Rural–Urban Disparities in In-Home Care Journeys in Sparsely Populated Areas: A Case From Northern Sweden

Abstract

This paper investigates rural–urban disparities in the experiences of in-home care services for older adults in a sparsely populated municipality (Storuman) in Northern Sweden. Such municipalities are characterised by long-term population loss and ageing, an increasing concentration of residents and services in municipal centres and resultant rural ‘resource deserts’. Disparities are measured through four ‘endpoint’ measures—exits to residential care, resource use, longevity and survival in the in-home care system. Data were drawn from the municipality’s care service contract database (2014–2020). Users living in the municipal centre had lower resource use and used direct care less frequently than those in smaller and more distant settlements. Those living near a grocery store were more likely than others to survive long term in the in-home care system. The research reveals a potential to reduce exits to residential care, to make more effective use of direct care and shopping services and to limit disruptive transfers of care, particularly between municipal and regional health services. Overall, there was limited evidence of rural–urban disparities in in-home care outcomes, but particular attention should be paid to transactional proximity of different parts of the care system and proactive rather than reactive care planning. The paper contributes to debates about quality measures for in-home care and the impacts of micro-urbanisation on the lives of people living in sparsely populated areas.