Rural Older Adults' Access Barriers to In-Home and Community-Based Services

This study identified specific access barriers to seven commonly used in-home and community-based services (HCBS) and examined factors that were related to barriers to these services. The data used in this study were extracted from the 1999 National Long Term Care Survey and included 283 dyads of rural older adults and their caregivers. The HCBS to which caregivers most frequently reported access barriers were respite care, transportation, and homemaker services. Although access barriers varied depending on individual services, the main access barriers were unavailability, unawareness, and affordability of HCBS. Findings showed that predisposing, enabling, and need factors had differential influence on access barriers to individual services. The older adult's race, educational attainment, and Medicaid enrollment were significant predictors of access barriers to homemaker services. The older adult's educational attainment and annual household income were significant predictors of access barriers to home modification services. Implications of these findings for social work practice are discussed.