Beth Virnig , PhD
Rural Health Research Center
University of Minnesota
420 Delaware Street SE
Minneapolis, MN 55455
National Study of Home Health Access in Rural America, Lead researcher
ORHP-funded Individual Grantees
Office of Rural Health Policy (ORHP)
Health services, Home health, Hospice and palliative care, Medicare
This project will develop home health care service areas that will allow for the measurement of access to home health care for rural Medicare beneficiaries who die of cancer, and recommend options for increasing access to home health care in underserved rural areas.
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- Do Rural Elders Have Limited Access to Medicare Hospice Services?
The authors examined whether there are urban-rural differences in use of the Medicare hospice benefit before death and whether those differences suggest that there is a problem with access to hospice care for rural Medicare beneficiaries. Rates of hospice care before death were negatively associated with degree of rurality. The lowest rate of hospice use, 15.2% of deaths, was seen in rural areas not adjacent to an urban area. The highest rate of use, 22.2% of deaths, was seen in urban areas. Rural areas adjacent to urban areas had an intermediate level of hospice use (17.0% of deaths). Hospices based in rural areas had a smaller number of elderly patients each year than hospices based in urban areas, and were more likely to have very low volumes. The authors conclude that the consistently lower use of Medicare hospice services before death and smaller sizes of rural hospices suggests that the combination of Medicare hospice payment policies and hospice volumes are problematic for rural hospices. Adjusting Medicare payment policies might be a critical step to assure availability of hospice services for terminally ill beneficiaries regardless of where they live.
- Providing Hospice Care in Rural Areas: Challenges and Strategies to Address Them
Hospices in rural settings face challenges in the provision of hospice care as a result of their location and the size of their service area population. To ascertain the challenges that hospices face in serving rural communities, researchers conducted in-depth case studies of four different models of hospice care in rural areas. The authors describe strategies used by the case study hospices and recommend policies that could increase access to hospice care for rural Medicare beneficiaries and other rural residents. National initiatives to improve end-of-life care need to consider the special challenges faced by rural hospices.
- Use of the Hospice Benefit by Rural Medicare Beneficiaries
Identifies urban-rural differences in hospice use in rural service areas.
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