Disparities in Home Health Utilization Among Rural and Urban Veterans

A recent study published in the Journal of Rural Health examined differences in home health care utilization among rural and urban veterans enrolled in the Veterans Health Administration (VA). Given that one-third of VA enrollees reside in rural areas and that older veterans have a higher prevalence of chronic conditions requiring ongoing care, understanding disparities in access to home health services is crucial. The study analyzed VA administrative data from 2019 to 2021 for veterans aged 65 years and older, comparing the likelihood of receiving home health services and the number of visits received.

The findings revealed that rural veterans were slightly more likely than their urban counterparts to receive any home health care, with an adjusted odds ratio of 1.10. However, among those who received at least 1 home health visit, rural veterans had significantly fewer expected visits, with an incident rate ratio of 0.70. This suggests that while rural veterans may access home health services, they receive fewer visits, which could indicate potential access barriers.

Rural and urban veterans in the study were similar in age and overall health status, though rural veterans were slightly less likely to be highly frail or diagnosed with dementia. Despite these similarities, rural veterans' lower utilization of home health visits may stem from systemic challenges such as provider shortages, long travel distances, and limited service availability in rural areas. The disparity in visit frequency widened during the COVID-19 pandemic, further highlighting the vulnerability of rural health care infrastructure.

These findings align with broader research demonstrating that rural populations often face barriers to accessing health services, including home health. The VA's home health services differ from Medicare in that they do not require veterans to be homebound and can be delivered for extended periods. However, the study suggests that despite these policies, logistical and workforce constraints may still limit rural veterans' ability to receive adequate care.

“This study makes an important contribution to understanding rurality-based differences in home health use by demonstrating that, although rural Veterans are slightly more likely to receive any home health than urban Veterans, they tend to receive considerably fewer visits,” researchers concluded. “Future research could use qualitative methods to examine reasons for this difference, and whether rural Veterans experience worse outcomes—such as more hospitalizations or greater likelihood of nursing home placement—as a result.”

Reference

Davila H, Mayfield B, Mengeling MA, et al. Home health utilization in the Veterans Health Administration: Are there rural and urban differences? J Rural Health. 2025;41(1):e12865. doi:10.1111/jrh.12865