Elders with disabilities overwhelmingly prefer their own home to an institutional site of care. Partially in response to this preference, home and community-based services (HCBS) have expanded to meet the needs of elders with disabilities. However, elders in rural areas continue to use nursing homes at a higher rate than their urban counterparts. Little is known about the various influences on elders who access long-term care services and how the separate effects of need and access influence the use of such services. This study proposes to analyze a sample of admission assessments for two years (July 1999-July 2001) from administrative data based on the Minimum Data Set for Nursing Homes (MDS) and the Minimum Data Set for Home Care (MDS-HC) to assess urban/rural differences in the characteristics of admission cohorts of nursing home residents and HCBS recipients in Michigan. The content and large sample size afforded by these datasets permits cross-comparisons of elders using similar measures across sites of care and ensures sample sizes large enough to test potential interactions in multivariate analyses. Until now, the data necessary to do these analyses have not been available. The proposed study will: (1) describe urban/rural differences in demographic and need characteristics of HCBS users; (2) describe urban/rural differences in demographic and need characteristics of nursing home users; (3) examine differences between HCBS and nursing home users within urban/rural boundaries; and (4) determine how differences in community resources influence access to long-term care services. This study will lay the groundwork for a future study on how access to HCBS influences outcomes of long-term care.
