Older Medicare Beneficiaries' Use of Long Term Services and Supports, 2015-2021
Link
Date
07/2026
Description
The combination of aging populations with chronic conditions is expected to increase the demand for long term services and supports. These services include home and community-based services and services provided within long term care facilities such as nursing homes (NHs) and other residential care settings such as assisted living or supported housing, referred to in this paper as community-plus (CP) facilities. This study examines the living circumstances of rural and urban Medicare beneficiaries age 65 and older between 2015 and 2021.
Key Findings:
Trends in Living Arrangements (2015–2021)
- Between 2015 and 2021, the percentage of older rural Medicare beneficiaries residing in NHs decreased from 5.6% to 3.6%, while urban residents declined from 4.1% to 2.5%.
- During the same period, the percentage of rural residents living in CPs fell from 2.2% to 1.9% and from 6.1% to 3.9%, for urban.
Rural-Urban Differences
- Between 2015–2019, rural beneficiaries aged 65+ were more likely than urban beneficiaries to live in NHs rather than the community (OR = 1.3) but less likely to live in CPs (OR = 0.39).
- Between 2020–2021, rural beneficiaries were even more likely than previous years to live in a NH (OR= 1.5) and less likely to live in a CP (OR = 0.44).
Adjusted Analyses
- Predictors of living in a NH or CP included: age ≥75 years, dual enrollment in Medicare FFS and Medicaid, fair or poor health, and more functional limitations.
- Conversely, beneficiaries who were Non-Hispanic Black, Hispanic, or another race, married, or enrolled in Medicare Advantage plans were less likely to reside in facilities.
Center
Maine Rural Health Research Center
Authors
Yvonne Jonk, Heidi O'Connor, Erika Ziller