Rural Health
Research Gateway

Aging

Research Products & Journal Articles

Browse the full list of research publications on this topic completed by the Rural Health Research Centers.

Products – Freely accessible products include policy briefs, fact sheets, full reports, chartbooks, and interactive data websites.

Journal Articles – Articles in peer-reviewed journals may require a subscription or affiliation with a subscribing library. For these publications, Gateway lists the article citation, a brief summary, a link to additional information and access to the full-text of the article, if available.

  • "They're Not Leaving Their Home; This Is Where They Were Born, This Is Where They Will Die.": Key Informant Perspectives From the U.S. Counties With the Greatest Concentration of the Oldest Old
    Journal Article
    University of Minnesota Rural Health Research Center
    Date: 07/2021
    Researchers share interview results with key informants from 50 rural U.S. counties with the highest percentage of the residents ages 85 and older or the "oldest old." Respondents shared unique challenges to serving this population, as well as positive attributes of rural communities that make them attractive places for growing older.
  • A National Examination of Caregiver Use of and Preferences for Support Services: Does Rurality Matter?
    Journal Article
    University of Minnesota Rural Health Research Center
    Date: 07/2018
    The objective of this study was to assess rural-urban differences in caregiver use of and preferences for support services.
  • Access and Capacity to Care for Medicare Beneficiaries in Rural Health Clinics
    Policy Brief
    University of Minnesota Rural Health Research Center
    Date: 12/2019
    Access to timely, high-quality healthcare is essential for health, but rural areas face particular barriers to access, including for primary care. We present findings from an online survey of RHCs describing clinic characteristics related to healthcare access for rural Medicare beneficiaries.
  • Access to Care Among Rural Minorities: Older Adults
    Rural and Minority Health Research Center
    Date: 10/2002
    This report profiles the health status of, and use of physicians by, non-metro older adults.
  • Access to Care Among Rural Minorities: Older Adults (Appendix - Methods, Data, and Detailed Tables)
    Rural and Minority Health Research Center
    Date: 10/2002
    This is the appendix of a report on health status and health services use among poor and minority older adults in non-metro areas.
  • Access to Rural Home Health Services: Views From the Field
    Report
    WWAMI Rural Health Research Center
    Date: 02/2016
    Access to home health care can be challenging for rural Medicare clients. Key informants for this study detailed obstacles, including financial, regulatory, workforce, and geographic issues. Rural communities will likely benefit from payment reforms that reward quality services while providing incentives to use best practices in home health care.
  • Access to Specialty Care for Medicare Beneficiaries in Rural Communities
    Policy Brief
    University of Minnesota Rural Health Research Center
    Date: 12/2019
    Access to care is a challenge in many rural communities for both primary care services and specialty care services. We present findings from an online survey of Rural Health Clinics describing access issues for rural Medicare beneficiaries in seeking care from specialty care providers.
  • Acuity Differences Among Newly Admitted Older Residents in Rural and Urban Nursing Homes
    Journal Article
    Maine Rural Health Research Center
    Date: 11/2020
    This study found newly admitted residents of rural nursing homes were more likely to have cognitive issues/problem behaviors than those in urban facilities. Yet rural facilities admitted less complex older (age 75+) residents than urban, raising questions about the rural long-term services and supports system and capacity of rural nursing homes.
  • Advancing the Age-Friendly Movement in Rural Communities
    Journal Article
    University of Minnesota Rural Health Research Center
    Date: 02/2023
    The research team looked at the role of Aging Life Care Managers® to help support the age-friendly movement in rural areas. The team explored ways in which Aging Life Care Managers® could advocate for the needs and interests of their clients, help them access care and support, and involve rural communities in the age-friendly movement.
  • The Aging of the Primary Care Physician Workforce: Are Rural Locations Vulnerable?
    Policy Brief
    WWAMI Rural Health Research Center
    Date: 06/2009
    Large numbers of primary care physicians are nearing retirement as fewer new U.S. medical graduates are choosing primary care careers. This policy brief describes the rural areas of the U.S. where impending retirements threaten access to primary care and offers potential solutions to the problem.
  • The Aging of the Rural Primary Care Physician Workforce: Will Some Locations Be More Affected than Others?
    WWAMI Rural Health Research Center
    Date: 09/2013
    This report shows that as the aging primary care physician population retires, rural provider shortages will be further exacerbated.
  • Approaches to Serving Rural Older Adults in State Plans on Aging: A Policy Content Evaluation
    Journal Article
    University of Minnesota Rural Health Research Center
    Date: 05/2022
    In this article, we share a policy content evaluation of State Plans on Aging from all 50 U.S. states, focusing on how the states will serve older adults and including common and innovative approaches to doing so.
  • Are Rural Older Adults Benefiting From Increased State Spending on Medicaid Home and Community-Based Services?
    Policy Brief
    Maine Rural Health Research Center
    Date: 06/2016
    Little is known about variations in the availability or use of Medicaid Home and Community-Based Services (HCBS) within states, across rural and urban areas. This study used national claims data to examine differences in HCBS use and expenditures among rural and urban older adult Medicaid beneficiaries receiving LTSS.
  • Assisted Living in Rural America: Results From a National Survey
    Southwest Rural Health Research Center
    Date: 03/2005
    This article examines the assisted living industry in metropolitan and rural areas. Results indicate that assisted living was largely a private-pay form of long-term care and was more common in metropolitan than rural areas. Findings suggest that assisted living will make only a marginal contribution to meeting the needs in rural areas.
  • Barriers to Aging in Place in Rural Communities: Perspectives From State Offices of Rural Health
    Policy Brief
    University of Minnesota Rural Health Research Center
    Date: 11/2021
    This policy brief presents findings from an online survey of State Offices of Rural Health describing barriers for older adults in successfully aging in place in rural communities, and recommendations for how to improve the ability to safely age in place in rural areas of their states.
  • Barriers to Health Care Access for Rural Medicare Beneficiaries: Recommendations From Rural Health Clinics
    Policy Brief
    University of Minnesota Rural Health Research Center
    Date: 01/2021
    This brief presents findings from an online survey of Rural Health Clinics describing barriers for Medicare patients in accessing healthcare services and recommendations for how to improve access to care for Medicare beneficiaries in rural areas.
  • Barriers to Nursing Home Care for Nonelderly Rural Residents
    Journal Article
    University of Minnesota Rural Health Research Center
    Date: 12/2017
    This study uses data from 23 semi-structured interviews with rural hospital discharge planners in five states to identify specific barriers to finding nursing home care for nonelderly rural residents. We found three primary themes—payment status, fit, and medical complexity—as well as two minor themes—caregivers and bureaucratic processes.
  • Beyond Clinical Complexity: Nonmedical Barriers to Nursing Home Care for Rural Residents
    Journal Article
    University of Minnesota Rural Health Research Center
    Date: 02/2018
    Using data from interviews with rural hospital discharge planners, we identified four themes around nonmedical barriers to rural nursing home placement with particular salience in rural areas: financial issues, transportation, nursing home availability and infrastructure, and timeliness. We also identified policy and programmatic interventions.
  • Challenges to Admitting Residents: Perspectives From Rural Nursing Home Administrators and Staff
    Journal Article
    University of Minnesota Rural Health Research Center
    Date: 03/2021
    This study uses a survey of rural nursing home administrators (n=209) to assess perceptions of difficulty rural nursing homes encounter in admitting and serving individuals with dementia, obesity, mental and behavioral health conditions, and medically complex conditions.
  • Characteristics of Counties With the Highest Proportion of the Oldest Old
    Policy Brief
    University of Minnesota Rural Health Research Center
    Date: 05/2020
    The "oldest old," or individuals age 85 and older, are one of the fastest-growing segments of the U.S. population, yet little is known about where those individuals tend to live and what their communities are like. This information is important for planning how to best respond to and support this growing population.
  • Chronic Disease and Functional Limitation Among American Indian and Alaska Native Elders
    Journal Article
    Upper Midwest Rural Health Research Center
    Date: 2005
    Reports the results of an analysis of chronic disease's effect on functional limitation from a survey of 7,107 Native elders representing 143 tribes from 77 sites.
  • Chronic Disease in American Indian/Alaska Native Elders
    Journal Article
    Upper Midwest Rural Health Research Center
    Date: 2005
    This journal article describes the prevalence of chronic diseases among Native American elders.
  • Colonoscopy Access and Utilization – Rural Disparities in the Carolinas, 2001-2010
    Policy Brief
    Rural and Minority Health Research Center
    Date: 07/2016
    This study aims to use data on where patients travel for their colonoscopies to determine the extent to which access is changing over space and time, and to better understand utilization patterns among rural residents of North and South Carolina between 2001 and 2010.
  • Community Factors and Outcomes of Home Health Care for High-Risk Rural Medicare Beneficiaries
    Policy Brief
    WWAMI Rural Health Research Center
    Date: 10/2016
    Outcomes of care vary by region of the country for rural Medicare beneficiaries receiving home health services for high-risk conditions such as heart failure. Those in the East South Central and West South Central Census Divisions had lower rates of community discharge and higher rates of hospital readmission and emergency department use.
  • Comparing the Health Workforce Provider Mix and the Distance Travelled for Mental Health Services by Rural and Urban Medicare Beneficiaries
    Journal Article
    WWAMI Rural Health Research Center
    Date: 08/2020
    This study used 2014 administrative Medicare claims data to describe the mix of health professionals who care for rural and urban patients with mood and/or anxiety disorders. It further describes where these beneficiaries received care and the one-way distance (miles) and time (minutes) they travelled to receive it.
  • Contact by Collection Agencies for Medical Debt: Rural-Urban Differences Among Older and Younger Medicare Beneficiaries
    Journal Article
    University of Minnesota Rural Health Research Center
    Date: 02/2022
    This study uses data from the 2016 Medicare Current Beneficiary Survey (n = 12,688 U.S. community-dwelling beneficiaries) to understand the impact of medical debt for rural residents. The study analyzed rural-urban differences in rates of collection agency contact for unpaid medical bills.
  • Demographics and Disability Status of Adults Living Alone in Rural Areas
    Policy Brief
    University of Minnesota Rural Health Research Center
    Date: 04/2021
    This policy brief examines how the types of people who live alone differ between urban and rural areas, focusing on differences in age and disability status.
  • Differences by Rurality in Satisfaction With Care Among Medicare Beneficiaries
    Journal Article
    University of Minnesota Rural Health Research Center
    Date: 05/2020
    There are stark differences between rural and urban areas in demographic characteristics, health status, and healthcare. Yet less is known about rural‐urban differences in Medicare beneficiaries' satisfaction with care. We seek to understand rural‐urban differences in satisfaction with care for Medicare beneficiaries.
  • Differences in Medicare Service Use in the Last Six Months of Life Among Rural and Urban Dual – Eligible Beneficiaries
    Report
    Rural and Minority Health Research Center
    Date: 08/2017
    In this brief, we compare rural and urban dual-eligible beneficiaries to Medicare-only beneficiaries in their service utilization in the last six months of life. Within rural beneficiaries, we further explore differences associated with race/ethnicity.
  • Differences in Medicare Utilization and Expenditures in the Last Six Months of Life Among Patients With and Without Alzheimer's Disease and Related Disorders
    Journal Article
    Rural and Minority Health Research Center
    Date: 10/2018
    The purpose of this study was to examine differences in utilization of inpatient services and Medicare expenditures (overall and by category) in the last six months of life for patients with, versus those without, a diagnosis of Alzheimer's disease and related disorders.
  • Disability Burdens Among Older Americans Associated With Gender and Race/Ethnicity in Rural and Urban Areas
    Rural and Minority Health Research Center
    Date: 09/2005
    No prior research has investigated differences in disability-free and disabled life expectancy associated with rural or urban residence. This report addresses this gap and identifies differences in healthy life expectancy that may signal important policy needs.
  • Disability Burdens Among Older Americans in Rural and Urban Area
    Fact Sheet
    Rural and Minority Health Research Center
    Date: 2005
    This fact sheet examines differences in disability-free and disabled life expectancy among rural or urban residents, using an indicator called "health expectancy."
  • Do Rural Elders Have Limited Access to Medicare Hospice Services?
    Journal Article
    University of Minnesota Rural Health Research Center, Upper Midwest Rural Health Research Center
    Date: 05/2004
    Examines 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.
  • The Effect of the Doctor-Patient Relationship on Emergency Department Use Among the Elderly
    Journal Article
    WWAMI Rural Health Research Center
    Date: 01/2000
    OBJECTIVES: This study sought to determine the rate of emergency department use among the elderly and examined whether that use is reduced if the patient has a principal-care physician.
    METHODS: The Health Care Financing Administration's National Claims History File was used to study emergency department use by Medicare patients older than 65 years in Washington State during 1994. RESULTS: A total of 18.1% of patients had 1 or more emergency department visits during the study year; the rate increased with age and illness severity. Patients with principal-care physicians were much less likely to use the emergency department for every category of disease severity. After case mix, Medicaid eligibility, and rural/urban residence were controlled for, the odds ratio for having any emergency department visit was 0.47 for patients with a generalist principal-care physician and 0.58 for patients with a specialist principal-care physician.
    CONCLUSIONS: The rate of emergency department use among the elderly is substantial, and most visits are for serious medical problems. The presence of a continuous relationship with a physician--regardless of specialty--may reduce emergency department use.
  • Emergency Department Use by the Rural Elderly
    Journal Article
    WWAMI Rural Health Research Center
    Date: 2000
    This study uses Medicare data to compare emergency department (ED) use by rural and urban elderly beneficiaries. Given the similarity of diagnostic conditions associated with ED visits, rural EDs must be capable of dealing with the same range of emergency conditions as urban EDs.
  • Examples of Statewide Age-Friendly Initiatives
    Policy Brief
    University of Minnesota Rural Health Research Center
    Date: 10/2021
    The purpose of these policy briefs is to identify the extent of statewide programs to support aging in place or age-friendly environments and, within those, to identify the extent to which such programs have an explicit rural focus. The "Examples" document provides an overview of the initiatives identified in the "Environmental Scan."
  • Gender and Geographic Differences in Medicare Service Utilization During the Last Six Months of Life
    Journal Article
    Rural and Minority Health Research Center
    Date: 11/2017
    End-of-life issues are important for senior women, particularly rural women, who are more likely than their urban counterparts to live alone. The role of residence has yet to be investigated. The purpose of this study is to examine whether service utilization in the last six months of life differs across gender and rurality.
  • Gender Differences in Social Isolation and Social Support Among Rural Residents
    Policy Brief
    University of Minnesota Rural Health Research Center
    Date: 08/2018
    This policy brief uses identifies gender differences in social isolation and social support among older rural residents and provides ways to reduce social isolation in rural communities.
  • Geographic Access to Health Care for Rural Beneficiaries in Five States: An Update
    Policy Brief
    WWAMI Rural Health Research Center
    Date: 04/2021
    Using data from five states, this study describes the mix of providers caring for rural Medicare beneficiaries, the quantity of care received, and how far rural beneficiaries traveled for care for several selected conditions in 2014. Results are also compared with a similar study of the same states that used data from 1998.
  • Geographic Access to Health Care for Rural Medicare Beneficiaries
    WWAMI Rural Health Research Center
    Date: 04/2005
    This study looked at where Medicare beneficiaries from five states obtain their care, how far they travel for that care, and the mix of physician specialties from whom they obtain their ambulatory care.
  • Geographic Access to Health Care for Rural Medicare Beneficiaries: A National Study
    Policy Brief
    WWAMI Rural Health Research Center
    Date: 09/2021
    Using national data from 2014, this policy brief describes geographic variation in the mix of providers caring for rural versus urban Medicare beneficiaries, the quantity of visits received by beneficiaries across Census Divisions and types of rural areas, and the distance traveled for care for several serious conditions.
  • Health Insurance Coverage and Access to Health Care for American Indian and Alaska Native Elders
    Upper Midwest Rural Health Research Center
    Date: 10/2007
    This policy brief reports findings from a study assessing health insurance coverage and access to healthcare among American Indian and Alaska Native elders using data from a national survey that included more than 8,300 Native elders.
  • Health Insurance Coverage of The Rural and Urban Near Elderly
    Maine Rural Health Research Center
    Date: 10/2003
    This paper reports the results of a study that used data from the 1996-1998 Medical Expenditure Panel Survey to address two principal research questions related to health insurance coverage for the rural near elderly.
  • Health Risks Factors Among American Indians and Alaska Native Elders
    Journal Article
    Upper Midwest Rural Health Research Center
    Date: 2006
    Chronic disease rates are higher among American Indian and Alaska Native elders although they exercise more and have higher rates of participation in multiple exercise activities. Research concerning the relationship between chronic disease and health risk factors is limited for American Indian and Alaska Native elder populations. This paper indicated results of an analysis of the effect of risk factors on chronic disease from a survey of 9,296 Native elders, representing 171 tribes from 88 sites. The sampling design employed systematic random sampling for larger tribes, with smaller tribes (fewer than 200) interviewing all or the majority of their elders. The data suggest that smokers, drinkers, and non-exercisers are at increase risk for chronic disease.
  • Health-Related Quality of Life Among Adults 65 Years and Older in the United States, 2011-2012: A Multilevel Small Area Estimation Approach
    Journal Article
    Rural and Minority Health Research Center
    Date: 10/2016
    This study compiled estimates, at the county level, of poor health-related quality of life among those ages 65 and older. The study examined physical and mental health and found significant differences in health across the United States.
  • Hospital Closures and Short-Run Change in Ambulance Call Times
    Journal Article
    Rural and Underserved Health Research Center
    Date: 11/2019
    Hospital closures affect the availability of emergency department services. This paper examines changes in ambulance ride times in areas with hospital closures compared to those in similar areas without hospital closures and separately analyzes changes in ambulance ride times between urban and rural areas and among Medicare-eligible patients.
  • The Impact of Health Insurance Coverage on Native Elder Health: Implications for Addressing the Health Care Needs of Rural Native American Elders
    Upper Midwest Rural Health Research Center
    Date: 10/2007
    This study examines health insurance coverage and access to healthcare among American Indian and Alaska Native elders, defined as 55 years or older. The authors conclude it is essential to develop policies that address the financial, geographical, and cultural aspects that negatively impact access to culturally appropriate healthcare.
  • Improving the Quality of Outpatient Care for Older Patients With Diabetes: Lessons From a Comparison of Rural and Urban Communities
    Journal Article
    WWAMI Rural Health Research Center
    Date: 08/2001
    Compares the quality of diabetic care received by patients in rural and urban communities in Washington State. Concludes that large rural towns may provide the best conditions for high-quality care-growing communities that serve as regional referral centers and have an adequate, but not excessive, supply of generalist and specialist physicians.
  • Integrated Care Management in Rural Communities
    Maine Rural Health Research Center
    Date: 05/2014
    This study reviews the opportunities and challenges reform initiatives under the Affordable Care Act present for rural communities. The study assesses four types of organizational models for delivering integrated care management. Each model has different strengths and drawbacks, weighing for and against implementation in rural areas.
  • Intensity of Service Provision for Medicare Beneficiaries Utilizing Home Health Services: A Closer Look at Cerebrovascular Disease, Diabetes, and Joint Replacement
    Report
    Rural and Minority Health Research Center
    Date: 11/2014
    This report details the impact of home health services provided to the rural elderly receiving Medicare by the number of visits, the use of rehabilitation specialists, and the median payment per each claim.
  • Key Informant Perspectives on Rural Social Isolation and Loneliness
    Policy Brief
    University of Minnesota Rural Health Research Center
    Date: 10/2018
    This policy brief uses data from interviews with 22 key informants in 12 states, all of whom were experts on the issue of social isolation and/or rural health, to describe key challenges and opportunities related to rural social isolation.
  • Long-Term Services and Supports Use Among Older Medicare Beneficiaries in Rural and Urban Areas
    Journal Article
    Maine Rural Health Research Center
    Date: 01/2019
    Analyzing the Medicare Current Beneficiary Survey, authors from the Maine Rural Health Research Center found that compared to their urban counterparts, rural Medicare beneficiaries had higher odds of nursing home use after controlling for beneficiary characteristics and contextual factors including nursing home bed supply.
  • Looking Ahead: Rural-Urban Differences in Anticipated Need for Aging-Related Assistance
    Policy Brief
    Rural and Minority Health Research Center
    Date: 07/2016
    Rural older adults with a disability can anticipate a longer lifespan than urban adults. Rural areas tend to be served by fewer providers of home health services. This brief describes the degree to which rural and urban pre-retirement age adults, persons ages 40-64, anticipate the need for assistance later in life and where they obtain such help.
  • Medical Barriers to Nursing Home Care for Rural Residents
    Policy Brief
    University of Minnesota Rural Health Research Center
    Date: 05/2017
    This policy brief describes barriers rural residents with complex medical care needs may face when seeking placement in a nursing home and identifies potential policy strategies to overcome them.
  • Medicare Advantage Enrollment Update 2023
    Policy Brief
    RUPRI Center for Rural Health Policy Analysis, Rapid Response to Requests for Rural Data Analysis
    Date: 11/2023
    This policy brief continues RUPRI Center's annual update of Medicare Advantage (MA) enrollment including the changes in enrollment in types of MA plans, and health policy changes that may have had an impact.
  • Multi-Sector Collaboration to Support Rural Aging
    Journal Article
    University of Minnesota Rural Health Research Center
    Date: 08/2023
    In this paper, researchers examine the lessons rural areas present for supporting aging, including the role that aging and social services, public health systems, and health care have to play.
  • Nursing Home Closures and Access to Post-Acute Care and Long-Term Care Services in Rural Areas
    Journal Article
    RUPRI Center for Rural Health Policy Analysis
    Date: 01/2024
    Nursing home closures have raised concerns about access to post-acute care (PAC) and long-term care (LTC) services. In this study, researchers estimate the additional distance rural residents had to travel to access PAC and LTC services because of nursing home closures.
  • Nursing Homes in Rural America
    Southwest Rural Health Research Center
    Date: 2003
    This policy brief discusses the main findings of a 2000 survey of 17,000 nursing homes related to rural elderly.
  • Nursing Homes in Rural America: A Chartbook
    Chartbook
    RUPRI Center for Rural Health Policy Analysis
    Date: 07/2022
    Closure of nursing homes and hospitals with swing beds in recent years has changed the availability of post-acute and long-term care services in rural areas. This study examines the availability of post-acute and long-term care services as well as characteristics of residents and nursing homes in noncore, micropolitan, and metropolitan counties.
  • Patterns of Health Care Use Among Rural-Urban Medicare Beneficiaries Age 85 and Older, 2010-2017
    Policy Brief
    Maine Rural Health Research Center
    Date: 11/2022
    This study examines rural-urban differences in health care use among Medicare beneficiaries age 85+.
  • Perspectives on Rural Caregiving Challenges and Interventions
    Policy Brief
    University of Minnesota Rural Health Research Center
    Date: 08/2018
    This brief presents findings from key informant interviews describing challenges and opportunities related to supporting informal caregivers in rural areas.
  • 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.
  • Post-acute Care Trajectories for Rural Medicare Beneficiaries: Planned Versus Actual Hospital Discharges to Skilled Nursing Facilities and Home Health Agencies
    Policy Brief
    WWAMI Rural Health Research Center
    Date: 03/2021
    This policy brief describes trajectories for rural Medicare beneficiaries following hospital discharge, including differences between planned and actual discharge to skilled nursing facilities and home health agencies. More than 40% of beneficiaries for whom home health care was indicated did not receive care from a home health agency.
  • Preferences for Long-Term Care Arrangements Among Rural and Urban Older Adults
    Policy Brief
    University of Minnesota Rural Health Research Center
    Date: 05/2021
    This study describes care preferences by rural and urban location and by demographic characteristics among rural residents.
  • Prevalence of Chronic Disease Among American Indian and Alaska Native Elders
    Upper Midwest Rural Health Research Center
    Date: 10/2005
    This report examines chronic disease prevalence and functional limitations among American Indian/Alaska Natives by rurality, gender, age, healthcare access, and health behaviors. It includes policy recommendations.
  • Profile of Rural Residential Care Facilities: A Chartbook
    Chartbook
    Maine Rural Health Research Center
    Date: 05/2014
    This chartbook offers information on part of the rural long-term services and supports (LTSS) continuum—the residential care facility (RCF). Survey results identify national/regional differences between rural and urban RCFs, focusing on facilities, resident and service characteristics of RCFs, and the ability to meet the LTSS needs of residents.
  • Providing Hospice Care in Rural Areas: Challenges and Strategies to Address Them
    Journal Article
    University of Minnesota Rural Health Research Center
    Date: 2005

    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.

  • Rates of Living Alone by Rurality and Age
    University of Minnesota Rural Health Research Center
    Date: 04/2020
    In this infographic, we identify rates of living alone for all adults and within specific age groups using two classifications of rurality.
  • Residential Settings and Healthcare Use of the Rural "Oldest-Old" Medicare Population
    Policy Brief
    Maine Rural Health Research Center
    Date: 03/2018
    This study used Medicare Current Beneficiary Survey data to profile rural/urban Medicare beneficiaries ages 85 & older. Rural adults in this age group are more likely to be disabled and live alone in the community or in nursing homes and less likely to live in assisted living facilities. Findings highlight rural needs for community-based services.
  • Resources for Caregiving in Rural Communities
    Policy Brief
    University of Minnesota Rural Health Research Center
    Date: 08/2018
    This policy brief describes resources that are being used across the country to support caregivers in rural communities.
  • Rural and Urban Physicians: Does the Content of Their Medicare Practices Differ?
    Journal Article
    WWAMI Rural Health Research Center
    Date: 1999
    Rural and urban areas have significant differences in the availability of medical technology, medical practice structures and patient populations. This study uses 1994 Medicare claims data to examine whether these differences are associated with variation in the content of practice between physicians practicing in rural and urban areas.
  • Rural Health Research in Progress in the Rural Health Research Centers Program, 9th Edition
    Maine Rural Health Research Center
    Date: 02/2005
    This book provides policymakers with a concise source of rural health services research underway in the Rural Health Research Centers funded by the Office of Rural Health Policy. It provides a context for legislation current that affects rural health services and populations.
  • Rural Long-Term Services and Supports: A Primer
    RUPRI Health Panel: Rural Policy Analysis and Applications
    Date: 11/2017
    This paper provides policymakers and other interested stakeholders a primer on the fundamentals of the rural LTSS system, rural access to and use of LTSS, and the opportunities and limitations of current federal and state LTSS policy for advancing rural health system transformation toward a high-performing rural health delivery system.
  • Rural Medicare Beneficiaries Have Fewer Follow-Up Visits and Greater Emergency Department Use Post-Discharge
    Journal Article
    North Carolina Rural Health Research and Policy Analysis Center
    Date: 09/2015
    Compares rates of post hospital discharge care among Medicare beneficiaries in rural and urban settings. Discusses the effect on policies for follow-up care and readmission penalties.
  • Rural Minority Elders
    Fact Sheet
    Rural and Minority Health Research Center
    Date: 2003
    This fact sheet provides data on health status, health insurance coverage, education, and income of rural elders.
  • Rural Transportation: Challenges and Opportunities
    Policy Brief
    University of Minnesota Rural Health Research Center
    Date: 11/2017
    This policy brief uses survey data from 113 key informants across all 50 states to describe challenges and opportunities related to rural transportation.
  • Rural-Urban Difference in Workplace Supports and Impacts for Employed Caregivers
    Journal Article
    University of Minnesota Rural Health Research Center
    Date: 06/2018
    This study finds that employed rural caregivers had significantly fewer workplace benefits available to them compared with urban caregivers. In particular, employed rural caregivers were less likely to have access to telecommuting, employee assistance programs, and paid leave.
  • Rural-Urban Differences Among Older Adults
    Chartbook
    University of Minnesota Rural Health Research Center
    Date: 08/2020
    This chartbook presents the characteristics of older adults in rural counties, as well as rural-urban differences among older adults, across four domains: demographics, socioeconomic characteristics, healthcare access and use, and health characteristics.
  • Rural-Urban Differences in Access to and Attitudes Toward Care for Medicare Beneficiaries
    Policy Brief
    University of Minnesota Rural Health Research Center
    Date: 12/2019
    Access to healthcare is important to health outcomes and well-being. Even among Medicare beneficiaries, access to care may differ by rural-urban location due to differences in the healthcare and socio-demographic landscape. We describe rural-urban differences in access to care for Medicare beneficiaries.
  • Rural-Urban Differences in Costs of End-of-Life Care for the Last 6 Months of Life Among Patients With Breast, Lung, or Colorectal Cancer
    Journal Article
    Rural and Minority Health Research Center
    Date: 04/2018
    Our findings indicate that Medicare expenditures are lower for rural beneficiaries with each type of cancer than urban beneficiaries, even after adjusting for age, gender, race, dual eligibility, region, chronic conditions, and type of service utilization.
  • Rural-Urban Differences in Medicare Service Use in the Last Six Months of Life
    Report
    Rural and Minority Health Research Center
    Date: 08/2017
    This brief focuses on the current status of healthcare use during the last six months of life among Medicare beneficiaries. We used data from a sample of Medicare beneficiary claims to assess whether service utilization differed between rural and urban decedents and across decedents of different race/ethnicity categories.
  • Rural-Urban Differences in Satisfaction With Medicare Part D: Implications for Policy
    Journal Article
    University of Minnesota Rural Health Research Center
    Date: 01/2016
    Examines the difference in rural and urban satisfaction with Medicare Part D coverage by using data from the 2012 Medicare Current Beneficiary Survey. The research found that rural residents have lower satisfaction with their coverage.
  • Rural-Urban Issues in the Wage Index Adjustment for Prospective Payment in Skilled Nursing Facilities (Brief Report)
    North Carolina Rural Health Research and Policy Analysis Center
    Date: 01/2004
    Hourly wage data from Medicare-participating nursing homes were used to examine urban/rural patterns in average hourly nursing home wages and wage variation within the statewide rural labor markets defined by CMS. The data were also used to examine the adequacy of the hospital wage index as an adjuster for skilled nursing facility rates.
  • Rural-Urban Issues in the Wage Index Adjustment for Prospective Payment in Skilled Nursing Facilities (Full Report)
    North Carolina Rural Health Research and Policy Analysis Center
    Date: 11/2003
    Hourly wage data collected were used to examine urban/rural patterns in average hourly nursing home wages and pattern variation within the statewide rural labor markets. The data were also used to examine the adequacy of the hospital wage index as an adjuster for skilled nursing facility rates.
  • Rural/Urban Disparities in Pneumococcal Vaccine Service Delivery Among the Fee-for-Service Medicare Population
    Policy Brief
    Rural and Underserved Health Research Center
    Date: 02/2018
    Using 2014 Medicare data, we found a significant disparity in pneumococcal vaccine service delivery to fee-for-service Medicare beneficiaries. Although primary care providers delivered the majority of pneumococcal vaccines to this population, pharmacy providers delivered a significantly greater proportion of vaccines in rural versus urban counties.
  • Rurality and Nursing Home Quality: Results From a National Sample of Nursing Home Admissions
    Journal Article
    Southwest Rural Health Research Center
    Date: 10/2004
    There are higher percentages of elderly population in and the utilization rates of nursing homes are higher in rural areas. Overall, problems in rural nursing homes are at a much higher risk for poor outcomes, but it is most apparent in extremely isolated rural areas.
  • Safety Net Clinics Serving the Elderly in Rural Areas: Rural Health Clinic Patients Compared to Federally Qualified Health Center Patients
    Policy Brief
    North Carolina Rural Health Research and Policy Analysis Center
    Date: 05/2014
    This brief, the third and final in a series on rural health centers (RHC), uses data from 2009 Medicare outpatient provider claims to look at clinic locations, number of beneficiaries served, and number of/cost per claim for each type of rural safety net clinic, as well as beneficiaries' ages, health problems, and distance traveled for care.
  • Satisfaction With Care Among Cancer Survivors With Medicare Coverage: Are There Rural vs. Urban Inequities?
    Journal Article
    Rural and Underserved Health Research Center
    Date: 03/2024
    This article examines satisfaction with health care among rural vs urban Medicare cancer survivors. Researchers looked at nine dimensions of health care and tested for rural/urban differences, adjusting for demographic factors, health insurance, and self-rated health.
  • Social Cohesion and Social Engagement Among Older Adults Aging in Place: Rural/Urban Differences
    Policy Brief
    University of Minnesota Rural Health Research Center
    Date: 01/2022
    This policy brief examines rural/urban differences in social cohesion and social engagement for older adults aging in place, as well as within-rural differences by race and ethnicity.
  • Social Isolation and Safety Issues Among Rural Older Adults Living Alone: Perspectives of Meals on Wheels Programs
    Journal Article
    University of Minnesota Rural Health Research Center
    Date: 05/2022
    In this article, we share results from a survey of 42 Meals on Wheels programs in rural areas across the US. Respondents highlighted challenges to meeting both social and safety needs of rural older adults living alone, as well as policy recommendations to improve the health and safety of older adults living alone in rural areas.
  • Statewide Age-Friendly Initiatives: An Environmental Scan
    Policy Brief
    University of Minnesota Rural Health Research Center
    Date: 10/2021
    The purpose of these policy briefs is to identify the extent of statewide programs to support aging in place or age-friendly environments and, within those, to identify the extent to which such programs have an explicit rural focus. The "Examples" document provides an overview of the initiatives identified in the "Environmental Scan."
  • Supply-Side Differences Only Modestly Associated With Inpatient Hospitalizations Among Medicare Beneficiaries in the Last Six Months of Life
    Journal Article
    Rural and Minority Health Research Center
    Date: 11/2017
    This study examined rural and urban Medicare beneficiaries and inpatient hospitalizations during their last six months of life. The study concluded that care at the end of life is much the same for rural and urban Medicare decedents.
  • Trends in Nursing Home Closures in Metropolitan and Nonmetropolitan Counties in the United States, 2008-2018
    Policy Brief
    RUPRI Center for Rural Health Policy Analysis
    Date: 02/2021
    Nursing home closures have raised concerns about access to long-term services and supports in rural areas. This study examines trends in closures and characteristics of open and closed nursing homes in metropolitan and nonmetropolitan counties. Furthermore, this study identifies metropolitan and nonmetropolitan counties without any nursing homes.
  • The Unique Impact of COVID-19 on Older Adults in Rural Areas
    Journal Article
    University of Minnesota Rural Health Research Center
    Date: 06/2020
    Older adults in rural areas of the U.S. face unique risks related to COVID-19, which puts them at risk of not only the virus, but of not being able to meet their healthcare, social, and basic needs. Rural/urban inequities, combined with within-rural inequities in health, healthcare, and financial resources cause particular challenges.
  • Unmet Need for Personal Care Assistance Among Rural and Urban Older Adults
    Policy Brief
    University of Minnesota Rural Health Research Center
    Date: 06/2019
    This brief presents data on rural-urban differences in unmet need for personal care among older adults with functional limitations.
  • Unmet Needs for Help With Mobility Limitations Among Older Adults Aging in Place: The Role of Rurality
    Journal Article
    University of Minnesota Rural Health Research Center
    Date: 10/2023
    This study identifies differences in unmet mobility needs among older adults by rurality. It uses data from the National Health and Aging Trends Study, limiting analyses to respondents who had not moved since baseline (average housing tenure of 27 years; n = 3343).
  • Who Will Care for Rural Older Adults? Measuring the Direct Care Workforce in Rural Areas (journal article)
    Journal Article
    University of Minnesota Rural Health Research Center
    Date: 02/2023
    In this manuscript, the research team used data from the 2021 Occupational Employment and Wage Statistics dataset to calculate the ratio of direct care workers relative to the population of older adults (ages 65+) across rural and urban areas in the US.