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Rural Health Information Hub

Family Caregiver Models for Rural Healthy Aging

In the U.S., 63 million adults provide ongoing care to adults or children with a medical condition or disability. Among older adults experiencing a chronic illness or disability, family members serve as the primary source of caregiving services. Caregivers dedicate significant time, energy, and financial resources to caring for their loved one. While rewarding, caregiving can be extremely difficult, taking a toll on the caregiver's health and well-being, leading to social isolation and loneliness. In rural areas, caregivers are usually unpaid and often have no access to paid support. Caregivers who support older adults in rural areas may live far away, requiring long travel for visits. This distance adds significant time and stress to their caregiving responsibilities.

Other factors that can create challenges for caregivers of older adults living in rural communities include geographic isolation, longer travel distances to healthcare and social services, lower median income and increased financial hardship compared to urban areas, and greater demand for long-term care among rural populations. For example, shortages in the rural healthcare and respite care workforce place strain on caregivers, increasing the financial burden of caregiving across rural states. Generally, caregivers of those living in rural communities find it difficult to get affordable services — such as home health and meal services — for the person they are caring for. In addition, rural caregivers generally have lower access to caregiver support services, such as respite care, support groups, home health agencies, and caregiver training education, and are less likely to use these services, despite facing higher caregiver burdens.

There are evidence-based and promising program models to support family caregivers of older adults in rural areas. Of note, caregivers' needs are complex — some may benefit from multiple program models.

Caregiver Support and Navigation Programs

Caregiver support and navigation programs help family caregivers access resources, education, and respite services tailored to their needs. These programs often include personalized assessments to identify specific challenges and match caregivers with appropriate supports. By reducing stress and improving access to services, they help caregivers maintain their own well-being while continuing to provide care.

Examples of Caregiver Support and Navigation Programs

  • The Montana Lifespan Respite Program provides affordable, flexible respite services for caregivers of individuals with special needs across all ages. Using a self-directed voucher system, caregivers in rural communities in Montana can hire trusted providers while accessing a statewide registry and training resources through the Aging and Disability Resource Center. By building coalitions, expanding outreach, and distributing more than 1,200 vouchers, the program broadened access to respite care.
  • Project CARE (Caregiver Alternatives to Running on Empty) in North Carolina supports caregivers of people with Alzheimer's disease or related dementias by offering care consultation, dementia-specific and caregiver education, funds for self-directed respite care, and referrals or connections to community-based services and resources via Area Agencies on Aging.
  • The Family Caregiver Support Program in Washington state provides assistance to unpaid caregivers of adults by connecting them with local resources and services. Support includes caregiver support groups, counseling, training on specific caregiving topics, supplies and equipment, respite services, and consultation on caregiving challenges. This statewide program serves all counties in Washington, including rural areas. It uses a screening and assessment tool to identify services tailored to each caregiver's needs.
  • Caregiver Tech Solutions is part of the Exhale Family Caregiver Initiative and focuses on providing technology-enabled respite for family caregivers who are living in any of three rural New York State counties. CTS uses digital tools and personalized coaching to help caregivers schedule and take short breaks at home, reducing stress and improving well-being. This approach is designed to overcome barriers to in-person respite in rural areas and has shown promising results in increasing respite frequency and lowering caregiver burden.

Caregiver Peer Support

Caregiver peer support has been shown to help alleviate stress and feelings of social isolation and loneliness. While in-person support groups may require travel for caregivers living in rural areas, some meet in online chats or via telephone call, which may be an alternative for some caregivers.

Examples of Caregiver Peer Support Programs

  • Resources for Enhancing Alzheimer's Caregiver Health (REACH VA) has been shown to improve caregivers' burden, depression, and caregiving frustration. This program offers veterans' caregivers one-on-one and group coaching to help practice stress and mood management techniques. It pairs veterans' caregivers with certified support coaches. Telephone support groups for caregivers focus on teaching problem-solving, stress management and positive thinking. In addition, REACH VA offers education on a care recipient's condition (for example, dementia, spinal cord injuries, multiple sclerosis, post-traumatic stress disorder).
  • Villages, as defined by the Village Movement California, are community-based groups that bring together older adults and their caregivers — such as spouses, family members, and friends — to foster connection and provide practical support. These networks help reduce isolation and offer access to essential programs and services, including brief respite care, grocery delivery and errands, transportation assistance, friendly phone calls, referrals to local resources, and caregiver support groups. Within the Village model, caregiver support groups play a vital role in building trust and strengthening community relationships. These groups provide a safe space for caregivers to share experiences, exchange advice, and access emotional support. For guidance on starting a caregiver support group within a Village, refer to the Caregivers' Support Group Toolkit. This resource offers practical steps for setting up a group, developing agendas, and facilitating meetings effectively.

Caregiver Education Models

Several programs offer caregivers in-depth education on health conditions impacting the person they care for along with training in self-care strategies. These programs aim to reduce caregiver stress, improve coping skills, and enhance confidence in the caregiving role.

Examples of Caregiver Education Programs

  • The Savvy Caregiver Program in Minnesota is a nationally-recognized evidence-based family caregiver training program for those caring for friends or family members with dementia. It integrates principles from gerontology, nursing, family systems, and occupational therapy and includes strategies to enhance caregivers' self-care practices. The Savvy Caregiver Program has been shown to decrease family caregiver distress, burden, and depression, while increasing caregiver confidence. This program is available in multiple languages.
  • Powerful Tools for Caregivers is a six-week class widely used in rural communities that teaches self-care and coping strategies through certified facilitators. This evidence-based class is implemented through Iowa State University Extension and Outreach. Among rural caregivers, this program has been shown to enhance self-care and positive coping strategies. Classes are available in multiple languages.
  • Skills2Care® is a home-based program led by occupational therapists to help caregivers manage dementia-related challenges and maintain their own health and well-being. Skills2Care has been shown to slow decline in daily functioning among people with dementia and reduce behaviors that lead to nursing home placement.
  • Eldercare Coach from AgeWell Middle Tennessee provides educational materials on caregiving topics, support services, and community resources; a tool to help caregivers understand their loved ones' needs and find the most appropriate care options; and a personalized phone consultation with an expert Eldercare Coach.
  • Resources for Enhancing Alzheimer's Caregiver Health (REACH VA) pairs caregivers with a trained and certified coach to provide education and support for caregivers on dementia, spinal cord injuries, multiple sclerosis, and post-traumatic stress disorder.

Clinical and Integrated Care Models Developed or Implemented by the U.S. Department of Veterans Affairs

Veterans and military personnel may have complex clinical and mental health needs related to their service. Recent estimates show there are over 14 million military/veteran adult caregivers in the U.S., most of whom care for adults over the age of 60. The U.S. Department of Veterans Affairs offers multiple evidence-based programs that include caregivers in care teams. These programs typically provide education on medical conditions and caregiver self-care and may offer services like travel benefits or telephone consultations that make it easier to reach caregivers in rural areas. Some have eligibility criteria, require insurance coverage, or involve out-of-pocket costs.

Examples of Clinical and Integrated Care Programs

  • Program of Comprehensive Assistance for Family Caregivers (PCAFC), offered by the U.S. Department of Veterans Affairs, provides family caregivers of veterans with a monthly stipend, access to health insurance, mental health counseling, travel benefits when traveling with a veteran to medical appointments, and at least 30 days of respite care. Both the caregiver and the veteran must apply and meet eligibility requirements.
  • Partners in Dementia Care (PDC) is a telephone-based care coordination program developed by the VA in collaboration with the Alzheimer's Association to support veterans with dementia and their family caregivers. Through this program, Dementia Care Coordinators and Care Consultants provide comprehensive assistance, including assessments, treatment planning, ongoing monitoring, and resource navigation. The telephone format makes PDC especially valuable for families in rural areas and for those facing transportation challenges. Research shows that PDC reduces hospital admissions, addresses nonmedical needs, and helps alleviate caregiver burden.
  • Peaceful Mind is an evidence-based cognitive behavioral therapy (CBT) program for anxiety in older adults with dementia or cognitive impairment. It simplifies CBT skills and involves family members and paid caregivers as coaches to reinforce learning. The U.S. Department of Veterans Affairs provides a manual to help healthcare providers deliver CBT regardless of specialized training in dementia or anxiety. The program is designed to be flexible, which makes it a well-suited option for people living in rural or hard-to-reach areas where mental health specialists may not be available. By involving family members or caregivers and using simple, easy-to-follow steps, Peaceful Mind helps veterans get the care they need without having to travel long distances.

Implementation Considerations

Partnerships are often essential for implementing family caregiver support programs. Collaborating with local Area Agencies on Aging, Cooperative Extension offices, universities, community organizations, businesses, libraries, or hospitals and health systems can strengthen recruitment, staffing, and training efforts. These partnerships help ensure rural family caregiver programs are practical and sustainable.

In addition to building strong partnerships, programs must also consider how they will be financed. Funding caregiver support programs in rural areas can be challenging because healthcare payment mechanisms may not cover caregiver interventions. Some funding streams have restrictions or limited resources. States may pursue grants through agencies like the Administration for Community Living under the Alzheimer's Disease Program Initiative, the National Institute on Aging, or private foundations and institutes. The U.S. Department of Veterans Affairs also provides benefits for qualifying caregivers of veterans. In addition to grants, programs may explore tax credits, respite vouchers, and Medicaid waiver programs to offset caregiver costs.

Even with funding in place, staffing challenges remain a significant barrier in rural areas. Workforce shortages in respite and home healthcare are common in rural areas. Training paraprofessionals or volunteer caregiver coaches can help fill gaps and expand service capacity in rural areas.

Beyond workforce issues, programs should focus on how they engage caregivers effectively. Engaging caregivers thoughtfully is important, especially since many unpaid caregivers do not see themselves as a "caregiver." Therefore, education on caregiving and thoughtful language that appeals to community members is important. Recruiting community champions to be vocal advocates of family caregiver programs can help spread information via word of mouth and put a familiar face to the program in rural areas. Unique and recognizable program branding, which may involve collaborating with a trusted institution or organization, can also facilitate program outreach.

Building on engagement strategies, programs should also incorporate safeguards. It is essential to obtain informed consent from caregivers — and, when appropriate, care recipients — before participation, ensuring both parties understand the benefits and risks, particularly when sensitive health information is shared or collaboration with healthcare teams is involved. Incorporating caregiver screening into routine primary care visits and leveraging telehealth can further strengthen integrated care programs, especially in rural settings.

Effective engagement also depends on tailoring outreach and resources to meet caregivers' needs. Providing materials in multiple languages and formats can support caregivers. Beyond language access, programs should consider tailoring programs for Native American communities and immigrant caregivers to ensure relevance and trust. Offering in-home, virtual, or hybrid services helps reach caregivers who cannot travel easily, though virtual participation requires digital literacy and broadband access. Programs may need to provide technology support or offer telephone-based options for those more comfortable with that format. For intensive programs, in-home support may be ideal. Individual and group peer support options may meet the needs of different family caregivers.

Technology access is another critical consideration, especially for virtual or hybrid program delivery. Programs should also address technology barriers in rural areas, such as limited broadband access and digital literacy. Offering technology support, loaner devices, or low-bandwidth options like telephone-based participation can help caregivers engage successfully.

Finally, programs should plan for evaluation and sustainability from the outset to ensure long-term impact. For more guidance, see Module 5: Evaluation Considerations for Rural Healthy Aging Programs and Module 6: Funding and Sustainability of Rural Healthy Aging Programs.

Resources to Learn More

Best Programs for Caregiving
Website
Provides a free online directory of proven support programs for family and friend caregivers of individuals living with dementia.
Organization(s): Benjamin Rose Institute on Aging and Family Caregiver Alliance

Caregivers Communications and Marketing Toolkit
Website
Provides customizable tools to help states, local agencies, and nonprofits reach family caregivers with services.
Organization(s): National Academy for State Health Policy

Caregiving and Direct Care Workforce
Website
Provides information on programs, strategies, policies, and research and training centers to support formal and informal caregivers.
Organization(s): Administration for Community Living

National Family Caregiver Support Program
Website
Shares information on the National Family Caregiver Support Program, which provides grants to states and territories to fund various supports that help family and informal caregivers care for older adults in their homes for as long as possible.
Organization(s): Administration for Community Living

National Rural Age-Friendly Initiative Programs: Supporting Family Caregiving & Home-Based Primary Care
Website
Shares resources for rural communities and their providers including resources for family caregivers on caregiving programs, toolkits, reports, and resources,
Organization(s): National Rural Health Association and The John A. Hartford Foundation

Resources for Caregiving in Rural Communities
Document
Summarizes research on resources used to support caregivers in rural communities, drawing on journal articles, government and organizational websites, and interviews with 41 subject-matter experts.
Author(s): Lahr, M. & Henning-Smith, C.
Organization(s): University of Minnesota Rural Health Research Center
Date: 8/2018

State Strategies to Support Working Caregivers
Document
Draws on data from Caregiving in the US and AARP's LTSS Scorecard to illustrate how states are supporting working caregivers through public policy, including through public-private partnerships with employers.
Organization(s): National Academy for State Health Policy
Date: 10/18/2025

Strengthening Family Caregiving Programs and Policies through Collaboration: Lessons from Six States
Document
This brief highlights the innovative cross-sector work of six states (Alabama, Idaho, Iowa, New Hampshire, South Carolina, and Virginia) and describes the elements needed for foundational state program changes to support family caregivers.
Organizations(s): The John A. Hartford Foundation, the Milbank Memorial Fund, the May & Stanley Smith Charitable Trust, the Gordon and Betty Moore Foundation, Center for Health Care Strategies
Date: 09/2020