Patterns and predictors of noninstitutional health care utilization by older adults in rural and urban America.

Noninstitutional long-term care is not often included in policy studies or recommendations in the United States even though there have been recent efforts to include this type of care in health reform proposals. This study was designed to provide insight into the patterns and predictors of noninstitutional medical, home-, and community-based services utilization by older adults in rural and urban America. The National Long Term Care Survey (NLTCS) was used to explore the relationship between residential setting and subsequent noninstitutional services utilization. Weighted logistic regression procedures for complex survey designs were used to guide the analysis. Living in the Northeast and residence in moderately densely populated areas (towns, small cities, and suburbs) were significant positive predictors of subsequent medical, home-, and community-based services utilization. Because some differentials were found in access to and use of services by regional and geographic setting, policy-makers need to develop alternative strategies to eliminate inequities in the distribution of noninstitutional long-term care services in more remote areas.