Location and Characteristics of Nursing Homes in the Rural and Urban U.S.

Research center:
Lead researcher:
Contact:
Project funded:
September 2020
Anticipated completion date:
August 2021

A previous analysis using data from 2001 found that the supply of nursing home beds per 1,000 elderly population older than the age of 65 is higher, on average, in rural areas than in urban areas. However, the availability of post-acute and long-term care services in rural areas has changed substantially since 2001 for two reasons. First, recent analysis found that a higher proportion of nursing homes in the rural areas have closed compared with urban areas between 2008 and 2018. Second, many rural residents rely on rural hospitals with swing beds for their short-term post-acute care services but the closure of many hospitals in rural areas may potentially leave residents with few to no options for post-acute care.

In addition, despite recent efforts to promote home- and community-based services instead of institutional care, residents living in rural areas have limited access to alternatives to nursing home care, such as assisted living facilities and adult day care centers. As a result, nursing homes remain an important part of delivering post-acute and long-term care services in rural areas. Yet, there isn't a good understanding of the availability of nursing homes in rural areas.

The Center hypothesizes that the supply of nursing home beds per 1,000 elderly population older than the age of 65 has declined substantially in rural areas compared with urban areas. In addition, the Center hypothesizes that a higher proportion of counties in the rural areas have no nursing homes or hospitals with swing beds compared with urban areas.

Project goals: In this project, the Center documents nursing home availability at the county level and identifies counties with no nursing homes. It evaluates the supply of nursing home beds per 1,000 elderly population older than the age of 65. In addition, the Center identifies county-level nursing home availability for counties with and without hospitals with swing beds. Finally, the Center examines the resident and nursing home characteristics in rural and urban areas, including occupancy levels and payer mix using descriptive and multivariate framework.