Challenges in Home Healthcare in Rural Areas
Joan Grant Keltner, PhD, RN
Home health care nursing faces many challenges in rural areas, including a rise in older populations who require complex care, with inadequate general and specialized healthcare providers, long travel distances to appointments, and social determinants of health that impact the availability and acceptability of home healthcare interventions. Not only has there been an increase in our older population (i.e., increased from 7.4 million to 9.7 million in rural areas), there are fewer individuals working in these areas, creating a significantly higher demand for individuals who provide care for both younger and older individuals. While home healthcareproviders have grown in some areas of the U.S., other areas have seen a significant decline. These rural areas also are more likely to have fewer healthcare facilities because of closures and insufficient healthcare providers (Farrigan et al., 2024; Urgent Supply, 2025).
Rural areas also have a greater prevalence of chronic illnesses and lower health literacy rates, limited resources, and technological barriers. In comparing urban and rural populations, those in rural areas had lower usage and quality of home health care services, including both physical therapy and rehabilitation. They also experienced a greater prevalence of emergency department visits and hospitalizations (Quigley et al., 2022).
Despite these barriers, home health nurses can explore innovative solutions in providing important services to the rural community. These include:
developing partnerships with local organizations such as community health programs, faith-based groups, and civic leaders to mobilize policy changes and offer innovative programs and services for health insurance, financial support; health literacy, and transportation);
- developing programs that offer financial incentives, loan forgiveness, and professional development for health providers who work in rural areas;
- training residents in basic health care practices through rural newsletters/newspapers, churches, community meetings, and networks;
- providing training and education for health providers regarding how to implement these innovative care solutions successfully into home healthcare services;
- improving health literacy through education and outreach campaigns;
- using telehealth platforms to assess chronic illnesses, provide education and support, and deliver services and care;
- utilizing mobile health clinics to deliver healthcare services, offering diagnostic tools, delivering screenings and preventive care, and providing specialized treatment for chronic illnesses (Javed, 2025);
- offering community health worker programs that provide information, education, support, and care coordination services to patients receiving home health services (Urgent Supply, 2025); and
- mentoring new health providers in understanding the critical role of societal and cultural dynamics for rural individuals to accept appropriate care and treatment (Nursing Education Staff, 2024).
References
Farrigan, T., Genetin, B., Sanders, A., Pender, J., Thomas, K. L., Winkler, R., Cromartie, J. (2024). Rural America at a glance (Report No. EIB-282). U.S. Department of Agriculture, Economic Research Service. https://doi.org/10.32747/2024.8722498.ers
Javed, A. (2025). Bridging the health care gap in rural populations: Challenges, innovations, and solutions. The American Journal of Medicine, 138(5), 761 – 762. https://doi.org/10.1016/j.amjmed.2025.01.008
Nursing Education Staff (2024, January 18). Nurse insights: What are the challenges of rural nursing? https://nursingeducation.org/insights/rural-nursing/
Quigley, D. D., Chastain, A. M., Kang, J. A., Bronstein, D., Dick, A. W., Stone, P. W., & Shang, J. (2022). Systematic review of rural and urban differences in care provided by home health agencies in the United States. Journal of the American Medical Directors Association, 23(10), 1653.e1-1653.e13. https://doi.org/10.1016/j.jamda.2022.08.011
Urgent Supply. (2025, June 6). Challenges and innovations in home health services for rural communities in the United States. https://www.urgent.supply/resources-7/Challenges-and-Innovations-in-Home-Health-Services-for-Rural-Communities-in-the-United-States
