Purpose: While rates of family caregiving and paid caregiving are increasing, how often they occur together ("shared care") and whether utilization varies geographically are unknown. We examined differences in family and paid caregiving utilization by rurality and region in the US.

Methods: The 2020 Cornell National Social Survey is an annual cross-sectional telephone-based survey of a random sample of 1,000 US adults. Participants were asked if they have been a family caregiver, including if they provided care alongside a paid caregiver. Rural-Urban Commuting Area Codes and Census areas classified rurality and region. The association between residence and the prevalence of caregiving was determined with multivariable Poisson regression.

Findings: Among 857 participants with geographic and caregiving data, 11.8% (n=101) were rural dwellers and 34.2% were family caregivers. Rural residence (vs. urban) was associated with a higher prevalence of family caregiving (PR: 1.59 [1.22, 2.06]), and Western residence (vs. Northeast) was associated with a lower prevalence of family caregiving (PR: 0.63 [0.46, 0.87], p=0.01). Forty percent of family caregivers shared care with a paid caregiver. There was no significant difference in shared care by rural residence in unadjusted (31.8% rural vs. 43.1% urban p=0.22) or adjusted models (PR: 0.85 [0.51, 1.41], p=0.53).

Conclusions: Although family caregiving was more prevalent in rural areas and certain regions, shared care did not differ by rurality or region. Studies are needed to understand why rural residents do more family caregiving without additional support from paid caregivers, and what the implications are for caregivers and care recipients.