Urban Versus Rural Differences in Services Requested, Received, and Interest Expressed Among Informal Caregivers of Older U.S. Veterans.

PURPOSE: Increasing population longevity has led to greater demand for home and community-based services (HCBS) to assist older adults as an alternative to institutional care. Despite the recognized benefits of HCBS, there are significant differences in their availability and utilization between rural and urban communities. This study aimed to (1) compare rural and urban caregivers of older veterans in terms of searching for and receiving services and (2) examine differences in expressed interest in various service types. METHODS: Five hundred and eleven older veterans' caregivers completed an online survey on various HCBS. Rural-Urban Commuting Area codes (RUCA) were utilized to determine rurality, and data were analyzed using chi-squares, t-tests, and logistic regressions. FINDINGS: There were no differences in service interest between urban and rural caregivers. However, there were differences between the services searched for and those received. Urban caregivers were less likely than rural caregivers to seek respite. Urban caregivers also reported receiving more services than rural caregivers. CONCLUSION: This study indicates that rural and urban caregivers' interest in services is similar; however, rural veterans receive fewer HCBS than their urban counterparts. This study highlights potential gaps in the service pathway for rural caregivers. It provides insights into which specific services might benefit from targeted interventions to improve access and utilization for veterans in rural areas. The findings directly inform evidence-based resource allocation, targeted program development, and policy interventions designed to mitigate rural-urban disparities in caregiver support.