Is Rural America Equipped to Care for Those in Need of Home Health Care

Objective: The number of US adults aged 55 to 75 living in rural areas and small towns is expected to reach 14.2 million by 2020. Our analysis examines whether home health services are equally available to rural and urban older adults, given known disparities in the availability of other providers. Method: We conducted a cross-sectional analysis using Medicare's Home Health Compare files and the Spatial Impact Factor databases developed by RTI International. The unit of analysis was the Zip Code (n = 32,239); the dependent variable was the number of Medicare-certified Home Health Care agencies (HHAs) serving each Zip Code. Rurality was measured at the Zip Code level using Rural Urban Commuting Area Codes. Comparative analysis used Poisson Regression. Results: The number of HHAs was highest in the most urban areas (mean = 30.9) compared to all other levels of rurality. The most rural areas had the fewest HHAs, at 3.4 on average. Even after adjusting for household income, race, education, population density, disability for those aged 65 and over, and the count of Medicare eligible and beneficiaries, significant differences remained. With rates in the most urban areas higher than the most rural areas and Micropolitan areas; 3.8 and 3.3 times respectively. Conclusions: The challenges facing rural HHAs include potential decreases in Medicare reimbursement, lower physician availability and a higher proportion of poor and elderly populations. Without resources in place, residents in more rural areas will be less likely to have access to needed care, resulting in lower quality-of-life.