Friday, 14 January 2005 - 8:00 AM

This presentation is part of: Family Caregiving

Rural Older Adults’ Access Barriers to In-home and Community-Based Services

Purpose: The purpose of this study was to assess the access barriers to seven commonly used in-home and community-based services and to identify risk factors that were related to these service barriers in rural areas. Previous research has identified generic barriers to using in-home and community-based services in rural areas. However, information linking specific service barriers to individual service is limited. We do not know whether rural older adults will encounter the same or different barriers when they access different supportive services and what risk factors identify rural older adults who may be vulnerable to access barriers.

Methods: The data used in this study were extracted from the 1999 National Long Term Care Survey (NLTCS) and included 283 dyads of rural older adults with functional impairments and their caregivers. The study used univariate analyses to describe the prevalence of access barriers to seven commonly used in-home and community based services including respite care, personal care, homemaker, meal, transportation, home modification, and assistive devices. Guided by the Andersen-Newman health service behavioral model, multiple logistic regression analyses were used to identify older adults’ risk factors to access barriers. Results:

Nearly two-thirds (61.5%) of caregivers reported access barriers to one or more services. Respite care (83.6%), transportation (75.0%), and homemaker (24.1%) were among the services to which caregivers most frequently reported barriers. Across the seven services, the major barriers identified by caregivers included that older adults or caregivers were not aware of the services (16.0% - 42.2%), a service was not available (4.0% - 33.3%), the services were not affordable (1.4% - 33.3%), and older adults or caregivers did not report a reason for not using the service (5.1% - 12.0%). Among the services tested, the logistic model was statistically significant in predicting access barriers to homemaker services and home modification services. In relation to access barriers to homemaker services, the older adult’s race, educational attainment, and Medicaid eligibility were statistically significant. Caregivers of older adults who were White (OR=0.15, p=.01), received more education (OR=0.34, p=.02), and were enrolled in Medicaid (OR=0.34, p=.03) were less likely to report access barriers than their counterparts. In relation to access barriers to home modification services, older adults’ educational attainment (OR=0.25, p=.01) and annual household income (OR=0.05, p=.007) were statistically significant. Caregivers of older adults who received more education and had more income were less likely to report access barriers than their counterparts. Implications: Given the multifaceted nature of clients’ access barriers, social work practitioners need to carefully assess the specific access barriers experienced by rural older adults and to develop strategies used to overcome these barriers. Special attention should be given to rural older adults who are vulnerable to the risk of access barriers. Furthermore, social work practitioners need to advocate on rural clients’ behalf to make services such as respite care, transportation, and homemaker services more available and affordable to rural residents.

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