popula- tion shift from rural to urban areas during the 1950's and 1960's appears to be reversing in some areas. Some metropolitan areas (those not part of any Census Standard Metropolitan Statistical Area) are not experiencing net in-migration according to the 1980 trend ahalysis conducted by the U. S. Census.5 Therefore, because both out- and in-migration patterns continue in rural areas, migration data will not be used for determining urban/rural distinctions in this study. Population size and density are more widely used and accepted criteria and will serve as this study's major urban/rural distinguishing device. However, because no one factor can be used to accurately and consistently determine if an area could be classified as urban or rural, the combining of several factors is necessary. O 70> Besides making the gross distinction between urban and rural areas, a more refined classification is necessary because of the existence of a rural/urban continuum. The term "rural" refers to all those areas outside (heavily) built-up areas one would call cities or suburbs. Rural areas range on the continuum from the near suburban through areas of non-farm residential and urban-oriented recreational land use, to areas that are clearly beyond any but the most specialized influences of large urban centers. The existence of this continuum suggeststhat further distinctions may bg_necessary in order to begin to define service areas geared to those distinctions. For example, a "near suburban" rural area may have different service standards and provisions from those of a farming community. For purposes of this study initially, only gross distinctions will be made. Time did not permit further analysis of service area data to determine service area differences within these gross classifications. However, the planner should remember that further breakdown is important. Initially, "urban areas" will refer to: (1) Genesee County and its settlements and (2) the settlement areas of Owosso, Corunna, and Durand in Shiawassee County and the City of Lapeer in Lapeer County. The reasons for these distinctions are as follows: 1. Population Distinctions: Genesee County is, for the most part, currently defined by Farmers Home Administration, the Department of Housing and Urban Development, and the Bureau of the Census as an Urban area (or county) due to the sheer numbers of persons living in the county. The settlements within Lapeer and Shiawassee Counties which will be termed "urban" are those which exhibit the highest population concentrations for their counties. None of these cities is considered urban by federal O O agencies because they have less than 25,000 persons. However, they do serve as population and service areas, and to a lesser degree employment centers for the rest of the county. Therefore, for purposes of this initial study, they will be labeled "urban" to distinguish them from the more rural service areas which surround them. 2. Employment: Genesee County contains less acreage devoted to nonmanu- facturing and noncommercial uses than either Shiawassee or Lapeer (see chart and map). According to the Michigan Bureau of Economic Analysis, Genesee County ranked first of all 83 Michigan counties in the percentage (60.77%) of labor and proprieters' earnings originating in manufacturing in 1977. Shiawassee County ranked 32nd with 36.52 percent, and Lapeer County ranked 47th with 25.9 percent. Both Shiawassee and Lapeer, however, ranked fourth and fifth, respectively, in the percentages of labor they exported in 1977. Genesee County, on the other hand, imported labor and, therefore, ranked 76th. None of the three counties ranked in the top ten of Michigan counties' percentage of labor and proprietors' earnings originating in either agriculture or mining in 1976. Therefore, when examining employment statistics, Genesee County is heavily industrialized and hence "urban." Shiawassee and Lapeer, on the other hand, tend to contain a mixture of urban and rural uses, but are distinguished by the numbers of commuters to external urban centers they contain. Therefore, these counties ‘will be termed "rural" in the sense that as counties they exist outside of the immediate suburban ring surrounding either Flint, Detroit, or Lansing. What follows is an exploration into the differences perceived to date in appropriate urban and rural service levels and techniques. Examined is the complete range of services and facilities provided by state, and local publicly funded agencies. PROTECTIVE FACILITIES Fire Protection Fire protection facilities are integral parts of any community. Not only is the provision of this service essential and of high priority, but it has an impact upon potential growth within an area. Rural areas in general have larger response times and corresponding higher insurance rates charged to owners of pr0perty within rural communities. The results of a sample questionnaire administered to selective areas by Region V during FY 1979 bears out this generalization.7 The response times tend to be shorter in the cities of Lapeer and Owosso and slower in the rural townships. Higher population densities, better sur- faced roads, and a higher percentage of full time paid employees would support this conclusion. Formal emergency assistance participation agreements are made for the most part with surrounding districts or with the county through Mutual Aid Pacts. This system helps to supplement the local fire forces during major emergencies. A key ingredient in most successful fire fighting efforts is the quantity of water available. Thus, the availability of adequate water resources is an important aspect in planning for fire protection services and in determining present and future equipment needs. Communities served with public water supply can install hydrants at key locations to better insure an adequate supply of water. Fire departments serving - 10 _ 0 3 areas not provided with hydrants will have to rely entirely upon the capacity of their pumper and tanker trucks. Consequently, the services planner should be aware that where public water supply does not exist, fire fighting equipment should include pUmper vehicles with a large capacity, preferably 1,250 gallons. A company is comprised of a piece of equipment and the manpower required to Operate it. The number of companies recommended by the American Insurance Association is expressed in the following formulas:8 Ladder Companies: Communities Over 20,000 One (1) company + 0.03 companies x total population in thousands Communities under 20,000 One (1) company Pumper Companies: Communities over 50,000 3.4 companies + 0.7 companies x total population in thousands Communities under 50,000 = 0.85 companies + 0.12 companies x total population in thousands Many rural areas are served only by volunteer firefighters. The full time paid professional firefighter is rarely found in nonurban areas. Their occurrence even in urban Genesee County is rare. In 1971, a study conducted by the Genesee County Metropolitan Planning Commission9 counted only three departments employing full time firemen; they included: Flint Township, the City of Fenton, and the City of Flint. The National Fire Protection Association recommends that 1.62 full time firepersons are needed to provide adequate fire protection for each 1,000 persons. These standards are based on a 56 hour work week per fireperson.10 _ 11 - Police Protection Police services in the tri-county area are generally a responsibility of local units of government. However, county and state police agencies also serve in a supportive capacity to local departments. They also pro- vide laboratory and detention facilities and are the primary investigative forces for certain criminal activities. To a large degree, the counties' respective police agencies within the region operate independently. Agencies which are in close proximity to each other use either an informal or, at times, formal system of mutual aid in emergency situations. The various county sheriffs' offices provide radio frequencies and jail facility services for those governing units which lack their own. The jail in Flint is also used by some agencies in the tri—county area.11 There are no accepted standards regarding manpower needs. The extent of manpower requirements are based on a number of factors such as density of p0pulation, crime statistics, roads to be patrolled, and other con- trolling factors. The standards for jail capacities has been established by the Michi- gan State Department of Corrections. They recommend one prisoner space per 1,000 population. A county jail must contain at least two holding cells, two segregation cells, and four maximum security cells.12 In the Region V area in 1979, urban/rural differences tend to be the greatest when examining per capita costs and the types of specialized services and equipment provided. Separate juvenile services and special- ized equipment are only provided in Grand Blanc Township and in the City of Flint. The greater number of police per person tend to be in the cities and villages, compared to their surrounding township areas and tend to be the highest in Genesee, compared to Shiawassee and Lapeer. - 12 - 6 0 Per capita costs are the lowest in the rural areas, especially in Lapeer and Shiawassee Counties and in those municipalities immediately adjacent to the City of Flint. The highest per capita cost is found in Flint at $76.54, while other cities in Genesee County average between $25.00 and $45.00 per person. The highest per capita costs in Lapeer County occur in the southeastern cities with high rates of between $40.00 and $55.00 per person. The highest per capita costs in Shiawassee County occur in the centralized urban area of Owosso, Corunna, and Durand which have rates of approximately $25.00 to $40.00 per person.13 Emergency Services While the majority of the p0pulation in this nation is urban in residence, the majority of highway fatalities are rural in occurrence. The fatalities include both rural and urban residents who often die not so much because of their injuries, but because care in inadequate to the problem at hand. The urban resident as well as his rural counterpart, therefore, has a stake in the care that is available in less populated areas.14 In the tri-county area the largest category of deaths occurring under the age of 35 is not due to natural causes. In Genesee, Shiawassee, and Lapeer Counties, accidents account for 28, 48, and 36 percent, respectively, of all deaths under 35 years of age. The estimated population per ambulance is lowest for Shiawassee County. Shiawassee also has seven different dispatch areas compared to only three for Lapeer County and nine for Genesee County.15 This presumably gives Shiawassee residents, as a whole, a more rapid emergency system. Otherwise, those involved in accidents within those cities where hospitals are located would receive the quickest emergency care. - 13 - O 73 The numbers of persons per ambulance for Genesee County are higher than both the region and state ratios. Despite the great need for such aid, ambulance services have been cut in some areas due to increased costs. Flint Township discontinued its emergency ambulance service April 1, 1979 because Flint Township voters had rejected a 1.5 mil tax increase. Rural areas are particularly susceptible to tax cuts. They depend on fewer sources of funding than do urban areas. Also rural areas have a greater need for emergency transportation and could have future emergency care reduced by escalating fuel and equipment costs. 16 A 1973 article in the Journal of the American Medical Association suggested several different approaches to emergency care applicable to rural areas as opposed to urban areas.17 Emphasis should be placed first on improving capability to respond to emergencies that threaten life and limb rather than responding to the much larger number of less serious events. Most persons who die unnecessarily could be saved with relatively simple techniques, and improvement of basic services and skills is much more important at this time than is develOpment of highly sophisticated training programs and response systems. Emergency room nurses need better training and standard protocols for emergency response in rural areas. Both nurses and ambulance personnel need frequent critique sessions to make up for the sparsity of real emergencies they see. Finally, the author suggests that program evaluation must be an integral part of any improvement effort. - 14 - LOCAL GOVERNMENT Most rural communities in the region house several uses (fire stations, maintenance yard, administrative offices, and police stations) within the same building. This is markedly different than urban muni- cipalities' segregation of these services. As borne out by the 1979 Region V survey, rural settings often have higher maintenance costs due to little new construction, rise in population and traffic flow, and in the case of one township, increased responsibility in road service. Several more urban communities indicated a decrease in road maintenance costs, the primary reason being that new paved streets, curb, and gutters reduced operating costs. A planner should realize that most administrative offices are part time or volunteer effort in a rural area, which can make long term improvement programs difficult. - 15 - PUBLIC FACILITIES Municipal Water and Sewer Systems All urban areas in the Genesee, Lapeer, and Shiawassee County area have municipal water and sewer systems. Considerable variation exists among rural cities and villages, however.19 These communities' future often rests on whether or not they have been able to build municipal systems within the last ten years. During this period, federal funds were available to assist in their construction. With recent attempts to decrease the federal budget, however, these funds are in jeopardy. Smaller communities are often unable to unwilling to use their own resources or to c00perate with surrounding areas for municipal water and sewer construc- } tion. The operating systems are often prerequisite for a rural village's survival. A planner should be aware that often this is the most crucial problem facing these rural cities and villages. Solid Waste Disposal Our system of solid waste disposal has remained unchanged since the beginning of civilization. We still dispose of our wastes on or in the land. Presently we face three major problems with this system: the contamination of our waters, lack of available sites, and escalating costs, particularly transportation costs. Few sites exist adjacent to urban areas due to local public pressure which perceives landfills as open dumps, breeding places for rodents, blowing paper, and foul odors.20 -16.. O ’ O For the most, these sites are located in nonpbpulated areas. The potential rural resident should be aware of these sites and their potential hazard prior to relocating. The rural planner must be aware of these sites; early in his/her job tenure due to the potential environmental concerns on existing and future devel0pment. A waste which contributes less to the total waste flow, but which is of greater concern than the typical municipal waste is industrial wastes. They include organic and inorganic residues, hazardous materials, hazardous and toxic chemicals, wood and paper. They present very real dangers to human life and all wildlife. In the past, sludges contaminated with hazardous wastes were deposited in landfills. Today because no incinerator exists in Michigan to dispose of these industrial by products, they have been sent out of state. -17- HEALTH CARE FACILITIES Introduction At one time, both the quality and quantity of health care services provided in urban and rural counties were distinctly different. However, as urban and rural areas have become more interdependent, their differences have decreased considerably. As the inventory of services in Region V illustrated, the vast majority of key medical care services are urban oriented.21 This is usually particularly evident in the distribution of dentists, medical specialists, general hospitals, and to a lesser extent general practioners. However, modern transportation and communication innovation have widely diffused over the past several decades into rural areas. Modern transportation has reduced the time-cost ratio between the rural environs and the urban centered medical services. Modern communication innovations have "faci— litated the transmission and penetration of urban thought-waves, including, one would assume, norms related to modern health care."22 Urban centered hospital services have increasingly expanded the health care and educational opportunities now available in rural areas. Also, shifts have occurred in the rural occupational structure of these counties. Urbanites have followed the relocation of jobs into the countryside, are members of "white flight" movements into more rural areas, and/or have been attracted by pleasant rural and small town living. Farmers have taken up full or part time employment in business and industry. - 18 _ This increased occupation and service flow into and out of urban and rural counties has increased the similarities in the two areas' health care systems. None the less, significant differences still exist in the health care delivery services among the three county area. Hospitals Hospitals are primarily concentrated in Flint. Lapeer County contains two hospitals; one in the City of Almont and the other in the City of Lapeer. Shiawassee County contains one hospital located in the City of Owosso. Genesee County has seven hospitals whiCh provide general care. Six of the seven are located in the City of Flint. Wheelock Memorial Hospital is located in the Village of Goodrich, approximately nine miles southeast of Flint. The total number of licensed beds for Lapeer County is 260, Shiawassee, 272, and in Genesee County 2,276.23 All hospitals in the region are AHA accredited. The following is a list of summarized standards or requirements for accepting general hospi- tals for registration:24 Function: The primary function of the institution is to provide patient services, diagnostic and therapeutic, for a variety of medical conditions, both surgical and nonsurgical. 1. The institution shall maintain at least six inpatient beds which shall be continuously available for the care of patients who are nonrelated and who stay on the average in excess of 24 hours per admission. 2. The institution shall be constructed, equipped, and main- tained to ensure the health and safety of patients and to provide uncrowded, sanitary facilities for the treatment of patients. 3. There shall be identifiable governing authority legally and morally responsible for the conduct of the hospital. 4. There shall be a chief executive to whom the governing authority delegates the continuous responsibility for the Operation of the hospital in accordance with established policy. 10. 11. 12. O I There shall be an organized medical staff of physicians that may include, but shall not be limited to, dentists. The medical staff shall be accountable to the governing authority for maintaining proper standards of medical care and it shall be governed by bylaws adopted by said staff and approved by the governing authority. Registered nurse supervision and other nursing services are continual. A current and complete medical record shall be maintained by the institution for each patient and shall be available for reference. Pharmacy service shall be maintained in the institution and shall be supervised by a registered pharmacist. The institution shall provide patients with food service that meets their nutritional and therapeutic requirements; special diets shall also be available. The institution shall maintain clinical laboratory service, with facilities and staff for a variety of procedures. Ana- tomical pathology services shall be regularly and conveniently available. ' The institution shall maintain diagnostic X-ray service, with facilities and staff for a variety of procedures. The institution shall maintain operating room service with facilities and staff. A comparison of the acute care hospital services offered in Shiawassee and Lapeer Counties to those offered in Genesee County indicates that specialized hospital services are more readily available in the Flint metropolitan area. Both the City of Lapeer and the City of Owosso offer five out of twelve outpatient services offered by the Flint service area hospitals, and three and fiveout of 14 special diagnostic, treatment, and support services offered in the Flint service area hospitals.25 Because there are no new major additions planned for the future, it can be assumed that Lapeer and Shiawassee Counties will continue to rely upon Genesee County facilities for specialized services. _ 20 - Health Care Manpower V26 reveals the An inventory of health care available in Region expected concentration of doctors, nurses, dentists, and psychiatrists in county urban centers and to a much greater extent within the Flint City boundaries. While both Lapeer and Shiawassee Counties offer under five doctors per 10,000 population, Genesee County offers approximately ten doctors per 10,000 pdpulation. This compares negatively to the state's ratio of over 15 doctors per 10,000 persons. The case is the same for other types of medical manpower including dentists, except for oste0pathic physicians. In that case, Lapeer shows having a slightly higher number per 10,000 population than Genesee and the state ratios. As can be expected, the general practice physicians compose a greater percentage of the total doctors in more rural counties. One would assume that those persons who were unable to obtain medi- cal services within their own county would seek those services either in Flint, Detroit, Pontiac, or Lansing. However, one must be physically and financially able to drive the required distances. The elderly, handi- capped, and economically disadvantaged groups in rural areas are in a particularly vulnerable position regarding the provision of routine pre- ventative and emergency medical assistance. One last note, one must not assume that the patient flow is from the rural to the urban areas. One study revealed a reverse trend. The researchers state: “Predictably, people living in small towns and rural areas go to large cities for some of their medical services. How- ever, it is generally not appreciated that physicians practicing in small towns spend a sizeable proportion of their time pro- viding medical care to people who live in somewhat distant, _ 21 - D 0 large metropolitan areas. Apparently, these urban citizens perceive the presence of a type of medical care in small towns that is more desirable than that provided in large cities." 27 If this is true, it would indicate that medical service adjustments must be made in urban areas as well as rural areas to create a more efficient system better able to meet the immediate service area needs. - 22 - SOCIAL WELFARE SERVICES As Ira Kaye, former Acting Director of the now defunct Office of Economic Opportunity's Office of Rural Programs, has said: "Rural social problems are the product of neglect of our rural human resources. Modern technology has been concentrated on the agricultural and extractive indus- tries, to the exclusion of human resource concerns. National policy has fostered this imbalance. Rural legislation has been farm legislation, and the result- ing subsidy programs have contributed heavily to rural institutional deterioration and the breakdown of the rural economic base. National policy on racial and ethnic quality has also been a force in the decay of rural areas. This combination of these factors has... produced conditions which make rgral areas places to get away from, not to live in."2 All of the social problems one expects to find in any community may be found in rural settings. As Ginsberg states: "A small scale of life does not imply simplicity. Rural communities are often as sociologically complex as urban communities. Many of their characteristics may be based upon little-remembered but nevertheless influential historical events focused on family con- flicts, church schisms, and a variety of other ocgur- rences which may deserve the status of legends."2 However, because of the small and scattered population in rural areas, some social services that are usually provided in urban areas are unavailable to rural Americans. According to Leon H. Ginsberg, editor of a book entitled, Social Work in Rural Communities, four major factors exist that appear to affect the delivery of social services in rural areas. They include: (1) lack of funding sources, (2) primary group orientation, (3) rural religious influence, and (4) transportation.30 _ 23 - 1. Lack of Funding "Even when the incidence of specific need is high, local solutions to local problems may be financially impossible because the total population is too small to provide suffi- cient taxes or voluntary contributions to support day-care centers for aged persons, mental health out—patient clinics, nursing homes, family service agencies, settlement houses, and most of the other social welfare servicgi that are routinely offered to the urban population." Increasingly, the federal and state governments are providing funding to rural distressed areas. Numerous countywide social service agencies receive direct and/or indirect federal funds. However, those agencies which rely heavily on provided funds have difficulty in managing multiple funding sources. The Catholic Service agencies expressed that the multi-grant funding creates the need for additional administration staff time. It also adds to the instability of the social service jobs, making the attraction and retention of qualified personnel difficult. The shortage of available volunteers compounds the staffing problem to create critical staff shortages for many of these privately funded agencies. Federally funded housing services are available to small com- munities through many social service agencies and through Michigan State Housing and Development Authority (MSHDA) and local units of government who work in c00peration with developers. However, the Report of the Task Force on Rural and Nonmetropolitan Areas con- cluded: ". . .that available resources either have not been provided efficiently, or at all, due to (1) deficiencies in the delivery system, and (2) a failure to make full and imaginative use of existing authority and resources. This stems in large part from the failure of government administrative machinery to take into account and adapt its procedures, forms, and communications to the capa- - 24 - O 0 cities of these smaller communities and rural areas and their mode of administration and of doing business. This includes the capacities of the type of business enter- prise that operates in these areas as well as the capa- cities Of the governmental entities." "The failure to deliver available resources has been compounded by the deliberate termination by a prior administration of programs which were serving these areas and communities successfully, such as programs under the United States Housing Act of 1937, consisting of public housing and the Section 23 (now Section 8) leasing pro- grams, and the National Housing Act Section 235 program. Also, the overlapping jurisdiction of Housing and Urban Development (HUD) and the Farmers Home Apministration (FmHA) creates some delivery problems." 2 2. Primary Group Orientation Carl F. Kraenzel, a professor of rural sociology, has suggested that rural and/or sparsely p0pulated areas are synony- mous with primary group (e.g., family) orientation, while urban and/or metropolitan ways tend to be synonymous with secondary (e.g., schools, businesses, civic organizations, and so forth) and/or special interest group orientation.3:3 Any social services organization, or for that matter, any institution that exists or develops in rural areas, is likely to be a primary unit. Faceless public servants common in urban areas are unlikely to be found in rural areas. In such a system an objectively organized and impersonally conducted social agency common in urban areas is unlikely to succeed. A general urban and rural services questionnaire was admini- stered to city managers, village and township clerks, and to school superintendents. The respondents were asked to rank various institutions as to the degree to which they contribute to community and individual welfare in their area. Although the survey was highly selective and given only to a very small - 25 - -.. 0' '0 sample size, the results are interesting. The family, church, school, and local government institutions were commonly ranked as providing the highest amount of social services. Federal and state agencies were ranked fourth out of six for total services provided in the more urban areas while they were hardly ranked at all for the more rural areas. This may indi- cate the general awareness that such institutions exist, but an ambiguity regarding their function. It also may indicate the lack of visibility of federal and state institutions in the more rural areas. These institutions tend to be located in population centers. Services were also termed more personal in rural areas as compared to urban areas with reasons being increased communi- cation and/or personal knowledge of one's background. 3. Rural Religious Influence In urban areas, social services are becoming increasingly secularized, but in many rural communities they are still closely related to churches. The initial results of the Urban and Rural Services Study seem to support the relevance of this statement for Lapeer and Shiawassee Counties. Churches were ranked as primary service institutions. However, when services were broken down by service category (recreation, education, health, etc.), the churches and church welfare agencies, combined, scored lower than any other social insti- tution, with the exception of private services and good samaritan individuals. - 26 - 3 -O The local units of government consistently scored the highest. This may indicate that the categories listed are phrased in such a manner so that they tend to reflect the activities of government. For example, both counties have Parks and Recreation Commissions; and therefore, the term "recreation" may be more readily identified with those institutions than the church recreational activities. Also, this may reflect the total integration of the church into the social fabric of the community. The church usually takes on a multi-purpose role. It often serves as a com- munity center, social center, town hall, and political organization meeting place. Ginsberg states: "The minister fulfills the whole range of social service roles from marriage counselor to youth club organizer. Whereas, the urban church usually oper— ates as a secondary institution and the minister as a specialized functionary, the roles of the rural church and the rural minister are inextricably woven into the whole fabric of community life...separating - religion from welfare services, education, and government is difficult to accept; they are all tied together. Therefore, most rural social services that are effective must involve churches and church leaders. Any other pattern is too far remoVed from the context of community life."34 4. Transportation and Communication Transportation appears to be the key problem in rural areas. "Almost all rural specialists from all disciplines cite this inadequacy as a major problan."35 Also, all of the countywide social service agencies surveyed in Lapeer and Shiawassee Counties mentioned transportation as being the main problem they face. Often clients lack cars and access to affordable public transportation. Many cannot afford -27- O ' 0 phone service. This isolation often compounds emotional and physical problems. The lack of transportation and community services makes service information dissemination to these areas difficult. Consequently, many rural persons lack a basic understanding of the social services available to them. However, companies selling appliances, books, and insur- ance have found it more feasible to extend their activities into isolated rural areas that have programs of social welfare. As one service agency administrator stated in the Region V Urban and Rural survey, "The staff has difficulty handling present caseloads due to underfunding. Therefore, no time can be allo- cated for designing an agressive outreach program which would only take away from present service hours and add to caseload waiting lists." The United States has yet to commit sufficient resources to deal with its social problems, urban or rural, and this lack is most dramatically visible in rural areas. 5. Rural Conservatism In addition to the above four reasons, the conservative nature of rural populations tends to influence the delivery of social welfare services. Often a local public welfare agency and its clients represent an affront to all that is held to be of value in many communities (self-sufficiency, independence, thrift, and family loyalty). After all, the department was "thrust" in by federal and state actions; it reflects outside values, and it is usually staffed by out- siders of higher educational level than most residents. This outside influence often represents an external threat. _ 28 - Many problems faced by rural social service agencies are a result of what is inherent in the word "rural." A small concentration of people makes, in most cases, the provision of specialists, varied services, and outreach programs difficult and cost prohibitive. Agencies face a shortage of manpower due to the shortage of dollars available and the increased cost per rural case. Even if dollars were readily available, it may be difficult to attract sufficient personnel due to the lack of other services in the community and surrounding areas. Recreational opportunities are fewer, professional stimulation is less available, and resources for effective practice are limited. The lack of professional services available compounds the problem. Often rural doctors, dentists, and psychiatrists are overwhelmed by their caseloads. Rural conservatism, provincialism, and an emphasis on self-reliance not only makes delivery of services difficult, it also tends to alienate new professionals who become frustrated by their inability to use new techniques. -29- LIBRARIES Libraries no longer merely dispense books to a reading public. They also provide a number of services to the community including education, entertainment, and information. Lecture series, reading progress film and record collections, and other similar programs are opening the library to a variety of population groups. Functions specifically geared toward children, young adults, the elderly, and handicapped are now part of many library programs. The State Board of Education is authorized by law (P.A. 89 of the Public Acts of 1977) to set standards for library cooperatives and public libraries and to issue certificates to library employees. These standards are based on the size and density of the population served. All libraries in the region, with the exception of Imlay City, are part of either the Mideastern Michigan Library, the Blue Water Federation, or the Capital Area Library Cooperatives. All receive state funding and, therefore, must meet the standards listed below. By law, cooperative libraries' services must include:36 1. A central pool or rotating book collection. 2. In-service training. . Book selection aids. 3 4. Bibliographic services. 5. Audio-visual services. 6 . Bookmobile services or other outlets to outlying areas. - 3o - O 4O 7. Publicity and public relations. 8. Printing. 9. A centralized purchasing operation. 10. Centralized processing including cataloging and marketing. 11. Reference services. 12. Delivery services. Public libraries (which include county, city, and village systems) by law are designated according to the following classes on the basis of population. As may be expected, staff, capital outlay, and operating requirements are considerably less stringent for more rural areas. Population Class Hours Library Expenditures O - 2,999 I IS/wk ' .45 per capita 3,000 - 5,999 II 20/wk .50 per capita 6,000 - 12,999 111 30/wk .55 per capita 13,000 - 24,999 IV 40/wk .60 per capita 25,000 - 49,999 V SO/wk .65 per capita 50,000 and over VI 55/wk .70 per capita P.A. 89 of Public Laws of 1977 states: "Certificates will be issued by the state board, based on educational attainment as follows: a) Type 1: Professional Certificate. A master's degree in library science or its equivalent from a college or university with a library school program accredited by the American Library Association. b) Type 11: Limited Professional Certificate. (i) A bachelor's degree with at least a minor in library science. (ii) A bachelor's degree in any subject area with at least 18 semester hours in library science or recommended by the Michigan Dept. of Education. -31- a. ‘— I. i ‘ o 0 ~ c) Type 111: Library Technician Certificate. (i) Graduation from a two year library technician pro- gram approved by the Michigan Dept. of Education. (ii) Two years of college training, nine credit hours of which must be library training as recompended by the Michigan Dept. of Education. d) Type IV: Clerk Librarian. One year of college from a college or university approved by Michigan Department of Education. All libraries in the region meet or exceed state standards. Differences do exist regarding the hours, staffing, and collection size per capita; areas of higher population density (Lapeer and Owosso) have much higher per capita collection ratios, are open longer, and have persons who hold more advanced library degrees. With the availability of Universal Borrower's Cards, the assumption is that the more urban areas (with the exception of Owosso) do provide services to areas larger than their defined area popu- lations. As the population continues to rise in these counties, the urban centers will continue to feel pressure to expand their services. This pressure will be exerted by residents moving into the rural areas as well as urban centers of Lapeer and Shiawassee. If these newly arrived residents originate from areas of greater population density, one can ex- pect ever greater pressure on these libraries to prOvide a greater quan- tity and variety of research assistance, materials, and programs. _ 32 _ RECREATIONAL SERVICES No methodology has yet been devised which can aid the researcher in predicting the degree of satisfaction with rural recreational services that will be felt by the newly arrived urbanite. The theory that urbanites desire to return to nature conflicts with the theory that urbanites desire more indoor activities than rural residents; therefore, the preference for certain types of outdoor recreation does not appear to be primarily depen- dent on whether one is an urban or rural resident. More reliable criteria for determining preferences include place of upbringing, age, occupation, income and education levels, and the density of the areas from which and to which one is moving. Also, there exists considerable differences within urban centers (cities and suburbs) and within rural areas (small towns, market communities, farm, and non-farm). Active/Passive Recreational Facilities: Recreational facilities pro- vide two basic types of recreational areas--active and passive. The active recreational areas are those which are devel0ped with apparatus and play- fields. Passive areas are those which are primarily for restful activity. Scenic and picnic areas are prime examples. Service Area: The population area which the recreational facility services determines the facility's size and form. Prbgressing from the most localized are home yards, neighborhood (adult and playgrounds), community, municipalwide, and regional facilities. (See Table I.) The degree of distinction between these different service areas will depend _ 33 - LA! 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For example, a rural township park could be described as both a community and municipalwide facility and even to some degree a neighborhood facility. The size and shape of a recreational facility is dependent on the above two factors of service area and functional use. Other factors in- clude clientele (for whose use it is designated and who will ultimately pay for the facility) and climate, scenery, natural areas, historic sites, soils, existing waters, and potential impoundment sites for water and wildlife habitat. Other factors may include the proximity and access of local roads and tourist routes, and the rural ownership and land use patterns. Planning for Recreational Facilities--Basic Difference Between Urban and Rural Approaches ' A Region V survey of existing recreational plans in the three county area turns up some basic differences between urban and rural approaches toward planning for open or recreational spaces. These differences are in- herent in the definition of urban and rural. Orban areas tend to be either: 1. Overly developed with no vacant land or area designated as either open space or for recreational use, or 2. Fragmented by extensive vacant land and/or deteriorating buildings. In the former case, the need is stated as being one of increasing vacant land to allow the city "to breathe." The active recreational as- pects of community facilities are played down; the emphasis is on "open space.” In the latter case, there is a described need for a "system of parks" which unites the city into a pleasing and coherent whole. Here the socializing aspects are emphasized. The city parks are projected as not only allowing the residents to experience visually the city as a _ 35 - .9 .rj .g whole system, but to socially experience a unified city. "They allow a diversified population to mingle, and the larger green spaces, parks and pathways, riverbanks, and waterfront give to a city the coherence that allows the urban dweller to have a feeling for the whole."38 In rural areas there is, of course, no need for "Open space." However, if the area is in an area of projected population increase, the plans stress the need for preserving land now for future recreational and open space needs. As stated in Elba Township's Comprehensive Plan: "It is wise to purchase lands for recreation early in a community's development before sites become scarce and prices inflated by the pressure of increased urbanization."39 The need to preserve wetlands, woodlands, and floodplains for passive recreational use is also a concern expressed in the rural plans. However, overall local plans tend to stress the more active recreational facility, leaving to the county and/or state the responsibility of preserving valuable positive scenic areas. The combination uses and hence the sharing of expenses is often pro- posed as being a logical approach to providing recreational facilities in rural areas. The coupling of existing and future school sites with recreational areas reflects the existing dependence on school sites for active recreational sites. To a lesser degree, suggestions are made for setting land aside for a community park/township office facility, thus creating a township focal point. Analysis of Present Recreational Facilities in Lapeer and Shiawassee Counties Standards: Recreational standards have been produced by several national planning and recreational professional societies and associa- tions and are listed in the following table. 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