Your dad lives forty minutes from the nearest specialist, on a road that ices over in winter. He knows every neighbour by name and wouldn't dream of moving. Your aunt lives in a city apartment three blocks from her doctor, a pharmacy and a bus stop, and some weeks she doesn't speak to anyone.
Both want the same things: to stay in their own home, stay independent and stay connected. But the support that helps each of them looks quite different.
This guide covers the strengths and challenges of ageing in rural and urban areas, and practical ways families can help, wherever a parent lives. For the basics of planning ahead, our guide to what ageing in place means and how to prepare is a good starting point.
Ageing in Rural Areas
The strengths
Rural communities often have deep roots. People may have lived in the same place for decades, know their neighbours well and have a strong sense of belonging. Informal support, like a neighbour who checks in or drops off the mail, can be a genuine safety net.
The challenges
The Rural Health Information Hub highlights several challenges for older adults in rural areas:
Transport. Rural communities are heavily car-dependent, with more than 90 percent of trips taken by car, and there are fewer options for people who can't or shouldn't drive.
Distance to care. Rural residents travel further and spend more time reaching health care and other services.
Workforce shortages. There are fewer health professionals and home care workers in many rural areas. RHIhub notes that access to home health agencies drops off in the most remote communities.
Housing. There are fewer housing options, which can make it harder to move somewhere more suitable nearby.
Internet access adds another layer. RHIhub cites a 2024 Federal Communications Commission report estimating that around 28 percent of rural residents lack access to fixed broadband that meets the FCC's minimum speed benchmark. That matters when so much care, from telehealth to online banking, now depends on a good connection.
Ageing in Cities
The strengths
Cities usually offer shorter distances to doctors, hospitals and pharmacies, more transport options and more community programs. There's often a wider choice of services, from home care agencies to adult day programs.
The challenges
Cost. Housing and services often cost more.
Isolation. Being surrounded by people isn't the same as being connected. Neighbours may change often, and family may live far away.
Housing design. Stairs, older apartment buildings and small spaces can make it harder to move around safely.
Navigating busy systems. More services can also mean more complexity: more phone trees, more forms, more places to go.
Loneliness can affect older adults anywhere. Our guide to tackling loneliness in later life has ideas that work in both settings.
How Families Can Help in Rural Areas
Plan for transport early. Before driving becomes unsafe, map out alternatives: family rosters, neighbours, community volunteer drivers, and any transport your parent's health plan covers. If driving is already a concern, our guide on driving and cognitive decline can help with that conversation.
Make the most of telehealth. Where the internet allows, video appointments can save long trips. Set up the device together, do a practice call, and keep instructions written down beside it.
Use local services. The Eldercare Locator connects families with their local Area Agency on Aging, which can point to meals, transport and caregiver support in the area. Meals on Wheels also reaches many rural communities.
Build a local circle. A neighbour, a church friend or the local pharmacist can all be part of the support network. With your parent's agreement, make sure a few trusted people know who to call if they're worried.
Prioritise home safety. When help is further away, preventing falls matters even more. Good lighting, grab bars and clear walkways all help. Our guides to fall prevention tools and bathroom safety have practical checklists.
How Families Can Help in Cities
Make regular contact a routine. A set call time, a weekly visit or a standing coffee with a friend adds structure and connection.
Help them find community programs. Senior centres, libraries, faith communities and classes can all reduce isolation. Offer to go along the first time.
Simplify the admin. Help organise appointments, prescriptions and paperwork so busy systems feel manageable.
Check the home. Apartments can hide risks: poor lighting in shared hallways, heavy doors, stairs without rails. Our guide to making a home safe for ageing in place covers what to look for.
Distance is one of the biggest worries for families, whether it's a long rural drive or a flight to another city. Elli Cares lets family in the care circle set up and manage reminders remotely, see the activity log, and send short video messages in their own voice. Safe Zones can add reassurance for people who still get out and about. It helps families stay informed between visits without calling to check up every day.
Care Programs Worth Asking About
In the US, two Medicare-linked programs are worth knowing about, wherever your parent lives:
PACE (Programs of All-Inclusive Care for the Elderly) provides coordinated medical and social care for people who need a nursing-home level of care but want to live at home. Availability varies by area. A federal advisory committee report on PACE in rural America notes that awareness is low in rural areas and that transportation is a service PACE programs must provide when a participant needs it.
The GUIDE Model supports people living with dementia and their family caregivers through participating programs. Read more on our GUIDE page.
Ask your parent's doctor or local Area Agency on Aging what's available nearby.
Supporting From a Distance
Many families support a parent in one setting while living in another. That's where technology and planning do the heavy lifting: regular video calls, a shared family calendar, and a local contact who can pop in. Our guides to long-distance caregiving and supporting a loved one with dementia from afar go into the detail.
What Everyone Wants
Rural or urban, most older adults want the same things: to stay at home, to feel safe, to keep their relationships and to make their own choices. The job for families is to understand what gets in the way in their parent's particular setting, and fill those gaps one at a time.
Frequently Asked Questions
Is it harder to age in place in a rural area?
It can be. Rural older adults often face longer distances to care, fewer transport options, fewer health workers and patchier internet. Strong community ties can help offset some of these challenges.
What are the challenges of ageing in a city?
Higher costs, isolation, housing that isn't designed for changing mobility, and complex systems to navigate.
How can I help a parent in a rural area get to appointments?
Plan transport early, use telehealth where possible, and contact the local Area Agency on Aging through the Eldercare Locator to find transport services.
What programs help older adults stay at home?
In the US, options include Area Agency on Aging services, Meals on Wheels, PACE where available, and the GUIDE Model for people living with dementia.
Start Where the Gap Is
Pick the one thing that most gets in the way for your parent, whether that's transport, isolation or safety at home, and start there. To see how Elli helps families stay connected across any distance, visit our Seniors and Families page.
