Statement of the problem - As the population ages, there will be an increasing need for long term care (LTC), including home health care (HHC), a lower-cost alternative to institutional care. Availability of HHC has fluctuated in response to Medicare and Medicaid payment policy. The current availability of HHC to rural populations, and the match between need and availability, is not fully known.

Project goals - The first purpose of this study ascertain the current distribution of HHC agencies, by ZIP Code and county of agency location and ZIP Code and county of service, across levels of rurality. Second, the project will estimate whether rural populations are at risk for inadequate access to HHC, based on projected population need population / provider ratios.

Methods - We will perform a cross sectional analysis using data from Medicare's Home Health Compare files and the Area Resource File (ARF). Provider files using ZIP Code as their geographic designator will be linked to the county-based ARF using the proprietary linkage algorithm developed by Claritas, Inc. For each ZIP Code and county we will document the number of HHC providers offering any services, the number of providers offering each of six specific services, and mean and ranges for HHC quality indicators. Population need will be estimated at the county level based on the number of persons age 65 or older and the number of persons with disability, using data from the ARF. Analyses will be reported across levels of rurality using the ZIP Code approximation of RUCAs and at the county level using Unit Identification Codes (UICs).

Anticipated publications or products - Results will be presented in both map and tabular form in the project report. Maps will be made available on the SCRHRC website. A technical report will summarize the methodology and findings, emphasizing areas at risk for inadequate service based on the combination of estimated population need and HHC agency availability.

Publications

• Home Health Care Agency Availability in Rural Counties
  Report
  Rural and Minority Health Research Center
  Date: 06/2014
  This report looks at home healthcare, including availability and service quality, in the United States and in rural counties. Findings include that counties at risk for limited service availability were almost all rural. Of the 34 counties lacking home health agencies, 30 were rural. Of the 120 counties served by single agencies, 118 were rural.
• Poorer Quality Outcomes of Medicare-Certified Home Health Care in Areas With High Levels of Native American/Alaska Native Residents
  Journal Article
  Rural and Minority Health Research Center
  Date: 04/2015
  Examines CMS quality indicators in home healthcare to determine disparities in rural areas with high population of Native American or Alaska Natives.
• Rural Area Deprivation and Hospitalizations Among Children for Ambulatory Care Sensitive Conditions
  Journal Article
  Rural and Minority Health Research Center
  Date: 10/2015
  Evaluates inpatient hospitalizations among children in nine states to determine the effect of rurality and social/economic advantage on health outcomes and health disparities.