Workers in rural areas who take care of an ailing adult or child have significantly less support at the workplace to buttress the strains of their dual roles than those in urban areas, a new study from the University of Minnesota finds.

Rural caregivers are much less likely to have access to workplace benefits such as telecommuting, employee assistance programs or paid leave, according to the findings, which were published this month in the Journal of Rural Health.

The study raises a flag for policymakers, employers, health care systems and families about the heightened burdens on those outside of urban centers, as rural areas are aging at a faster rate and have higher disability rates than urban areas.

“We suspected [rural working caregivers] may have had fewer supportive services than those in urban areas, but we were surprised by the magnitude and extent of the difference,” said the report’s lead author, Carrie Henning-Smith, an assistant professor at the U’s School of Public Health. “It’s alarming.”

More than 43 million Americans provide help for a family member or friend. The numbers are expected to spike in the next decade as the first wave of the baby boom generation starts to turn 80, an age when health conditions and frailty make them exponentially more likely to need help getting through the day.

Using survey data from AARP and the National Alliance for Caregiving, Henning-Smith and co-author Megan Lahr, a research fellow at U’s Rural Health Research Center, analyzed 635 working caregivers living in rural and urban communities across the country.

They found that 15 percent of rural caregivers worked for a company that offered employee assistance programs or other services that lend resources or emotional support, compared with 26 percent of urban caregivers.

Less than 10 percent of rural caregivers are able to work from home, because they lack access to reliable broadband internet or because their workplace policies don’t allow it. A quarter of urban workers are able to take advantage of that flexibility.

The gap is even wider when it comes to paid leave, according to the research. Just 18 percent of rural caregivers have access to paid time away to care for a sick loved one, compared with 34 percent of urban caregivers.

“I think we have this romantic idea that people will look around for a job that will offer this elusive work-life balance,” Henning-Smith said. “I’m not sure it’s practical for anyone, but it’s a lot less practical for people in rural areas where there are fewer employers in town, and then those employers are under constraints.”

Henning-Smith noted that some of the issues stem from federal policies or basic infrastructure, such as improving reliable internet access.

“It’s easy to villainize the employers and say they don’t care,” she said. “I don’t think that’s the case at all. I think they do care, but I think the employers are also working with slimmer margins and more difficult conditions.”

Caregivers in both urban and rural areas spend an average of 35 hours a week at a paid job, plus 15 or more hours of unpaid, informal work, such as helping a loved one with cooking and chores, driving to doctors’ appointments or managing medications.

Rural workers tend to work in smaller businesses and industries that provide fewer family-friendly policies, the report said, and also tend to earn less than their urban peers.

But Henning-Smith noted that the growing physical and emotional stress on working caregivers isn’t just a rural issue. The majority of workers in urban areas lack access to paid sick time.

“Everyone has a really long ways to go. As a society we rely so heavily on informal, unpaid caregivers,” she said. “The onus should not be entirely on workplace environments and employers. But it’s one starting place, and it’s where people really start to feel squeezed when they’re juggling these multiple responsibilities.”