Acuity Differences Among Newly Admitted Rural and Urban Nursing Home Residents

Research center:
Lead researcher:
Project funded:
September 2017
Project completed:
November 2020

To promote state compliance with the Americans with Disabilities Act and the Olmstead decision, the federal government and states have employed a wide range of strategies to shift long-term services and supports (LTSS) from a reliance on nursing home care to assisted living and home- and community-based services (HCBS) options that allow elders to age in place in their homes or communities. Although HCBS expenditures have risen from 18% of all Medicaid LTSS spending in 1995 to 55% in federal fiscal year 2015, our recent studies suggest that older rural residents are still more likely than their urban counterparts to use nursing home versus HCBS services. Moreover, in a study using 2000 data, Bolin and colleagues showed significant rural-urban differences in nursing home resident acuity. More recently, we found that rural Medicare beneficiaries in nursing homes have lower impairment in activities of daily living than urban nursing home residents. Understanding more about the health and preferences of rural and urban nursing home residents will inform federal and state policies aimed at ensuring equitable access to the full range of LTSS to meet older and disabled individuals' needs as they age. This study used national, standardized Medicare and non-Medicare nursing home assessment data (MDS 3.0) to examine (1) differences in resident acuity (i.e., health and functional status) and other characteristics of rural and urban nursing home residents upon admission; (2) whether differences persisted among newly admitted Medicare and non-Medicare residents; and (3) whether and how nursing home, local health system and market characteristics (e.g., nursing home bed supply) were associated with differences in resident acuity. Study findings informed federal and state policy strategies to enable rural (and urban) older adults to access LTSS services most appropriate to their social, health, and functional needs.


  • Acuity Differences Among Newly Admitted Older Residents in Rural and Urban Nursing Homes
    Journal Article
    Maine Rural Health Research Center
    Date: 11/2020
    This study found newly admitted residents of rural nursing homes were more likely to have cognitive issues/problem behaviors than those in urban facilities. Yet rural facilities admitted less complex older (age 75+) residents than urban, raising questions about the rural long-term services and supports system and capacity of rural nursing homes.