Patterns of in-home care service use among older adults: a rural-urban comparison

Abstract

This study investigated how patterns of in-home care utilization and predictors of service use differ for older adults based on whether they live in a rural or an urban environment and whether the service is provided from an informal, a formal, or a combination informal/formal source. The specific in-home services under consideration were: checking, continuous supervision, homemaker-household, meal preparation, nursing care, and personal care.

Although the study was comparative in nature, the investigator was particularly interested in identifying patterns of service utilization that might be translated into effective and cost-efficient service delivery strategies for rural communities. The rural elderly population was the focus of this research because older people tend to live disproportionately in rural areas. Further, older rural residents seem to have more objective needs than their urban counterparts while they have access to fewer services.

This study was based on data from the Statewide Survey of Older Virginians, a probability sample of 2,146 noninstitutionalized persons 60 years of age and older. The 87% response rate included 8% of the respondents who participated via an informant.

A multiple regression analysis was performed for each of the eight subsamples into which the total sample was divided. The 20 independent variables were categorized according to Andersen's paradigm for conceptualizing service utilization as either predisposing, enabling, or need variables. The need variables were significant (p < .05) predictors of service use more often than the other categories, with ADL performance emerging as a significant predictor of service use across all subsamples.

Evidence from existing service utilization literature formed the basis for five hypotheses included to focus the study. Results of the hypothesized relationships confirmed the generalization that this body of literature lacks the necessary precision to accurately profile rural and urban service users. Further investigation of utilization patterns of in-home care services was indicated by this research.