The need for in-home care in rural areas has increased rapidly, coinciding with the aging of the Baby Boom generation, which is driving industry growth. Yet opportunities for providers to meet the growing need in rural spaces are countered by a slew of challenges.

Home health care providers serving rural areas must overcome staffing and geographic problems to meet the growing need for care. However, embracing technology and adopting a comprehensive approach to patient health and wellness can help future-proof home health operations in rural locations.

“Rural areas experience issues with clinical and support staffing because there tend to be fewer job opportunities compared to more urban settings,” Dr. Binoy Singh, chief medical officer at Gentiva, told Home Health Care News. “Added to that, patients often live at greater distances, requiring home care clinicians to spend more time driving, which can result in providers serving fewer patients daily. The lack of health care providers and transportation challenges often mean that patients may have more advanced and complex diseases or illnesses by the time they receive care.”

Atlanta-based Gentiva offers a range of home-based care services, including hospice, home health and palliative care. It has over 590 locations across the U.S., spanning 38 states.

Demographic shifts in the population resulted in a notable increase in “older age counties” in rural places – where 20% or more of the population is aged 65 or older – which has nearly tripled since 2010, according to a study published by the U.S. Department of Agriculture’s (USDA) Economic Research Service (ERS).

Working-age populations in rural areas have declined, creating a higher demand for caregiving for both younger and older age groups, the study’s researchers wrote. The number of people aged 65 and older in non-metro counties grew from 7.4 million in 2010 to 9.7 million in 2023.

This shift has caused the health care sector to experience a worker shortage in rural areas and challenges in delivering services and care. As the rural population’s age structure evolves, so too have the delivery methods and preferences within health care organizations.

An increasing demand for home health care

Since 2010, nearly all growth in rural-based health care has been driven by home health care services. The report highlighted that this sector has experienced steady expansion over the past 13 years, finishing Q3 of 2023 with 36% more organizations than in Q1 of 2010.

The growth of home health care services was not uniform across rural America during this period. In the Midwest, states such as Michigan and Ohio experienced significant increases, particularly in the number of home health care providers in northern Michigan and southern Ohio.

Home health care growth in the Southern and Western U.S. is concentrated in Arkansas, Arizona, New Mexico, Washington and Idaho, according to the report. Conversely, large parts of Texas and the Central Plains states, including Oklahoma, Missouri and Kansas, have experienced a decline in home health care providers from 2010 to 2023.

While the home health sector is growing in rural areas overall, providers face challenges in finding sufficient workforces to meet the rising demand. The most rural counties have fewer health care facilities and are more likely to experience shortages of health professionals compared to urban areas, according to the ERS report. Furthermore, rural communities tend to have fewer and less specialized health care resources, as rural hospitals have been closing or converting away from acute care in recent years.

Care Advantage CEO Tim Hanold previously told HHCN that finding employees is an issue across all roles.

“Access to health care professionals at all levels can be challenging,” Hanold said. “Matching supply and demand is a more complex equation in rural settings due to limited financial resources, geographic spread, low population density and potentially more complex patient needs.”

For more than 30 years, Care Advantage has provided home-based care services to clients in Virginia, Maryland, Washington, D.C., and Delaware through over 38 locations.

Future-proofing home care access

To overcome staffing and geographic barriers, providers can forge partnerships with local organizations, including community health programs, faith-based groups and civic leaders to extend their reach and enhance access, Singh said.

“Rural communities frequently encounter health care professional shortages, necessitating tailored recruitment strategies and innovative solutions such as telehealth integration and strategic partnerships with local academic institutions,” Gentiva CEO David Causby told HHCN. “Similarly, rapidly expanding metropolitan areas present unique recruitment demands. We remain committed to adapting our recruitment strategies to address the specific needs of each market.”

Workforce development programs will be critical in addressing staffing shortages, Singh said. Efforts such as training, loan forgiveness and telecommuting options can ensure a sustainable supply of clinicians.

Health care providers should also focus on consistently and effectively interacting with patients to deliver the right care at the right time for each individual, according to Singh. A standard care plan may not be practical or appropriate for everyone, so it is crucial to shift the mindset to consider the whole person.

Holistic care approaches should focus on social determinants of health such as housing, nutrition and social engagement, Singh said.

A broader approach to health and wellness is also essential. Providers should explore supporting fitness programs to promote healthy living, creating educational opportunities that are approachable and relatable for patients and organizing cultural and social events where various forms of care delivery might be appropriate. Initiatives such as establishing a diabetes awareness program or a community fitness challenge should also be considered as a way to serve patients both individually and as a community, Singh said.

“Demographics are consistently evolving, and providers need to understand the cultural sensitivities, dietary habits and religious norms of a diverse patient population,” Singh said. “It is critical for clinicians to be willing to learn about different cultures and their specific needs to provide better care. Delivering holistic, individualized care that respects cultural differences is vital for offering high-quality services to a changing demographic.”

Value-based care models that reward quality and outcomes can support shifts toward whole-person care, Singh said. He expects these reimbursement structures to continue to gain traction in the future.

Providers are also turning to advocacy work to improve the status quo in rural places.

“Policy advocacy will also play a key role, with organizations pushing for funding to sustain rural hospitals and expand telehealth reimbursement, ensuring long-term viability of care systems,” Singh explained. “These trends suggest a future where rural senior care is more integrated and responsive, though challenges like resource disparities may persist.”

Technology influences home care delivery

The rural senior care industry is poised for significant transformation over the next 10 years, driven by demographic shifts and technological advancements, according to Singh. Advanced remote patient monitoring will evolve to include sophisticated tools that provide comprehensive health insights, enabling proactive interventions that reduce the need for hospitalizations.

“Gentiva is advancing our strategy on this front with our Illumia Health line of business,” Singh explained. “Digital health expansion, particularly telehealth, will continue to grow, improving access to specialists and care coordination, supported by anticipated improvements in rural broadband access.”

The complexities of providing health care in rural areas highlight the need for robust connected care solutions, Jim Conti, vice president of sales and marketing at Vantiva, told HHCN.

“These solutions bridge the gap between patients and health care providers, tackling the challenges of geographical barriers, limited resources and delayed care delivery,” Conti said. “By implementing technology-driven approaches, connected care solutions ensure that patients in remote areas receive timely, efficient and personalized health care.”

Paris-based Vantiva has been a global provider of connectivity technologies for more than 130 years. Today, teh company continues to redefine connectivity with industry-leading broadband, video and smart systems for its global customers.

For patients, connected care solutions make technology accessible, even to those who are less tech-savvy. Platforms like Vantiva’s HomeSight use televisions to facilitate interaction between patients and health care providers, ensuring ease of use.

For providers, connected care solutions reduce travel costs and delays, improving operational efficiency and enhancing patient outcomes. These platforms enable remote monitoring and automated tasks, allowing providers to focus on patients with urgent needs.

Most virtual care solutions do require Internet connectivity, which can be provided via a wired network connection or a cellular network connection. The cellular network can serve as a backup to the wired network, providing additional resilience in rural locations, Conti said.

SIngh further explained that health care providers need to consider how technology can best serve their organizations and their patients.

“Telehealth and remote patient monitoring significantly improve access to health care – the most important thing we can do for seniors,” Singh said. “These technologies allow for the collection of real-time clinical data, providing a comprehensive view of a patient’s health compared to episodic, in-person visits. This enables providers to address patient condition changes more quickly, facilitating early detection and timely interventions, ultimately reducing emergency department (ED) visits and hospitalizations.”

Singh explained that remote options can also enhance patients’ quality of life. Seniors no longer spend half or a full day traveling to appointments, allowing them to address their health care concerns more promptly. As a result, they can maintain better health and greater independence.

The cost-effectiveness of telehealth is another benefit for health care providers, patients and the community. By leveraging telehealth options, transportation costs can be reduced along with physician copays, time spent away from home and the likelihood of hospitalization or ED visits.

“Providers need to acknowledge that technologies such as remote patient monitoring and telemedicine are not only viable but necessary for the future,” he said. “It is important to modernize thinking by incorporating innovations like smart home integration and artificial intelligence, recognizing that these evolving tools can enhance care delivery. These resources are now available to support better patient care, and embracing them is essential.”