Nursing Homes in Rural America: A Chartbook


Nursing homes are an important part of delivering post-acute and long-term care services in rural areas but the closure of nursing homes and hospitals with swing beds in recent decades has substantially changed the availability of these services. In this chartbook, we document nursing home availability at the county level and identify counties without nursing homes. We also evaluate the supply of nursing home beds per 1,000 population aged 65 and older. In addition, we identify county-level nursing home availability for counties with and without hospitals with swing beds. Finally, we describe the resident and nursing home characteristics including occupancy levels, payer mix, demographics, and health care needs. We summarize data for the noncore, micropolitan, and metropolitan counties.

Our findings suggest that a lower proportion of noncore counties have nursing home post-acute care and long-term care services. Even the inclusion of hospitals with swing beds does not eliminate the differences in access to post-acute care and long-term care services between noncore counties and metro/micropolitan counties. Many noncore counties have a higher number of nursing home beds per 1,000 population aged 65 and older, particularly in the Midwest. However, differences in the beds per 1,000 population aged 65 and older between noncore counties and metropolitan counties vary by states/regions. Residents of nursing homes in noncore counties are less likely to have functional limitations but are more likely to have behavioral/mental health needs.

RUPRI Center for Rural Health Policy Analysis
Hari Sharma, Lili Xu, Fred Ullrich, Clint MacKinney, Keith Mueller