Being online helps learn about and access some activities for older adults in rural Minnesota

MinnPost reports

Social well-being is essential to good health. Yet, as the COVID-19 pandemic roiled the country and upended social routines, supporting social well-being became even more challenging, including in rural areas. Social well-being was impacted most directly by the need to socially distance and isolate, and many people moved some or all their social activity online. However, this proved more challenging in rural areas, where broadband connectivity is less available and devices are less omnipresent, and for older adults, who generally report lower use of online technology than their younger counterparts.

In an April, 2022 report released by AP and NORC at the University of Chicago, rural adults age 50 and older reported the lowest level of satisfaction with available social activities in their community (only 38% thought the area they lived in was doing a good job at providing social activities, compared with 52% in urban areas and 55% in suburban areas, despite the fact that older adults make up a disproportionate share of rural residents). The survey also showed that rural residents reported lower satisfaction with transportation and availability of services to help them age in their own homes, compared with their urban and suburban counterparts.

They looked at the impact of broadband access and info…

We researched social opportunities in all 60 non-metropolitan counties in Minnesota, focusing most on those geared toward older adults. We found ample opportunities, but also variation between counties. Most – but not all – counties offer some combination of social infrastructure, including public libraries, senior centers, farmer’s markets, faith-based organizations (notably mostly Christian churches), American Legions and/or VFWs, and public parks. For some, there were community arts centers and hobby groups (e.g., quiltingfitness classes, bee keepingcardsgardeningcommunity theatermovie nightsbingophotographyfishingart classeswine tastingbook clubs).

Some counties and communities made it easy to find opportunities online. For example, the Todd County website listed a variety of opportunities and social infrastructure resources in an accessible, user-friendly fashion. This is good for residents looking for new ways to connect with each other, but is also important for loved ones who live out of town and are trying to find opportunities for those they care about. Many counties also have local news sources through which activities and events can be shared, although the availability and independence of those has decreased nationally in recent years, potentially making it more difficult to share local social opportunities.

Other counties and communities were much more opaque about social opportunities for older adults. Either the opportunities don’t exist, or, more likely, they organize by word of mouth or other forums. That begs the question, who might that be leaving out? How would newcomers to communities learn about social opportunities and connections, and how can out-of-town loved ones help their family members find ways to connect?

Only 13 percent of eligible households in Minnesota take advantage of Lifeline subsidy program

The Benton Institute for Broadband and Society reports

During the first quarter of 2022, the Lifeline National Verifier received 4,457,395 applications. Of the applications received, 48% were fully qualified automatically, and 7% were qualified through manual documentation review. The overall qualification result is determined after eligibility is checked and includes further checks related to identity and duplicates. Of the applications submitted, 1,989,492 applications were determined to be “Not Qualified” because they did not meet the program criteria and were not resolved by the applicant within 45 days.

Based on Lifeline National Verifier Quarterly Eligibility Data from USAC that also provides data by state, including participation rates…

State January 2022 Subscriber Count 2020 Lifeline Eligible Households Based on ACS Data Estimated 2022 Lifeline Participation Rate
Minnesota 59,451 469,873 13%


The online Digital Skills Library is now open

World Education Inc has just unveiled their new Digital Skills Library

The Digital Skills Library is an open repository of free learning resources designed to help all adult learners develop the digital skills needed to achieve their personal, civic, educational, and career goals.

It is a open collaboration…

The Digital Skills Library is managed by CrowdED Learning, the open education initiative of the EdTech Center @ World Education. It is crowdsourced by adult educators, digital navigators, digital skills training providers, and other individuals dedicated to ensuring all adults have access to quality digital skills content to help them achieve their personal, civic, educational, and career goals.


RESOURCE: Stronger Together: Federal funding and planning strategies

There’s not much to say about the resource (Stronger Together: Federal funding and planning strategies designed to promote sustainable economic development in rural America) so I’ll borrow from the document itself…

Together, the U.S. Department of Commerce Economic Development Administration (EDA) and the U.S. Department of Agriculture Rural Development (USDA RD) are pleased to offer this joint planning resource guide, designed to help you eliminate barriers and encourage collaboration among your stakeholders.

It is a series of super useful tables. More of a reference work than a coffee top (or even night stand) book. It would be easy to spur conversation based on the info or get follow up information.

Average US Pay TV Customer Is Paying $204 a Month for Broadband and Video Entertainment

Next TV reports on TiVo research…

Americans are paying almost as much for connected living room services as they are for electricity, natural gas and water, according to TiVo’s Q4 Video Trends Report.

TiVo’s latest survey said that U.S. consumers who still take traditional bundled video are spending, on average, $124.40 a month for pay TV and broadband, up 11% in the six months from when TiVo conducted its Q2 report last year. Add to that a bill Netflix and other subscription streaming services, and pay TV consumers are forking out an average of $203.60 a month for internet and video entertainment.

It sounds like Netflix and others are as much a part of the cost as broadband. But still interesting to compare. I have to say for my own household, those paid programming services kept us sane and not fighting during the depth of the pandemic. The question is will we keep them all now that we can go to live events again.

Collocating broadband and powerlines study in MN seems postitive

Energy News Network reports…

A Minnesota feasibility study finds multiple benefits of co-locating high-voltage transmission lines and broadband along highway rights of way, which could apply across the country and produce $1 billion in societal value through faster decarbonization.

EnergyWire takes a deeper look…

The study identified some clear barriers to siting broadband or electric transmission along highways — including that Minnesota law doesn’t allow longitudinal utility siting in highway rights of way, so a policy change would be needed.

The DOT must also ensure that non-transportation infrastructure located in highway easements doesn’t interfere with the ability to maintain and expand roadways.

None of the challenges identified by the study have deterred the DOT’s interest in the concept, and a second phase is in the works later this year that will take a deeper dive some of the issues raised, Oh said. Along the way, additional state agencies, utilities and other parties need to be brought in to help with the analysis, she said.

While numerous policy and process barriers stand in the way of Minnesota burying power and communications lines in highway easements, Oh and the study authors agree that none are insurmountable. And for technical guidance, the state can look at its neighbor to the east, said Laura Rogers, deputy director for the Ray.

Telehealth Use Among Medicare Beneficiaries Multiplied by 88 during the Pandemic

Internet Innovation reports..

Medicare beneficiaries completed 54.5 million virtual office visits in 2020, according to a new federal report released by the Department of Health and Human Services’ Office of Inspector General. The analysis considers Medicare fee-for-service claims data and Medicare Advantage encounter data from March 1, 2020, to Feb. 28, 2021, and from March 1, 2019, to Feb. 29, 2020.

The COVID-19 pandemic caused telehealth use to skyrocket. Medicare beneficiaries used 114.4 million telehealth services from March 2020 to February 2021, which is 88 times the use of these services by this population the year prior.

From March 2020 through February 2021, 43 percent of Medicare’s 66 million beneficiaries – more than 28 million people enrolled in Medicare – used a telehealth service. Prior to the pandemic, just one percent of beneficiaries used telehealth.

Human capital as important as broadband in digital equity

Brookings reports…

Providing fast and reliable broadband is only a first step; as policymakers need to think holistically about how to achieve widespread and inclusive technology use—enhancing not just infrastructure, but the digital human capital to use it in both urban and rural communities.

Making new investments can generate significant benefits for local economies, according to our recent research. In what economist Enrico Moretti has called the human capital century, individual and community fortunes are driven by human capital, which is often defined as educational attainment. We argue that broadband use is a form of digital human capital. Like education, broadband use can facilitate access to information and the development of skills. As with other forms of human capital, broadband use can also be expected to affect outcomes for the broader community, with multipliers and spillover effects for labor markets and local institutions, and richer information networks to encourage innovation.

A good reminder as we start serious investment in technology – the technology is only as good, or ubiquitous, as the people who know how and can afford to use it.

Community Conversation in Chisago County with Ben Winchester

Last week I attended a great session in Lindstrom Minnesota (Chicago County) where Ben Winchester was keynote. Here’s the official description of the event …

MN rural sociologist Ben Winchester presents his “Rewriting the Rural Narrative” keynote speech at Chisago Lakes Performing Arts Center in Lindstrom, MN. Prefaced by Chisago Lakes Chamber Exec Director Katie Malchow and her description of local Blandin Foundation grant programs, Ben leads the audience through a fascinating dose of rural reality, unveiling all the media and anecdotal misinformation that gives rural Minnesota a bad rap. Speech followed by a panel discussion with 3 local newcomers and what it’s like to move out to the Chisago Lakes area. Video by Jack Doepke, Chisago Lakes Public TV.

[at the speaker’s request, this video may be taken down in 30 days – so late April 2022]

Ben is always an engaging speaker. He has more statistics than Carter’s got pills, he’s on the frontlines and he is able to make connections clear. His mission last week seemed to be to remind attendees that rural areas are not dying. As he said, how can rural areas be dying and yet, it’s so hard to find a house to buy in a small town?

The rural/urban/suburban population numbers get skewed because once a town grows too much – it slips into a new category. So the biggish small town suddenly becomes suburban or metro.

Rural folks have to help change the narrative that rural is dying. Recognize that your town isn’t in the middle or nowhere – especially with broadband – you’re suddenly in the middle of everywhere. On tactic is to think regionally, not hyper-locally. Your hometown may include you’re the towns of your home, school, work and hobbies.

Ben’s talk is inspiration and it’s fun to hear from the panel of transplants to Chisago County too.

How does your county rank for broadband access and use?

I was working on something completely different – when I had to find broadband adoption rates in Minnesota. The best I could find was access in the Census. The good news is that the numbers appear to be pretty recent (2020); the bad news is that while it’s listed as subscription rate, it appears in the small print (spelled out below) that they are tracking whether anyone in the house has access.

Here are the top ranked counties:

County Subscription Rate rank
Washington 92.6 1
Scott 92.3 2
Carver 91.9 3
Dakota 91.5 4
Wabasha 91.4 5
Anoka 90.8 6
Sherburne 90.6 7
Hennepin 89.2 8
Chisago 88.9 9
Ramsey 88.5 10

It’s striking to see that while the top ranked counties for broadband availability are a mix of rural and urban counties; the  top counties for access/use are decidedly metro leaning.

And the bottom 10 ranking counties (in reverse order)

County Subscription Rate rank
Lake of the Woods 62.2 87
Roseau 72 86
Watonwan 73.4 85
Todd 73.5 84
Renville 73.9 83
Norman 75.2 82
Redwood 75.7 81
Mahnomen 75.7 80
Kittson 75.8 79
Murray 76.7 78

Also interesting to see that the bottom rank counties for access/use included only one county that is on the bottom ranking for availability. (Redwood has that unfortunate distinction.)

Often I focus on availability here, which simply means there is access available to your household (or business). Access and use get into whether you take advantage of broadband. Availability can be solved with a big check – and we know that unprecedented amounts of funding will be coming into Minnesota to build broadband. We just need to pay the right providers to deploy service. That doesn’t mean it’s easy but encouraging use is more complex.

Access and use come down to affordability, knowledge and interest in using technology – inherent is affordability, knowledge and interest in a device as well as access. Some of the technology/broadband funding coming into the State will be available for tackling those barriers but that means changing people and how they do things.

Here is the full list of counties. (You can also download the list for a more usable format.)

County Subscription Rate rank
Aiktin 76.9 75
Anoka 90.8 6
Becker 83.7 30
Beltrami 82.5 37
Benton 85.2 26
Big Stone 81.8 45
Blue Earth 86.7 17
Brown 83 35
Carlton 78.6 67
Carver 91.9 3
Cass 81.5 46
Chippewa 80.1 56
Chisago 88.9 9
Clay 83.5 31
Clearwater 79.7 59
Cook 88.2 12
Cottonwood 77.8 72
Crow Wing 83.9 28
Dakota 91.5 4
Dodge 87.9 14
Douglas 78.2 70
Faribault 79.6 60
Fillmore 80.6 54
Freeborn 80 57
Goodhue 86.3 19
Grant 78.7 66
Hennepin 89.2 8
Houston 83.3 33
Hubbard 82.3 40
Isanti 86.1 23
Itasca 81.1 51
Jackson 82.1 41
Kanabec 78.6 68
Kandiyohi 83.5 32
Kittson 75.8 79
Koochiching 79.6 61
Lac qui Parle 81.4 47
Lake 81.9 44
Lake of the Woods 62.2 87
Le Sueur 86.3 20
Lincoln 78 71
Lyon 86.3 21
Mahnomen 75.7 80
Marshall 81.1 52
Martin 82 42
McLeod 84.3 27
Meeker 82.5 38
Mille Lacs 81.2 49
Morrison 78.6 69
Mower 82 43
Murray 76.7 78
Nicollet 86.4 18
Nobles 80 58
Norman 75.2 82
Olmsted 88.3 11
Otter Tail 79.2 63
Pennington 85.5 24
Pine 77.5 74
Pipestone 81.1 53
Polk 83.8 29
Pope 79.5 62
Ramsey 88.5 10
Red Lake 78.8 65
Redwood 75.7 81
Renville 73.9 83
Rice 86.8 16
Rock 83 36
Roseau 72 86
Scott 92.3 2
Sherburne 90.6 7
Sibley 79 64
St. Louis 82.5 39
Stearns 85.4 25
Steele 86.2 22
Stevens 83.2 34
Swift 76.8 77
Todd 73.5 84
Traverse 76.9 76
Wabasha 91.4 5
Wadena 80.5 55
Waseca 81.3 48
Washington 92.6 1
Watonwan 73.4 85
Wilkin 77.8 73
Winona 87.4 15
Wright 88 13
Yellow Medicine 81.2 50

So here’s the interesting small print…

The internet subscription info is sourced by U.S. Census Bureau, American Community Survey (ACS) and Puerto Rico Community Survey (PRCS), 5-Year Estimates. The PRCS is part of the Census Bureau’s ACS, customized for Puerto Rico. Both Surveys are updated every year.

“Subscription” seems to be a confusing term; they aren’t asking about subscriptions, they are asking about access

Question 10 asked if any member of the household has access to the internet. “Access” refers to whether or not someone in the household uses or can connect to the internet, regardless of whether or not they pay for the service. Respondents were to select only ONE of the following choices:

Yes, by paying a cell phone company or Internet service provider– This category includes housing units where someone pays to access the internet through a service such as a data plan for a smartphone; a broadband internet service such as cable, fiber optic or DSL; satellite; dial-up; or other type of service. This will normally refer to a service that someone is billed for directly for internet alone or sometimes as part of a bundle.

Yes, without paying a cell phone company or Internet service provider– Some respondents may live in a city or town that provides free internet service for their residents. In addition, some colleges or universities provide internet service. These are examples of cases where respondents may be able to access the internet without a subscription.

No access to the Internet at this house, apartment, or mobile home- This category includes housing units where no one can connect to or uses the internet using a paid service or any free service

Minnesota ranks 31 for strength of its broadband ecosystem

Broadband Now reports…

Examining pricing data from fifty national and regional providers, we’ve found that prices have decreased across all major download speeds (25Mbps up to 1Gbps+) and technologies (cablefiberDSL and fixed wireless). This study utilizes average pricing of broadband internet plans for 50 providers since 2016. See full methodology.

Here are the key findings…

  • Prices have fallen since 2016, with the highest speed plans falling the most. When looking at the average price for internet in each speed bucket starting in the first quarter of 2016 compared to the fourth quarter of 2021:
    • The average price decreased by $8.80 or 14% for 25 – 99 Mbps.
    • The average price decreased by $32.35 or 33% for 100 – 199 Mbps.
    • The average price decreased by $34.39 or 35% for 200 – 499 Mbps.
    • The average price decreased by $59.22 or 42% for 500+ Mbps.
  • Fiber tends to be cheaper than cable for most high-speed plans, even as fiber is generally considered to be the most robust and highest quality type of wired internet connection.
  • Local prices are reflective of competition. Every speed type and technology type have plans of $70 somewhere in the U.S., depending on which alternatives are available. See our most recent report looking at affordability and access by state.

And what they say about Minnesota

And how they collect the data…

Every year, we collect pricing and speed data on all 2,000 U.S. ISPs, and combine it with publicly available data sets and our own proprietary research on over-reporting of internet access to publish this report.

Researchers find connection between COVID deaths and lack of broadband

Vox reports on the connection between COVID deaths and broadband access…

Two years into the pandemic, researchers are still trying to understand what makes some people more likely than others to die from Covid-19. Although we know some of the risk factors — like age and underlying disease — others are less obvious. Identifying them could ease our current pain, protect communities from future epidemics, and point us toward some of the societal fractures we should most urgently try to mend.

One of the more surprising answers to this question is one that appears to have a relatively straightforward solution: internet access.

This March, researchers at the University of Chicago published a study in the journal JAMA Network Open that showed one of the factors most consistently associated with a high risk of death due to Covid-19 in the US was the lack of internet access, whether broadband, dial-up, or cellular. This was regardless of other demographic risk factors like socioeconomic status, education, age, disability, rent burden, health insurance coverage, or immigration status.

The study authors estimated that for every additional 1 percent of residents in a county who have internet access, between 2.4 and six deaths per 100,000 people could be prevented, depending on the makeup of the region.

Why is lack on broadband a factor?

These inequities were not created by chance. In the US, private internet service providers developed the infrastructure for broadband internet access where it was profitable. As a consequence, many of the country’s most marginalized communities have the fewest, most expensive, and lowest-quality choices when it comes to an internet service provider.

As those access gaps persisted over the years, more and more health services came online. That left those without access unable to use telemedicine, or even easily look up information about health conditions. Over the last few years, researchers have started to see internet access, and in particular high-speed broadband, as a critical component of health — something vital for connecting people not only with health care, but also with food, housing, education, and income, all of which are considered social determinants of health.

Then, as Covid-19 pushed routine health care provider visits into the telehealth space, people without internet access — many of them already medically underserved — found health care even harder to access. Home broadband drew a sharper line than ever before between haves and have-nots; access to internet bandwidth suddenly determined access to educational instruction, economic stability, food pantry sign-ups, vaccine availability and safety information, human contact, and so many other resources.

From no telehealth visits to 3,500 per day within weeks at Essentia (Baxter MN)

Duluth News Tribune reports on telehealth at local at Essentia in Baxter…

Prior to March 2020, Essentia reported it had never conducted a virtual visit. But in a robust response to the pandemic, the health care provider was performing more than 3,500 per day within weeks. Two years later, they had about 645,000 telehealth visits.

The article goes on to give a nice glimpse of what that looks like for different patients. For folks with substance use disorders, depression and anxiety…

Staff at Essentia Health’s clinic in Baxter, Minnesota, said they were initially working with their technology services to add telehealth for patients who had substance use disorders, depression and anxiety. The goal was to disrupt their lives as little as possible while working with them to improve their health and their lives.

Then the pandemic hit and those telehealth visits expanded exponentially as a way to reduce exposure to the virus. The Baxter facility went from two rooms for virtual visits to six in the family practice clinic. Patients across the board are able to schedule virtual visits, or video appointments, and speak directly to their doctor using computers, tablets or smartphones.

For Nutritionists …

Nutritionists could see what people had to work with at home. Those who were working from home, with children at home or other family to care for, could still connect for a needed appointment. Older residents didn’t have to make the trip or feel they had to find someone to take them to an appointment. Those who may have had trouble getting time off from work could still do a check-in and consult with their primary care provider.

1 in 7 Minnesotans who needed reliable broadband during pandemic, didn’t have it

A report from APM Research Lab finds…

According to our Minnesota’s Diverse Communities Survey, only half of those from households that included someone either working from home or attending school online reported a “very reliable” internet connection. One-third indicated that their internet connection is “somewhat reliable,” with the remainder split between “slightly reliable” (9%) and not at all reliable (6%).

The survey looked a broadband access and use of broadband during the pandemic (did anyone in household work or go to school online) and cross referenced with demographic information.

Despite a large proportion of Minnesotans with reliable internet access, more than 1 in 7 Minnesotans who needed a reliable internet connection for work or school did not have one. A small but notable proportion of Asian (excluding Hmong) and White Minnesotans reported lacking an internet connection in their home.

Among those who needed the internet for work or school, a higher proportion of residents of the Twin Cities 7-country metro had a “very reliable” connection than is the case for residents of the remainder of the state. Somewhat surprisingly, a similar gap exists between those identifying as Democrats versus those identifying as either politically independent or Republican.

They found that affordability was an important as access…

Our data from the Minnesota’s Diverse Communities Survey suggests a similar conclusion. Since there is a strong correlation between education level and income, the fact that fewer Minnesotans with less education report access to reliable internet than Minnesotans with more education implies that this difference hinges on the affordability of high-speed internet.

While the state has made great progress on overall access to broadband, there is still a lot of work to do—especially in terms of affordability and adoption—before every Minnesota household and business can regularly and reliably use the internet. The reliance on internet-based schooling during the pandemic has further underscored the equity concerns at the heart of the push toward universal broadband.

Benefits of telehealth in the oncology world – for those with access

AJMC reports on the various benefits of telemedicine in the oncology world once COVID lower barriers of reimbursement, including weather resilience…

Rajini Katipamula-Malisetti, MD, a medical oncologist and hematologist with Minnesota Oncology who practices in Coon Rapids, has seen telehealth’s usefulness up close. She spoke with Evidence-Based Oncology™ in December 2021, as the Omicron variant fueled another surge of COVID-19 cases and triggered another rise in hospitalizations.4 This happened as Minnesota reached the season when, in prior years, a wintry blast could wipe out an entire day’s schedule.

But now, schedulers at Minnesota Oncology know that if patients call to say they can’t come in because of a snowstorm, there’s a solution. “We’re just asking them to offer telehealth appointments,” Katipamula-Malisetti said. “We don’t want to cancel appointments.”

Better yet, the team can look at the forecast and proactively switch patients to telehealth appointments if a storm is coming. “It’s been really helpful,” she said.

… telemedicine reduces exposure to infection and makes staffing easier…

Having patients see their physician, social worker, or nutritionist via telehealth obviously reduces the opportunity for infection, but that’s not the only problem it solves, Katipamula-Malisetti said. Staffing shortages have emerged across health care, and Minnesota Oncology may not have staff at each clinic for every type of service. Telehealth helps address that: “There are certain specialties where we’re still leveraging telehealth significantly,” she said.

… telemedicine makes it easier to get family history when family can join the call…

Another example: a genetics session at which family history is taken—having multiple family members participate is a plus, she said. Depending on the practice or the insurer, telehealth was used for these visits even before the pandemic due to the relative scarcity of certified genetic counselors.4 She cited visits about nutrition as a third example.

The article outlines the best uses of telemedicine (based on survey results)…

The Minnesota Oncology experience with telehealth generally aligns with survey results reported at the most recent ASCO meeting, in May 2021. Only 3 types of visits were found appropriate for telehealth by more than 50% of the providers: discussions of imaging or laboratory results, chemotherapy education, and genetics counseling. More than 50% of survivors found visits on imaging or laboratory results or financial counseling to be appropriate; 90% of providers thought financial counseling was appropriate within the context of a broader visit on supportive care. Follow-up care found appropriate for telehealth by more than 50% of both providers and survivors included symptom management; for survivorship care, more than 50% of providers and survivors endorsed nutrition consultations and patient navigation via telehealth.

And notes that of course these benefits only apply when patients have access to broadband, devices and the skills to use them…

For all the positives that telehealth can offer, the question of whether all patients have the same access to technology has lingered since the start of the pandemic. The ASCO survey results showed that among survivors, 2.5% reported having no phone or no smartphone, 6.7% reported no or unreliable broadband or internet access, and 10.9% reported being uncomfortable using technology.