Adequacy of Home Health Care Availability in Rural Counties

Research center:
Lead researcher:
Project funded:
September 2010
Project completed:
July 2014

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.