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The Journals of Gerontology Series B: Psychological Sciences and Social Sciences Advance Access originally published online on February 4, 2009
The Journals of Gerontology Series B: Psychological Sciences and Social Sciences 2009 64B(2):258-268; doi:10.1093/geronb/gbn003
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© The Author 2009. Published by Oxford University Press on behalf of The Gerontological Society of America. All rights reserved. For permissions, please e-mail: journals.permissions@oxfordjournals.org.

Formal Home Care Utilization Patterns by Rural–Urban Community Residence

William J. McAuley1, William Spector2 and Joan Van Nostrand3

1 Department of Communication, George Mason University, Fairfax County, Virginia
2 Center for Delivery, Organization and Markets, Rockville, Maryland
3 Department of Health and Human Services, Office of Rural Health Policy, Health Resources and Services Administration, Rockville, Maryland

Correspondence should be directed to W. J. McAuley, PhD, Department of Communication, George Mason University, 4400 University Drive, Research 1 Building, Room 253, MSN 6A9, Fairfax, VA 22030 Email: wmcauley{at}gmu.edu.


  Abstract

Background: We examined formal home care utilization among civilian adults across metro and nonmetro residential categories before and after adjustment for predisposing, enabling, and need variables.

Methods: Two years of the Medical Expenditure Panel Survey (MEPS) were combined to produce a nationally representative sample of adults who resided in the community for a calendar year. We established 6 rural–urban categories based upon Urban Influence Codes and examined 2 dependent variables: (a) likelihood of using any formal home care and (b) number of provider days received by users. The Area Resource File provided county-level information. Logistic and negative binomial regression analyses were employed, with adjustments for the MEPS complex sampling design and the combined years.

Results: Under controls for predisposing, enabling, and need variables, differences in likelihood of any formal home care use disappear, but differences in number of provider days received by users emerged, with fewer provider days in remote areas than in metro and several other nonmetro types.

Conclusions: It is important to fully account for predisposing, enabling, and need factors when assessing rural and urban home care utilization patterns. The limited provider days in remote counties under controls suggest a possible access problem for adults in these areas.

Key Words: Home health • Metropolitan • Nonmetropolitan • Long-term care

Received January 16, 2008; Accepted September 17, 2008

Decision Editor: Kenneth F. Ferraro, PhD


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