The effects of on- and off-reservation residence on in-home service use among Great Lakes American Indians.

Community-based, in-home services are a crucial component in the long-term care continuum. Research has shown rural populations to be less likely to use these services. American Indian elders are more likely than their non-American Indian counterparts to reside in non-metropolitan areas, yet little rural research has focused on this subpopulation. The purpose of this article is to explore differences in in-home service use among urban, rural off-reservation, and rural on-reservation older American Indians using data from a statewide needs assessment. The sample includes 206 Great Lakes American Indians aged 55 and older. Predictor variables include the residential classification variable (rural off-reservation, rural on-reservation, and urban) along with sociodemographic, social support, health and functional status, and general knowledge of services. Results of logistic regression analysis indicate that the odds are significantly greater for on-reservation rural American Indian elders use of home services, home health aides, and home visits, than for urban American Indian elders. The off-reservation rural American Indian elder is significantly less likely than the urban American Indian elder to use a home health aid. Health rating, activities of daily living/instrumental activities of daily living (ADL/IADL) impairments, and general knowledge of in-home service availability increase the odds for all groups use of home services and home health aides.