Rural vs. Urban Aging

Hey everyone,

Where someone lives can dramatically shape their access to care and support in life’s final chapter. In my work here at Moonset Health, I've had the privilege of working with both rural and urban hospices, and wanted to share my learnings about the real-world differences between rural and urban aging. I also share some practical wisdom I've learned from our hospice customers about how to handle these differences. 

1. Rural visits can be logistically difficult

Nearly 1 in 5 rural seniors live alone (source: Rural Health Info Hub). For rural seniors, a single home visit can demand hours of travel planning for both families and staff. To reduce travel burdens, cluster rural visits geographically and schedule them on the same day each week so families can plan in advance. You can consider partnering with local home‑health agencies for shared staffing resources, and engage volunteer driver programs (such as Retired Seniors Volunteer Program) to ensure reliable transportation. Additionally, have families use remote monitoring devices to catch issues between visits that they can report out to you directly.

2. Urban seniors often come from different cultural backgrounds
City seniors benefit from many options for nearby medical care, but tend to be much more diverse. By 2030, metro areas will see more than 70% of the growth in the 65+ demographic (source: Urban Institute Report). Those additional numbers won’t all look the same: we’ll serve retirees from across the globe, each with unique health beliefs, dietary needs, and family structures. For example, a Vietnamese patient may expect traditional herbal remedies alongside Western medicine, and a Somali grandmother might rely on large extended‑family support for daily care. Hospices that embed bilingual coordinators in local faith centers and partner with neighborhood associations can offer care plans that respect these diverse traditions.

3. Rural/urban caregivers have different concerns and constraints
Caregivers in rural areas often juggle unpredictable farm seasons or multiple part‑time roles, while their urban counterparts navigate long commutes and costly childcare. These pressures can lead to skipped visits and unmet needs. Consider offering micro‑visits (brief check‑ins aligned with caregivers’ work breaks) and flexible scheduling tools so families can swap or adjust appointments easily. We've also heard from a few hospices that partner with local employers and community groups to create respite‑care vouchers or “care credits” that caregivers can use for short‑term relief.

4. Strategies to boost revenue for rural and urban hospices

Hospices can tap a widening array of nontraditional funding streams beyond standard Medicare rates. Rural providers may bill as a Rural Health Clinic (RHC) to qualify for cost‑based reimbursement on certain services and supplies, while both rural and urban programs can leverage telehealth waivers under Section 1135 or the CARES Act to bill for virtual visits at parity with in‑person care. Consider applying for Health Center Controlled Network grants (Section 330e) to support telehospice infrastructure and QAPI awards to underwrite staff training in revenue‑cycle optimization.

Conclusion

Whether they live miles apart or just a subway ride away, rural and urban seniors share the same fundamental need: compassionate, personalized care at the end of life. By understanding the distinct challenges, we can design hospice services that truly fit the communities we serve!

I'm always happy to share more learnings from my on-the-ground ridealongs. Reach out to me to learn more: sherril@moonsethealth.com