Rural Health
Research Gateway

Aging

Completed Projects

Listed by project completion date. You can also view these projects alphabetically.

2023

  • Rural/Urban Differences in Health and Health Care Access for LGBT Adults
    The purpose of this project was to identify rural/urban differences in health and health care access for lesbian, gay, bisexual, and transgender (LGBT) adults. We also identified within-rural differences among LGBT adults by race, ethnicity, age, disability status, and socio-economic status. Finally, we identified examples of best practices supporting LGBT health and wellness in rural areas.
    Research center: University of Minnesota Rural Health Research Center
    Topics: Aging, Cancer, Disabilities, Health disparities and health equity, Healthcare access, Lesbian, Gay, Bisexual, Transgender, Queer (LGBTQ+), Mental and behavioral health, Minority health, Poverty, Rural statistics and demographics, Social determinants of health
  • The Direct Care Workforce in Rural Areas
    In this study, we measured the supply of long-term care services and supports (LTSS) direct care workers relative to older adult populations in rural and urban areas and measure employer and industry turnover among LTSS direct care workers. We also explored how compensation levels – including wages and employer-based health insurance – are related to and predict worker turnover in the LTSS direct care workforce in rural and urban areas.
    Research center: University of Minnesota Rural Health Research Center
    Topics: Aging, Allied health professionals, Health services, Home health, Long-term care, Post-acute care, Poverty, Rural statistics and demographics, Social determinants of health, Workforce

2022

  • Aging in Place in Rural America: What Does It Look Like and How Can It Be Supported?
    In general, people want to age in place. This project looked at the structures in place to help them do so and how those structures vary by rurality. Federal, state, and local policy implications for improving health outcomes and quality of life for rural older adults aging in place were also be identified.
    Research center: University of Minnesota Rural Health Research Center
    Topics: Aging, Disabilities, Health disparities and health equity, Healthcare access, Home health, Long-term care, Social determinants of health
  • Healthcare Use and Expenditures Among Rural and Urban Medicare Beneficiaries Aged 85 and Over
    The proportion of U.S. residents ages 85+ is expected to grow substantially in the coming decades with the impact of this growth in rural areas likely to be pronounced. This project used data from the Medicare Current Beneficiary Survey to examine rural-urban differences in healthcare use and expenditures among Medicare enrollees ages 85+.
    Research center: Maine Rural Health Research Center
    Topics: Aging, Healthcare access, Long-term care, Medicare
  • Location and Characteristics of Nursing Homes in the Rural and Urban U.S.
    This project examined rural and urban nursing home availability; assessed the nursing home bed supply relative to the elderly population in rural and urban counties; summarized resident and nursing home characteristics; and analyzed the relationship between the rural location of nursing homes and resident and nursing home characteristics.
    Research center: RUPRI Center for Rural Health Policy Analysis
    Topics: Aging, Health services, Healthcare access, Healthcare financing, Long-term care, Medicare

2021

  • Geographic Access to Healthcare for Rural Medicare Beneficiaries: An Update and National Look
    This objective of this study was to compare, at a national and census division level, where rural and urban Medicare beneficiaries receive ambulatory care, which types of specialists they utilize and how far beneficiaries are traveling to obtain care.
    Research center: WWAMI Rural Health Research Center
    Topics: Aging, Chronic diseases and conditions, Health services, Medicare, Workforce
  • Post-acute Care Trajectories for Rural Medicare Beneficiaries
    Utilization and costs of post-acute care for Medicare fee-for-service beneficiaries have grown rapidly during the last decade. This study examined post-acute care utilization for rural Medicare beneficiaries following acute hospitalization, describing use of home health and skilled nursing care and trajectories of care across settings.
    Research center: WWAMI Rural Health Research Center
    Topics: Aging, Allied health professionals, Health services, Home health, Hospitals and clinics, Medicare, Nurses and nurse practitioners, Post-acute care
  • Rural Nursing Home Closures - Trends, Characteristics, and Impact on Access
    This project built a database of nursing home closures across rural and urban areas in the U.S. and evaluated the changes in access to post-acute and/or long-term care providers. It also described the differences in organizational, financial, and market characteristics between open vs. closed nursing homes in rural vs. urban areas.
    Research center: RUPRI Center for Rural Health Policy Analysis
    Topics: Aging, Healthcare access, Long-term care, Medicare

2020

  • Acuity Differences Among Newly Admitted Rural and Urban Nursing Home Residents
    This study used nursing home assessment data to examine rural-urban differences in resident acuity upon admission; whether differences persisted among newly admitted Medicare and non-Medicare residents; and whether and how nursing home, local health system, and market characteristics were associated with differences in resident acuity.
    Research center: Maine Rural Health Research Center
    Topics: Aging, Long-term care
  • Community Context and Rural Strategies to Support the Oldest Old
    This project developed a chartbook profiling older adults (65 and older) in rural areas and assessed where rural residents ages 85 and older were most likely to live, what rural counties had experienced the fastest growth of those 85 and older, and what strategies were in place or were possible for supporting this population in aging in place.
    Research center: University of Minnesota Rural Health Research Center
    Topics: Aging, Hospice and palliative care, Long-term care, Rural statistics and demographics

2019

  • Access to Care for Rural Medicare Beneficiaries
    This project examined multiple dimensions of access to care, with a focus on rural Medicare beneficiaries, including rural-urban differences in access to care, and within-rural differences in access to care by region, coverage type (traditional fee-for-service vs. supplemental Medigap coverage), and socio-demographic characteristics.
    Research center: University of Minnesota Rural Health Research Center
    Topics: Aging, Healthcare access, Medicare, Medicare Advantage (MA)

2018

  • Addressing Rural Social Isolation as a Health and Mortality Risk Factor
    This project aimed to describe rural/urban differences in the prevalence of social isolation, as well as to identify challenges and strategies related to addressing rural social isolation in order to inform policy-making.
    Research center: University of Minnesota Rural Health Research Center
    Topics: Aging, Health promotion and disease prevention
  • Caring for Caregivers: Available Support for Unpaid Caregivers in Rural Areas
    This project describes rural-urban differences in the prevalence and intensity of informal caregiving for older adults and associated socio-demographic correlates and as well as identifies potential policy interventions to improve the quality of life and health outcomes of rural caregivers.
    Research center: University of Minnesota Rural Health Research Center
    Topics: Aging, Home health, Long-term care
  • Rural Demography and Aging: The LTSS Imperative in Rural America
    The project created a current, broad-ranging, detailed profile of healthcare/LTSS needs and used patterns among rural and urban older adults through a literature review and analysis of data sets including the American Community Survey, the Area Health Resource File, and the Medicare Current Beneficiary Survey.
    Research center: Maine Rural Health Research Center
    Topics: Aging, Rural statistics and demographics

2017

  • Paving the Way: Addressing Transportation as a Social Determinant of Health for Rural Residents
    This project will use a mixed-methods design to examine ways in which transportation operates as a social determinant of health for vulnerable rural residents, and to identify exemplar transportation programs that are successfully improving health and well-being of those residents.
    Research center: University of Minnesota Rural Health Research Center
    Topics: Aging, Health services, Networking and collaboration, Transportation
  • Provision of Skilled Nursing in Rural America: Skilled Nursing Facilities and Swing Beds
    This project will allow researchers and policy makers to understand the nature of swing bed and skilled nursing facility care provision in rural areas of the U.S. Our national comparison will include indicators such as service mix, length of stay, discharges, volume and census, and certifications and provider characteristics.
    Research center: Southwest Rural Health Research Center
    Topics: Aging, Hospitals and clinics, Long-term care, Medicare
  • Rural-Urban Differences in Medicare Service Use and Expenditures in the Last Six Months of Life
    Patterns of end-of-life care are known to vary by rurality and by minority status, and the availability of facilities such as hospice also vary with rurality. This study will examine the relationship between level of service use during the last six months of life and facility availability in county of residence (hospital, SNF, IRF, home health, hospice), as well as minority status of the beneficiary and whether the beneficiary is also eligible for Medicaid ("dual eligible").
    Research center: Rural and Minority Health Research Center
    Topics: Aging, Medicaid and CHIP, Medicare, Minority health

2016

  • Access To and Use of Home and Community-Based Services in Rural Areas
    This study will use data from the 2010 Medicaid Analytic eXtract (MAX) file and in-depth policy reviews and interviews in four states to examine differences in the use of institutional and home and community-based service (HCBS) use by older adults across urban and rural areas, and the policy and community factors that contribute to differences or comparability in use.
    Research center: Maine Rural Health Research Center
    Topics: Aging, Home health, Long-term care
  • Access to Home Care Services in the Rural United States
    This study will identify and describe the scope of home health services required to meet current and future needs in rural areas of the U.S., identify current and anticipated barriers to accessing those needs, and describe ways that may help overcome these barriers.
    Research center: WWAMI Rural Health Research Center
    Topics: Aging, Home health
  • Rural Population Hospice Care
    Relatively little is known about rural hospice care. The objectives of this project are to review and describe what is already known about rural hospices and to perform initial quantitative analyses on available data to describe the: number of rural hospices and their use patterns (e.g., length of stay and utilization rates), rural residents to urban hospice utilization, and rural versus urban resident hospice utilization rates. For this project, rural is be subdivided into categories such as large rural, small rural, isolated small rural, and frontier. To supplement this information, qualitative information was obtained and integrated into the findings report.
    Research center: North Dakota and NORC Rural Health Reform Policy Research Center
    Topics: Aging, Health services, Quality
  • Rural-Urban Differences in Anticipated Need for Aging-Related Assistance Among Pre-Retirement Age Adults
    We will use information from a nationally representative survey to ascertain how rural and urban adults aged 40-64 view their future and their plans for coping.
    Research center: Rural and Minority Health Research Center
    Topic: Aging

2015

  • Perspectives of Rural Hospice Directors
    Rural hospice care, as it is currently configured, is under pressure by a variety of factors (e.g., policy and regulation, economic and financial, and organizational and structural) which are reviewed in this document. However, a central core element of rural hospice remains the strong sense of community that is embodied in the system (i.e., typically a small non-profit arrangement) and design (i.e., a delivery system reliant on community connections and personal relationships) of care. This policy brief is the result of a national phone survey of rural hospice directors or key staff in 47 states. Fifty-three directors or key staff members were interviewed during a three-month period in 2013.
    Research center: North Dakota and NORC Rural Health Reform Policy Research Center
    Topics: Aging, Health services, Quality, Telehealth

2014

  • Adequacy of Home Health Care Availability in Rural Counties
    This project will describe current distribution of HHC agencies, by ZIP Code and county of facility location and of service provision, across levels of rurality. Second, the project will estimate whether rural populations at risk for inadequate access to HHC, based on projected population need population / provider ratios.
    Research center: Rural and Minority Health Research Center
    Topics: Aging, Home health
  • Rural Residential Care: The Implications of Federal and State Policy Changes
    This project will assess the impact on Medicaid-funded rural residential care options of new and proposed federal policy guiding state compliance with the Americans with Disabilities Act (ADA). The extent to which rural facilities are able to comply with the proposed guidelines may affect their eligibility for funding through Home and Community-Based Services waiver programs.
    Research center: Maine Rural Health Research Center
    Topics: Aging, Disabilities, Medicaid and CHIP

2013

  • Challenges and Opportunities for Improving Rural Long-Term Services and Supports under the Affordable Care Act
    This project will examine strategies, models, and policy options for improving access to, and quality of, rural long-term services and supports. Through focused policy analyses, we will highlight the rural options, opportunities, and barriers of implementing the coordinated care, health home, and long-term services and supports provisions in the Affordable Care Act.
    Research center: Maine Rural Health Research Center
    Topics: Aging, Care management, Long-term care

2009

  • Preventive Care: Supports and Barriers to Best Practices for a National Sample of Rural Medicare Beneficiaries
    Preventive health screenings are generally underutilized in the United States by the elderly, especially those residing in rural areas. Using an integrative approach, including secondary data analysis of a large nationally representative dataset (Medicare Current Beneficiary Survey) and complementary qualitative interviews with rural elders, the proposed research study aims for a more complete understanding of the factors influencing use of these practices.
    Research center: FORHP-funded Individual Grantees
    Topics: Aging, Health promotion and disease prevention

2008

  • Rural-Urban Differences In The Use, Type, And Quality Of Depression Treatment
    As access to evidence-based treatment for affective disorders (major depressive disorder, dysthymia, and bipolar disorder) improves in urban areas, it is critical to monitor rural-urban differences in the use and quality of treatment over time to identify and address rural disparities, especially for vulnerable populations such as the elderly and ethnic minorities.
    Research center: WICHE Center for Rural Mental Health Research
    Topics: Aging, Health disparities and health equity, Mental and behavioral health, Minority health

2007

  • Tribal Long-Term Care: Barriers to Best Practices in Policy and Programming for a National Sample of Rural Tribes
    This project will examine barriers experienced by rural American Indian and Alaska Native (AI/AN) tribes in developing long term care policy and service provision, identify tribes which exemplify best practices in the area of long term care policy, and document what other tribes would need to know to develop successful long term care programs (i.e., lessons learned).
    Research center: FORHP-funded Individual Grantees
    Topics: Aging, American Indians and Alaska Natives, Long-term care, Minority health

2006

  • Impact of Health Insurance Coverage on Native Elder Health: Implications for Addressing the Health Care Needs of Rural American Indian Elders
    This project examined the types of health insurance coverage of rural Native American elders ages 55 and older, and examine how different types of health insurance coverage and lack of health insurance coverage impact access to health care services among Native American elders by geographic location (rural frontier, rural non-frontier and urban).
    Research center: Upper Midwest Rural Health Research Center
    Topics: Aging, American Indians and Alaska Natives, Frontier health, Healthcare access, Minority health, Private health insurance, Rural statistics and demographics, Uninsured and underinsured

2005

  • Access to Physician Care for the Rural Medicare Elderly
    This study described where Medicare beneficiaries in five states obtain their health care, how far they travel for that care, and the mix of physician specialties from which they obtain ambulatory care. Special attention was paid to beneficiaries who have dual Medicare-Medicaid status, who reside in poorer income areas, and who live in designated Health Professional Shortage Areas.
    Research center: WWAMI Rural Health Research Center
    Topics: Aging, Chronic diseases and conditions, Health services, Medicare, Physicians, Poverty
  • Disability Burdens Among Rural and Urban Older Americans
    This project will use the 1994-2000 Second Longitudinal Study of Aging to develop detailed estimates of healthy, disabled, and total life expectancy among rural and urban populations. We will develop and compare the estimates between women and men, by race/ethnicity, and across differing levels of education.
    Research center: Rural and Minority Health Research Center
    Topics: Aging, Disabilities, Health disparities and health equity, Long-term care, Rural statistics and demographics
  • Medicaid Budget Cuts: Effects on Rural Nursing Homes and Rural Elderly and Disabled
    This project will investigate whether nursing home quality and access to nursing home care have eroded in rural areas as a result of changes in Medicare payments or reductions in Medicaid nursing home payments from 2000-2003.
    Research center: Southwest Rural Health Research Center
    Topics: Aging, Disabilities, Long-term care, Medicaid and CHIP
  • Native Elder Care Needs Assessment: Development of a Long Term Care Planning Tool Kit
    A long term care planning tool kit will assist tribes with interpreting long term care data obtained through a national Native Elder Care Needs Assessment. It will also assist tribes in using the data to develop long term care infrastructure and comprehensive services that respond to local needs and services.
    Research center: FORHP-funded Individual Grantees
    Topics: Aging, American Indians and Alaska Natives, Long-term care, Minority health
  • Trends in Swing Bed and Skilled Nursing Facility Use in Rural Hospitals, 1996-2003
    This study will examine trends in the distribution of skilled nursing facility (SNF) services in rural hospitals during a period of dramatic change in Medicare reimbursement, most notably the transition from cost-based reimbursement to SNF prospective payment system (PPS).
    Research center: North Carolina Rural Health Research and Policy Analysis Center
    Topics: Aging, Hospitals and clinics, Long-term care, Medicare Prospective Payment System (PPS)

2004

  • Medicaid Budget Cuts and Long-Term Care Supplement
    Data on each state will be collected identifying all the changes made to their Medicaid program in the area of long-term care or related services to the frail elderly and disabled, and a policy paper addressing the impact of Medicaid cuts on long term care services, particularly among the elderly in rural areas, will be produced.
    Research center: Southwest Rural Health Research Center
    Topics: Aging, Disabilities, Long-term care, Medicaid and CHIP
  • Prevalence of Chronic Disease and the Degree of Rurality of American Indian Elders in a Nationally Representative Sample of 100 Tribes
    This project will determine if there are differences in prevalence of chronic disease in American Indian elders across age groups in urban vs. rural vs. frontier counties. Moderating factors of chronic disease will also be examined including health damaging behaviors, access to health care services and providers and degree of functional limitation.
    Research center: FORHP-funded Individual Grantees
    Topics: Aging, American Indians and Alaska Natives, Chronic diseases and conditions, Frontier health, Long-term care, Minority health, Rural statistics and demographics

2003

2001

1999

Unknown

  • Access to Cancer Services for Rural Colorectal Cancer Medicare Patients: A Multi-State Study
    This study examined a comprehensive database to quantify the distance and access to four types of cancer services in a sample of rural, Medicare-insured, CRC patients of different racial and ethnic groups, and will inform future work designed to understand discrepancies in cancer service use by the rural elderly in different racial and ethnic groups.
    Research center: WWAMI Rural Health Research Center
    Topics: Aging, Cancer, Chronic diseases and conditions, Health services, Medicare, Minority health