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The “oldest old,” age 85 and older, constitute one of the fastest growing segments of the U.S. population. Yet, surprisingly little is known about the characteristics of U.S. counties with the highest percentage of the oldest old, nearly all of which are rural. We used qualitative analysis of key informant interviews ( n = 50) with county commissioners and other county-level representatives from rural counties with the highest prevalence of the oldest old, targeting the 54 rural counties with ≥5% of the population age 85+. We found that the rural counties with the highest proportion of residents age 85+ face unique challenges to supporting successful aging among the oldest old, including resource constraints, limited services, isolated locations, and widespread service areas. Still, interviewees identified particular reasons why the oldest old remain in their counties, with many highlighting positive aspects of rural environments and community.

Objectives. The goal of this study was to measure unionization in the direct care workforce and the relationship between unionization and earnings, looking closely at differences across race/ethnicity and gender. Methods. Using data from the Current Population Survey from 2010 to 2020, we first used logit analyses to predict the probability of unionization among direct care workers across race/ethnicity and gender. We then measured the relationship between unionization and weekly earnings. Results. We found that male (12%) and Black (14%) direct care workers were most likely to be unionized, followed by Hispanic and other direct care workers of color. Unionized direct care workers earn wages that are about 7.8% higher than nonunionized workers, but unionized workers of color earn lower rewards for unionization compared with White direct care workers. Conclusions. Unions are a mechanism for improving job quality in direct care work, and protecting workers’ rights to unionize and participate in collective bargaining equitably may be a way to stabilize and grow the direct care workforce. (Am J Public Health. 2022;112(11):1676–1684. https://doi.org/10.2105/AJPH.2022.307022 )