Home health: Rural Health Research Products & Journal Articles

2024

Estimated Impacts of Multiple Payment Policies on Rural-Serving Home Health Agencies
Policy Brief
WWAMI Rural Health Research Center
Date: 07/2024
This brief examines the estimated impact of three Medicare payment policy changes on home health agency (HHA) reimbursement by rural-serving status, geographic location, and select HHA characteristics.

2023

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).
Availability of Dialysis Facilities in Minoritized Racial/Ethnic Group Areas
Policy Brief
Rural and Minority Health Research Center
Date: 08/2023
This brief is one of a series of findings briefs documenting disparities in geographic access to health services for ZIP code tabulation areas containing a high proportion of minoritized racial/ethnic residents. The brief looks at the availability of dialysis providers in minoritized racial/ethnic areas.
Availability of Primary Care Safety Net Providers in Minoritized Racial/Ethnic Group Areas
Policy Brief
Rural and Minority Health Research Center
Date: 08/2023
This brief is one of a series of findings briefs documenting disparities in geographic access to health services for ZIP code tabulation areas containing a high proportion of minoritized racial/ethnic residents. This report looks at the distance to the nearest primary care safety net provider.
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.
Distribution of Direct Care Workforce COVID-19 Funding Between Rural and Urban Counties in Minnesota and Illinois
Policy Brief
University of Minnesota Rural Health Research Center
Date: 05/2023
The purpose of this policy brief is to examine trends in the distribution of federal Coronavirus Aid, Relief, and Economic Securities Act of 2020 (CARES Act) funding designed to support the direct care workforce between rural and urban counties in Minnesota and Illinois.
Access to Health Services Across Rural and Urban Minoritized Racial/Ethnic Group Areas
Policy Brief
Rural and Minority Health Research Center
Date: 03/2023
This brief summarizes selected results from a series of reports documenting disparities in geographic access to health services for rural and urban places that have a relatively high proportion of residents from minoritized racial and ethnic groups. "Areas" were examined at the ZIP Code Tabulation Area level.
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.

2022

Who Will Care for Rural Older Adults? Measuring the Direct Care Workforce in Rural Areas (policy brief)
Policy Brief
University of Minnesota Rural Health Research Center
Date: 11/2022
The policy brief examines disparities in the supply of home health aides and nursing assistants in rural areas compared to urban areas. Researchers estimate the ratio of home health aides and nursing assistants relative to the population of adults (age 65+) across rural and urban areas in the U.S.
Availability of Home Health Services in Minoritized Racial/Ethnic Group Areas
Policy Brief
Rural and Minority Health Research Center
Date: 08/2022
This brief is one of a series of findings briefs documenting disparities in geographic access to health services for ZIP code tabulation areas containing a high proportion of minoritized racial/ethnic residents. This report looks at the availability of home health services in minoritized racial/ethnic areas.
Availability of Medicare-Certified Hospice Services in Minoritized Racial/Ethnic Group Areas
Policy Brief
Rural and Minority Health Research Center
Date: 08/2022
This is one of a series of briefs documenting disparities in geographic access to health services for ZIP code tabulation areas containing a high proportion of minoritized racial/ethnic residents. This brief explores access to hospice services.
Availability of Pharmacies in Minoritized Racial/Ethnic Areas
Policy Brief
Rural and Minority Health Research Center
Date: 08/2022
This brief is one of a series of findings briefs documenting disparities in geographic access to health services for ZIP code tabulation areas containing a high proportion of minoritized racial/ethnic residents. This report looks at access to pharmacies.
Spatial Access to Hospital-based Obstetric Units in Minoritized Racial/Ethnic Areas
Policy Brief
Rural and Minority Health Research Center
Date: 08/2022
This brief is one of a series of findings briefs documenting disparities in geographic access to health services for ZIP code tabulation areas containing a high proportion of minoritized racial/ethnic residents. This report looks at spatial access to hospital-based obstetric units in minoritized racial/ethnic areas.
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.
The Problem of the Color Line: Place, Race, and Access to Health Care in America
Journal Article
Rural and Minority Health Research Center
Date: 02/2022
Using ZIP Code Tabulation Area boundaries and associated rural-urban commuting area codes, urban and rural places with the largest share of minoritized racial and ethnic groups were identified. A StoryMap was then created to illustrate disparities experienced based on where Indigenous populations and people of color reside spatially.
Quality of Home Health Agencies Serving Rural Medicare Beneficiaries
Policy Brief
WWAMI Rural Health Research Center
Date: 02/2022
This policy brief describes the quality of home health agencies (HHAs) by rural-serving status. While quality of patient care star ratings were not associated with rural-serving status, rural HHAs and urban HHAs that serve rural patients had higher patient experience star ratings than urban HHAs that do not serve rural patients.

2021

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.
"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.
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.

2020

Variation in Use of Home Health Care Among Fee-for-Service Medicare Beneficiaries by Rural-Urban Status and Geographic Region: Assessing the Potential for Unmet Need
Policy Brief
WWAMI Rural Health Research Center
Date: 02/2020
This study describes use of home healthcare by rural-urban status and geographic region. Findings suggest geographic region drives variation more than rural-urban status. Unmet need may be highest in the most remote rural counties and rural counties within the West North Central, East North Central, Mountain, and Pacific Census Divisions.

2019

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.
Differences in Care Processes Between Community-Entry Versus Post-Acute Home Health for Rural Medicare Beneficiaries
Policy Brief
WWAMI Rural Health Research Center
Date: 04/2019
This study describes home healthcare processes for rural Medicare beneficiaries who are admitted from the community (community-entry) versus those who are admitted following an inpatient stay (post-acute). Care processes include timely initiation of care, length of stay, and services provided (e.g., physical therapy, medical social work).

2018

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.
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.
Different Populations Served by the Medicare Home Health Benefit: Comparison of Post-Acute Versus Community-Entry Home Health in Rural Areas
Policy Brief
WWAMI Rural Health Research Center
Date: 07/2018
This study describes differences between rural, fee-for-service Medicare beneficiaries who are admitted to home health from the community (community-entry) and those who are admitted to home health following an inpatient stay (post-acute) in terms of their clinical and non-clinical characteristics as well as the communities in which they live.
Service Provision and Quality Outcomes in Home Health for Rural Medicare Beneficiaries at High Risk for Unplanned Care
Journal Article
WWAMI Rural Health Research Center
Date: 06/2018
This study examined service provision and quality outcomes among rural Medicare beneficiaries who used home health from 2011-2013 and were at high risk for unplanned care. More skilled nursing visits and visits by more types of providers were associated with higher hospital readmission and emergency department use and lower community discharge.

2017

Home Is Where the Heart Is: Insights on the Coordination and Delivery of Home Health Services in Rural America
Policy Brief
North Dakota and NORC Rural Health Reform Policy Research Center
Date: 08/2017
Access to home health in rural areas is an important public policy concern, particularly with the growing number of older adults residing in rural America. This qualitative study seeks to better understand how home health services are provided in rural areas, and identifies facilitators and barriers to providing care.

2016

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.
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.
Disparities in Home Health Service Providers Among Medicare Beneficiaries with Stroke
Journal Article
Rural and Minority Health Research Center
Date: 01/2016
Examines the intensity of home health services, by the number of visits and service delivery by rehabilitation specialists, among Medicare beneficiates with stroke. There were no significant rural-urban differences in the number of home health visits, but rural residents were less likely to receive services from rehabilitation specialists.

2015

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.

2014

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.
Differences in Case-Mix Between Rural and Urban Recipients of Home Health Care
Report
Rural and Minority Health Research Center
Date: 10/2014
This report provides a description of the health status and service needs of rural and urban Medicare home health patients based on professional assessments of their conditions at the start of care.
Home Health Care Agency Availability in Rural Counties
Report
Rural and Minority Health Research Center
Date: 06/2014
This report looks at home healthcare, including availability and service quality, in the United States and in rural counties. Findings include that counties at risk for limited service availability were almost all rural. Of the 34 counties lacking home health agencies, 30 were rural. Of the 120 counties served by single agencies, 118 were rural.

2013

Are Primary Care Practices Ready to Become Patient-Centered Medical Homes?
Journal Article
RUPRI Center for Rural Health Policy Analysis
Date: 2013
Measures the readiness of rural primary care practices to be eligible as patient-centered medical homes (PCMHs) by comparing PCMH readiness scores with metropolitan and nonmetropolitan primary care practices.

2006

Performance of Rural and Urban Home Health Agencies in Improving Patient Outcomes
NORC Walsh Center for Rural Health Analysis
Date: 05/2006
This study was conducted to determine whether rural and urban home care agencies differ in terms of patient care outcomes and to ascertain whether there are agency characteristics that are associated with better or worse outcomes.

2005

Utilization of Home Health Services Among Rural Medicare Beneficiaries Before and After the PPS
NORC Walsh Center for Rural Health Analysis
Date: 08/2005
This report describes a study conducted on the rural effects of the PPS, including whether the PPS contributed to changes in the demographic and clinical characteristics of home care users, the likelihood of using each of six home care disciplines, and the intensity of services.
Home Health Payment Reform: Trends in the Supply of Rural Agencies and Availability of Home-Based Skilled Services
NORC Walsh Center for Rural Health Analysis
Date: 03/2005
Findings from this study suggest that changes in home health reimbursement were associated with dramatic reductions in the supply of home care agencies; however those reductions appear to have occurred primarily during the time in which the Interim Payment System was in place.
Patterns of Post-Acute Utilization in Rural and Urban Communities: Home Health, Skilled Nursing, and Inpatient Medical Rehabilitation
NORC Walsh Center for Rural Health Analysis
Date: 03/2005
This report describes rural Medicare beneficiaries' patterns of post-acute utilization of home health services, skilled nursing facilities, and inpatient rehabilitation facilities.

2004

Medicare Home Health Care in Rural America
Policy Brief
NORC Walsh Center for Rural Health Analysis
Date: 01/2004
This study looked at the characteristics of rural Medicare beneficiaries served by urban home health agencies as compared with those served by rural agencies.

2003

Medicare Home Health Care in Rural America (Full Report)
NORC Walsh Center for Rural Health Analysis
Date: 06/2003
This study looked at the characteristics of rural Medicare beneficiaries served by urban home health agencies as compared with those served by rural agencies.

2001

Rural Hospitals' Ability to Finance Inpatient, Skilled Nursing, and Home Health Care
University of Minnesota Rural Health Research Center
Date: 10/2001
This study surveys 448 rural hospitals to see how they are restructuring in light of the Balanced Budget Act of 1997.

2000

Rural Home Health Agencies: The Impact of the Balanced Budget Act
Policy Brief
NORC Walsh Center for Rural Health Analysis
Date: 04/2000
This policy analysis brief examines how the characteristics of rural and urban Medicare-certified home health agencies differ, estimates the impact of interim payment system on these agencies, and discusses policy implications for a Medicare home health prospective payment system.
Rural and Urban Patterns of Home Health Use: Implications for Access Under the Interim Payment System
Policy Brief
NORC Walsh Center for Rural Health Analysis
Date: 03/2000
This policy analysis brief compares patterns of home health utilization among rural and urban Medicare beneficiaries in order to estimate the potential impact of an interim payment system on access to home care in rural areas of the country.