Long-Term Services and Supports Use Among Older Medicare Beneficiaries in Rural and Urban Areas

Abstract

State and federal policies have shifted long-term services and support (LTSS) priorities from nursing home care to home and community-based services (HCBS). It is not clear whether the rural LTSS system reflects this system transformation. Using the Medicare Current Beneficiary Survey, we examined nursing home use among rural and urban Medicare beneficiaries aged 65 and older. Study findings indicate that even after controlling for known predictors of nursing home use, rural Medicare beneficiaries exhibited greater odds of nursing home residence and that the higher odds of rural nursing home residence are, in part, associated with higher rural nursing home bed supplies. A complex interplay of policy, LTSS infrastructure, and social, cultural, and other factors may be influencing the observed differences. Federal and state efforts to build rural HCBS capacity may be necessary to mitigate stubbornly persistent rural-urban differences in the patterns of institutional and community-based LTSS use.

Location Matters: Disparities in the Likelihood of Receiving Services in Late Life

“…Policy efforts continue to rebalance LTSS in favor of HCBS over institutional care. However, availability of HCBS does not meet the demand, which is especially problematic given the growing numbers of nursing home closures in rural communities (Tyler & Fennell, 2017) and the lower likelihood of HCBS use among rural versus urban individuals (Coburn et al, 2019). Geographic disparities persist and require greater federal and state efforts to build HCBS capacity (Coburn et al, 2019).…”

“…However, availability of HCBS does not meet the demand, which is especially problematic given the growing numbers of nursing home closures in rural communities (Tyler & Fennell, 2017) and the lower likelihood of HCBS use among rural versus urban individuals (Coburn et al, 2019). Geographic disparities persist and require greater federal and state efforts to build HCBS capacity (Coburn et al, 2019). Location matters—moving away from the dichotomy of rural versus urban allows for attention to the spatial nuances, complexities, and diversity of location; this supports ongoing conversation about moving away from a “have” versus “have not” dichotomy.…”

“…Each measurement approach yields a slightly different population-based estimate, revealing challenges with each definition. Researchers typically use a binary urban-rural designation to analyze data (e.g., Coburn et al, 2019), but we argue that using the U.S. Census Bureau designation maintains parsimony yet provides nuance with three categorizations.…”

Virtual Intergenerational Reverse-Mentoring Program Reduces Loneliness among Older Adults: Results from a Pilot Evaluation

“…As rural Appalachian areas increase access to broadband [ 2 , 19 ], there will be an increased demand for partnerships to build community capacity for addressing the digital needs of older adults. In rural Appalachian communities, older adults face economic disadvantages, a greater risk of chronic disease, and limited access to the internet and devices [ 46 , 47 ]. Although this study was conducted during COVID-19 physical distancing restrictions, rural communities historically have struggled to provide services to residents due to physical distance from large healthcare institutions and service providers and limited staff [ 48 ].…”

A Scoping Literature Review of Rural Institutional Elder Care

“…Furthermore, the differences between admission and discharge status of urban and rural residents and the exploration of related influencing factors remain a main focus. In the research on the status quo of admission to nursing homes, in general, the rural elderly tend to care for nursing homes better than the urban elderly [ 26 , 62 , 63 , 64 ]. The rehospitalization rates of rural elderly are also higher [ 65 ].…”