Study Identifies Factors Inhibiting Rural Home and Community-Based Services Access

April 16, 2019

Rural patients continue to face challenges accessing adequate home health care services, supports, and resources. A new study in the April issue of JAMDA suggests that addressing this issue calls for stakeholder collaboration and comprehensive policy approaches focusing on rural infrastructure.

In “Rural-Urban Disparities in Access to Home- and Community-Based Services and Supports: Stakeholder Perspectives from 14 States,” the authors looked at factors inhibiting access to rural home and community-based services (HCBS). Health care stakeholders interviewed for the study — such as Medicaid administrators, service agency managers and staff, and patient advocates — identified a number of factors that inhibit access, including limited availability of long-term supports and services (LTSS) providers, lack of adequate transportation, telecommunications barriers, threats to business viability, and challenges to caregiving workforce recruitment and retention. They further suggested that rural patients rely more on informal caregiving supports, either due to cultural preferences or efforts to compensate for lack of available HCBS.

The authors noted that LTSS rebalancing efforts may have unintended consequences in rural contexts. The various factors identified in this study not only inhibit patients’ access to HCBS, but also affect the adequacy and continuity of these services. Additionally, the authors said, they potentially impact long-term business viability for HCBS providers. Addressing these problems, they suggest, will require stakeholder collaboration and comprehensive policy approaches with attention to rural infrastructure.

This study was conducted by researchers at the Rand Corporation in Pittsburgh, PA, Arlington, VA, Santa Monica, CA, and Los Angeles, CA; Borum Center, UCLA Division of Geriatrics, Las Angeles, CA; and Veteran’s Health Administration, Los Angeles, CA.

Click here for more information on the findings above and more details about the study. To contact the researchers or JAMDA editor for an interview, please email



JAMDA is the official journal of AMDA – The Society for Post-Acute and Long-Term Care Medicine. JAMDA publishes peer-reviewed articles including original studies, reviews, clinical experience articles, case reports, and more, on all topics more important to post-acute and long-term care medicine. Visit for more information.

About the Society for Post-Acute and Long-Term Care Medicine
AMDA – The Society for Post-Acute and Long-Term Care Medicine is the only medical specialty society representing the community of over 50,000 medical directors, physicians, nurse practitioners, physician assistants, and other practitioners working in the various post-acute and long-term care (PA/LTC) settings. Dedicated to defining and improving quality, we advance our mission through timely professional development, evidence-based clinical guidance, and tireless advocacy on behalf of members, patients, families, and staff. Visit for more information.