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Using a Real-Time Locating System to Measure Walking Activity Associated with Wandering Behaviors Among Institutionalized Older Adults

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Defining Veteran Rurality: An Analysis of the U.S. Veterans Health Administration Rural-Urban Taxonomy.

Diana J Govier^1,2,3,4, Travis I Lovejoy^1,2,3,4, Sarah S Ono^1,2,4

¹Veterans Rural Health Resource Center-Portland, VHA Office of Rural Health, Portland, Oregon, USA.

The Journal of Rural Health : Official Journal of the American Rural Health Association and the National Rural Health Care Association

|July 10, 2026

Summary

The Veterans Health Administration's (VHA) rural designations better identify veterans facing geographic barriers to care compared to another taxonomy. This evaluation used drive times and VHA's rural-urban classification system.

Keywords:

access to care drive time rural–urban commuting areas veteran veterans health administration

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Area of Science:

Health Services Research
Rural Health Access
Veterans Affairs Healthcare

Background:

Veterans Health Administration (VHA) uses rurality to improve healthcare access.
VHA's rural-urban taxonomy guides these efforts but requires evaluation against new access standards.

Purpose of the Study:

To compare VHA's rural-urban taxonomy with University of Washington's "Categorization B" taxonomy.
To assess how both taxonomies classify veterans as rural.
To compare drive times to VHA care based on these rural-urban designations.

Main Methods:

Utilized Rural Urban Commuting Area (RUCA) codes for VHA enrollees in Fiscal Year 2023.
Assigned rural-urban designations using VHA and Categorization B taxonomies.
Calculated enrollee percentages and drive times (>30 min primary care, >60 min secondary/tertiary care) to VHA facilities.

Main Results:

81.0% of enrollees received similar rural-urban designations between VHA and Categorization B taxonomies.
VHA's rural designations captured more veterans with drive times meeting MISSION Act eligibility standards compared to Categorization B.
Significant differences emerged due to RUCA 2.0, classified differently by VHA (rural) and Categorization B (urban).

Conclusions:

VHA's rural and highly rural designations are more effective in identifying veterans with potential geographic barriers to care.
Refining rural-urban taxonomies may require integrating additional data for other VHA access priorities, like temporal access.