Title: Literature Review of Home- and Community-Based Services (HCBS) in Diverse Communities: Rural Communities

Publication date: November 2023

Rural older adults and their caregivers face unique challenges. Rural older adults are much less likely to utilize HCBS than urban older adults and comparatively more likely to use nursing home care. A great deal of this difference is driven by the lack of services in rural areas; although the home care workforce is going through a major staffing crisis throughout the country, this issue is especially prominent in rural areas where long distances to clients’ homes and particularly low rates of pay represent a significant challenge for workers. Rural cultural values related to self-reliance, as well as the perception from service providers that rural people are “hardier,” may also contribute to a preference for family caregiving and a reluctance to seek formal services. Rural caregivers also struggle with lack of awareness of the services available to them, as well as the physical and social isolation associated with providing care in rural areas.