Document Type

Article

Publication Date

7-2026

Publication Title

Maine Rural Health Research Center Research & Policy Brief

Abstract

By 2040 the adult population age 65 and older is projected to grow from 48 million in 2014 to over 83 million people.1 This is due to aging Baby Boomers, as well as increased longevity associated with favorable shifts in health behaviors such as an overall decline in smoking and alcohol consumption.2 Yet, physical inactivity and substance use are contributing to higher incidences of obesity and chronic health conditions. The combination of aging populations with chronic conditions is expected to increase the demand for long term services and supports (LTSS). These services include home and community-based services (HCBS) and services provided within long term care (LTC) facilities such as nursing homes (NHs) and other residential care settings such as assisted living or supported housing, referred to in this paper as community-plus (CP) facilities. Since at least 2010, federal and state policy has worked to shift care from NHs to community or CP settings to align with consumer preferences and to address rising LTSS costs.3,4 The integration of HCBS and other LTSS has been shown to delay nursing home (NH) admissions,5 however rural beneficiaries have historically experienced lower access to HCBS.6,7 Recent research suggests that efforts to reduce NH admissions have not been met by sufficient increases in community based services to ensure adequate service levels for all who need LTSS, particularly in rural areas.4 Given this, it is critical to understand how policy may be shaping access to LTSS. However, ruralurban trends in the percentage of beneficiaries living in the community, in NHs, or in CP unknown. This study addresses this knowledge gap by examining the living circumstances of rural and urban Medicare beneficiaries age 65 and older between 2015 and 2021.

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