More than 20 percent of older adults in the United States live in rural areas, and in some states, that number exceeds 50 percent. Rural communities face challenges to accessing health care, including transportation, care facility closures, and workforce shortages. Most older adults prefer to age in place, valuing their independence and community connections. Achieving this goal requires targeted strategies that build on the strengths of rural areas to support aging at home.
This Evidence-to-Action Collection features three proven care models that can be adapted to the strengths and culture of rural communities. By leveraging local infrastructure and trusted relationships, these models support personalized, community-based care that coordinates care to help older adults navigate health care services and stay healthy and independent at home.
- Program of All‑Inclusive Care for the Elderly (PACE) delivers integrated care to adults aged 55+ who need nursing home-level support. PACE is centered around a community-based PACE center where services are coordinated and financed through a capitated payment system. The PACE model enables participants to live safely in the community and has proven results in reducing institutionalization, hospitalizations, and emergency department use, even among older adults with significant cognitive and functional impairments.
- Community‑based palliative care brings comfort-focused symptom management into homes, outpatient clinics, long-term care facilities, and hospice settings. Designed for individuals with advanced chronic illness or life-limiting conditions, it supports informed decision-making and helps people remain at home while managing symptoms. Evidence from multiple studies — including some focused on rural populations — shows that these models can significantly reduce emergency department visits, hospitalizations, and intensive care unit admissions.
- Community paramedicine, or mobile integrated health, provides scheduled, non-emergency care in the home. These programs combine integrated emergency medical services with traditional care providers to help older adults manage chronic conditions, medications, and care transitions. They improve access to care, reduce emergency department visits, hospitalizations and inpatient days among medically complex patients in rural areas, and support aging safely at home.
Together, these models create a continuum for older adults: PACE ensures access to long‑term services and supports; community-based palliative care addresses the needs of those with serious illness or advanced chronic conditions; and community paramedicine fills day‑to‑day care gaps for individuals at home. All three rely on interdisciplinary teams, flexible funding, and in‑home delivery — critical components for reaching individuals in areas where hospitals and specialists are distant or inaccessible.
State policymakers, plans, providers, and community organizations can use this Evidence-to-Action Collection to review emerging evidence, case examples, practical tools, and policy considerations to implement these models in rural settings.
Explore the Collection to learn about:
Evidence
Case Examples
Implementation Tools
Policy Considerations
CHCS acknowledges the valuable contributions of Celia Huang, graduate intern, and Nancy Wexler, program officer of The John A. Hartford Foundation, who supported the research and development of this Collection.
