ArticleJournal of the American Medical Directors Association2019
Rural-Urban Disparities in Access to Home- and Community-Based Services and Supports: Stakeholder Perspectives From 14 States.
Article in Journal of the American Medical Directors Association, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 56 papers, 1 of them a synthesis that pooled it.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
56 citing papers in PubMed, 1 synthesis or guideline pooled it, 95 citations in OpenAlex.
- Assessing Financial Toxicity in Cancer: A Global Systematic Review and Meta-Analysis Using an Asset Framework.Cancer medicine · 2026Pooled it
- Building on and tailoring to: Adapting a cancer caregiver psychoeducational intervention for rural settings.Cancer medicine · 2024Trial
- Disadvantaged children in rural communities in the United States: A concept analysis.Journal of pediatric nursing · 2026Review
- Geographic variation and factors associated with home-based long-term care utilization across municipalities in Japan.BMC global and public health · 2026Article
- The Rural Community-Based Occupational Therapy Model (Rural CB-OT): Community-Codesigned Solution to support Aging in Place in Rural Underserved Areas.Research square · 2026Article
- Rural-Urban Variability in Home and Community-Based Service Use Among Veterans.Journal of the American Geriatrics Society · 2026Article
- Development and Validation of a Predictive Model for Identification of Cognitive Impairment Risk in Older Adults with Subjective Cognitive Decline：A Longitudinal Study.Neurological sciences : official journal of the Italian Neurological Society and of the Italian Society of Clinical Neurophysiology · 2026Article
- Trends and Factors in Nursing Home Closures.JAMA health forum · 2026Article
- Home- and Community-Based Service Use and Preferences Among Post-9/11 Veterans With or at High Risk of Alzheimer Disease and Related Dementia and Their Caregivers: Protocol for a Mixed Methods Observational Study.JMIR research protocols · 2026Observational
- Perceived quality of home- and community-based services and urban-rural disparities in aging-in-place intentions: evidence from Chinese older adults.BMC geriatrics · 2026Article
- From Disease to Illness: Reframing Periodontitis Through an Anthropological Lens.Journal of periodontal research · 2026Review
- Satisfaction with urban rural sports integration at the county level in China and its determinants.Frontiers in public health · 2026Article
- Article
- Trends in Assisted Living and Memory Care Supply From 2019 to 2023.Journal of the American Medical Directors Association · 2025Article
- Association of home-and community-based services with health-related quality of life among Chinese older adults.BMC public health · 2025Article
- Rate of incident dementia and care needs among older adults with new traumatic brain injury: a population-based cohort study.CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne · 2025Article
- Improving information sharing in Medicaid home and community-based services with learning health systems: Implications for older adults and individuals living with disabilities and dementia.Learning health systems · 2025Article
- Associations of Place-Based Factors with Service Use and Consumer-Reported Unmet Service Needs Among Older Adults Using Publicly Funded Home- and Community-Based Services in the United States.International journal of environmental research and public health · 2025Article
- Between-and within-socioeconomic groups temporal inequality in the uptake of malaria prevention strategies among pregnant women and under-five children in Ghana (2003-2022).Malaria journal · 2025Article
- Financial performance of rural and urban nursing homes: A comparative analysis.The Journal of rural health : official journal of the American Rural Health Association and the National Rural Health Care Association · 2025Article
Corrections and comments
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Authors and funding
7 authors at 1 institution in 1 country.
Funding
Abstract
objectivesTrends over time in the United States show success in rebalancing long-term services and supports (LTSS) toward increased home- and community-based services (HCBS) relative to institutionalized care. However, the diffusion and utilization of HCBS may be inequitable across rural and urban residents. We sought to identify potential disparities in rural HCBS access and utilization, and to elucidate factors associated with these disparities.
designWe used qualitative interviews with key informants to explore and identify potential disparities and their associated supply-side factors. SETTING AND
participantsWe interviewed 3 groups of health care stakeholders (Medicaid administrators, service agency managers and staff, and patient advocates) from 14 states (n = 40). MEASURES: Interviews were conducted using a semistructured interview guide, and data were thematically coded using a standardized codebook.
resultsStakeholders identified supply-side factors inhibiting rural HCBS access, including limited availability of LTSS providers, inadequate transportation services, telecommunications barriers, threats to business viability, and challenges to caregiving workforce recruitment and retention. Stakeholders perceived that rural persons have a greater reliance on informal caregiving supports, either as a cultural preference or as compensation for the dearth of HCBS. CONCLUSIONS/IMPLICATIONS: LTSS rebalancing efforts that limit the institutional LTSS safety net may have unintended consequences in rural contexts if they do not account for supply-side barriers to HCBS. We identified supply-side factors that (1) inhibit beneficiaries' access to HCBS, (2) affect the adequacy and continuity of HCBS, and (3) potentially impact long-term business viability for HCBS providers. Spatial isolation of beneficiaries may contribute to a perceived lack of demand and reduce chances of funding for new services. Addressing these problems requires stakeholder collaboration and comprehensive policy approaches with attention to rural infrastructure.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.