Long-term care
Research Products & Journal Articles
Browse the full list of research publications on this topic completed by the Rural Health Research Centers.
Products – Freely accessible products include policy briefs, fact sheets, full reports, chartbooks, and interactive data websites.
Journal Articles – Articles in peer-reviewed journals may require a subscription or affiliation with a subscribing library. For these publications, Gateway lists the article citation, a brief summary, a link to additional information and access to the full-text of the article, if available.
2024
-
Nursing Home Closures and Access to Post-Acute Care and Long-Term Care Services in Rural Areas
Journal Article
RUPRI Center for Rural Health Policy Analysis
Date: 01/2024
Nursing home closures have raised concerns about access to post-acute care (PAC) and long-term care (LTC) services. In this study, researchers estimate the additional distance rural residents had to travel to access PAC and LTC services because of nursing home closures.
2023
-
Multi-Sector Collaboration to Support Rural Aging
Journal Article
University of Minnesota Rural Health Research Center
Date: 08/2023
In this paper, researchers examine the lessons rural areas present for supporting aging, including the role that aging and social services, public health systems, and health care have to play. -
Who Will Care for Rural Older Adults? Measuring the Direct Care Workforce in Rural Areas (journal article)
Journal Article
University of Minnesota Rural Health Research Center
Date: 02/2023
In this manuscript, the research team used data from the 2021 Occupational Employment and Wage Statistics dataset to calculate the ratio of direct care workers relative to the population of older adults (ages 65+) across rural and urban areas in the US.
2022
-
Nursing Homes in Rural America: A Chartbook
Chartbook
RUPRI Center for Rural Health Policy Analysis
Date: 07/2022
Closure of nursing homes and hospitals with swing beds in recent years has changed the availability of post-acute and long-term care services in rural areas. This study examines the availability of post-acute and long-term care services as well as characteristics of residents and nursing homes in noncore, micropolitan, and metropolitan counties. -
Approaches to Serving Rural Older Adults in State Plans on Aging: A Policy Content Evaluation
Journal Article
University of Minnesota Rural Health Research Center
Date: 05/2022
In this article, we share a policy content evaluation of State Plans on Aging from all 50 U.S. states, focusing on how the states will serve older adults and including common and innovative approaches to doing so. -
Contact by Collection Agencies for Medical Debt: Rural-Urban Differences Among Older and Younger Medicare Beneficiaries
Journal Article
University of Minnesota Rural Health Research Center
Date: 02/2022
This study uses data from the 2016 Medicare Current Beneficiary Survey (n = 12,688 U.S. community-dwelling beneficiaries) to understand the impact of medical debt for rural residents. The study analyzed rural-urban differences in rates of collection agency contact for unpaid medical bills.
2021
-
"They're Not Leaving Their Home; This Is Where They Were Born, This Is Where They Will Die.": Key Informant Perspectives From the U.S. Counties With the Greatest Concentration of the Oldest Old
Journal Article
University of Minnesota Rural Health Research Center
Date: 07/2021
Researchers share interview results with key informants from 50 rural U.S. counties with the highest percentage of the residents ages 85 and older or the "oldest old." Respondents shared unique challenges to serving this population, as well as positive attributes of rural communities that make them attractive places for growing older. -
Trends in Nursing Home Closures in Metropolitan and Nonmetropolitan Counties in the United States, 2008-2018
Policy Brief
RUPRI Center for Rural Health Policy Analysis
Date: 02/2021
Nursing home closures have raised concerns about access to long-term services and supports in rural areas. This study examines trends in closures and characteristics of open and closed nursing homes in metropolitan and nonmetropolitan counties. Furthermore, this study identifies metropolitan and nonmetropolitan counties without any nursing homes.
2020
-
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. -
Long-Term Care Planning, Preparedness, and Response Among Rural Long-Term Care Providers
Journal Article
Southwest Rural Health Research Center
Date: 09/2020
This manuscript explores how rural long-term care providers plan, prepare, and respond to slowly or rapidly unfolding disasters (i.e., hurricanes, wildfires, and environmental spills) in three U.S. geographic areas. Data includes secondary sources and semi-constructed interviews with long-term care facilities and disaster management organizations.
2019
-
Long-Term Services and Supports Use Among Older Medicare Beneficiaries in Rural and Urban Areas
Journal Article
Maine Rural Health Research Center
Date: 01/2019
Analyzing the Medicare Current Beneficiary Survey, authors from the Maine Rural Health Research Center found that compared to their urban counterparts, rural Medicare beneficiaries had higher odds of nursing home use after controlling for beneficiary characteristics and contextual factors including nursing home bed supply.
2018
-
A National Examination of Caregiver Use of and Preferences for Support Services: Does Rurality Matter?
Journal Article
University of Minnesota Rural Health Research Center
Date: 07/2018
The objective of this study was to assess rural-urban differences in caregiver use of and preferences for support services. -
Rural-Urban Difference in Workplace Supports and Impacts for Employed Caregivers
Journal Article
University of Minnesota Rural Health Research Center
Date: 06/2018
This study finds that employed rural caregivers had significantly fewer workplace benefits available to them compared with urban caregivers. In particular, employed rural caregivers were less likely to have access to telecommuting, employee assistance programs, and paid leave. -
Market Characteristics Associated With Rural Hospitals' Provision of Post-Acute Care
Policy Brief
North Carolina Rural Health Research and Policy Analysis Center
Date: 04/2018
This brief uses data from Medicare cost reports, the Provider of Services File, and the U.S. Department of Agriculture to provide a window into current hospital-based post-acute care offerings by summarizing both hospital- and market-level factors that are associated with rural hospitals that provided post-acute care between 2012 and 2015. -
Rural and Urban Provider Market Share of Inpatient Post-Acute Care Services Provided to Rural Medicare Beneficiaries
Policy Brief
North Carolina Rural Health Research and Policy Analysis Center
Date: 04/2018
The purpose of this brief is to characterize rural providers' market share of inpatient post-acute care services provided to rural Medicare beneficiaries. -
Residential Settings and Healthcare Use of the Rural "Oldest-Old" Medicare Population
Policy Brief
Maine Rural Health Research Center
Date: 03/2018
This study used Medicare Current Beneficiary Survey data to profile rural/urban Medicare beneficiaries ages 85 & older. Rural adults in this age group are more likely to be disabled and live alone in the community or in nursing homes and less likely to live in assisted living facilities. Findings highlight rural needs for community-based services. -
Beyond Clinical Complexity: Nonmedical Barriers to Nursing Home Care for Rural Residents
Journal Article
University of Minnesota Rural Health Research Center
Date: 02/2018
Using data from interviews with rural hospital discharge planners, we identified four themes around nonmedical barriers to rural nursing home placement with particular salience in rural areas: financial issues, transportation, nursing home availability and infrastructure, and timeliness. We also identified policy and programmatic interventions.
2017
-
Barriers to Nursing Home Care for Nonelderly Rural Residents
Journal Article
University of Minnesota Rural Health Research Center
Date: 12/2017
This study uses data from 23 semi-structured interviews with rural hospital discharge planners in five states to identify specific barriers to finding nursing home care for nonelderly rural residents. We found three primary themes—payment status, fit, and medical complexity—as well as two minor themes—caregivers and bureaucratic processes. -
Rural Long-Term Services and Supports: A Primer
RUPRI Health Panel: Rural Policy Analysis and Applications
Date: 11/2017
This paper provides policymakers and other interested stakeholders a primer on the fundamentals of the rural LTSS system, rural access to and use of LTSS, and the opportunities and limitations of current federal and state LTSS policy for advancing rural health system transformation toward a high-performing rural health delivery system. -
The Financial Importance of Medicare Post-Acute and Hospice Care to Rural Hospitals
Policy Brief
North Carolina Rural Health Research and Policy Analysis Center
Date: 07/2017
This brief describes Medicare post-acute and hospice care provided by hospitals in rural areas by characterizing the variation in the number of rural hospitals that provide PAC and hospice care, the average amount of Medicare revenue rural hospitals receive for these services, and the financial importance of PAC and hospice care to rural hospitals.
2016
-
Are Rural Older Adults Benefiting From Increased State Spending on Medicaid Home and Community-Based Services?
Policy Brief
Maine Rural Health Research Center
Date: 06/2016
Little is known about variations in the availability or use of Medicaid Home and Community-Based Services (HCBS) within states, across rural and urban areas. This study used national claims data to examine differences in HCBS use and expenditures among rural and urban older adult Medicaid beneficiaries receiving LTSS.
2014
-
Profile of Rural Residential Care Facilities: A Chartbook
Chartbook
Maine Rural Health Research Center
Date: 05/2014
This chartbook offers information on part of the rural long-term services and supports (LTSS) continuum—the residential care facility (RCF). Survey results identify national/regional differences between rural and urban RCFs, focusing on facilities, resident and service characteristics of RCFs, and the ability to meet the LTSS needs of residents.
2013
-
Challenges and Opportunities for Improving Mental Health Services in Rural Long-Term Care
Maine Rural Health Research Center
Date: 06/2013
This study explores practices for increasing the quality, quantity, and accessibility of mental health services in rural long-term care.
2010
-
The Patient Protection and Affordable Care Act of 2010: Impacts on Rural People, Places, and Providers: A First Look
RUPRI Health Panel: Rural Policy Analysis and Applications
Date: 09/2010
This report summarizes six issue areas of the Affordable Care Act and discusses implications for access to services and improving the health status of rural residents. The issue areas are health insurance coverage; Medicare and Medicaid payment; quality, financing, and delivery system reform; public health; healthcare workforce; and long-term care.
2006
-
Differences Between Newly Admitted Nursing Home Residents in Rural and Nonrural Areas in a National Sample
Journal Article
Southwest Rural Health Research Center
Date: 02/2006
This research investigates whether differences in acuity are a function of differences in resident payer status and occur for both individuals admitted for short stays, with Medicare as payer, and those needing chronic care. -
Rural Hospitals and Long-Term Care: the Challenges of Diversification and Integration Strategies
Maine Rural Health Research Center
Date: 2006
There are many contemporary challenges experienced by older rural residents and their communities in accessing and providing services. However, the issue is not in comparing rural older adults to their urban counterparts; rather, it is that rural people have unique characteristics that must be considered when planning and providing services.
2005
-
Patterns of Post-Acute Utilization in Rural and Urban Communities: Home Health, Skilled Nursing, and Inpatient Medical Rehabilitation
NORC Walsh Center for Rural Health Analysis
Date: 03/2005
This report describes rural Medicare beneficiaries' patterns of post-acute utilization of home health services, skilled nursing facilities, and inpatient rehabilitation facilities. -
Rural Implications of Medicare's Post-Acute-Care Transfer Payment Policy
Journal Article
NORC Walsh Center for Rural Health Analysis
Date: 2005
Examines how the initial policy change affected rural and urban hospitals and investigates the likely impact of the FY2004 expansion and other possible future expansions. The authors conclude that rural hospitals are not disproportionately harmed by the post-acute-care transfer policy.
2004
-
Rurality and Nursing Home Quality: Results From a National Sample of Nursing Home Admissions
Journal Article
Southwest Rural Health Research Center
Date: 10/2004
There are higher percentages of elderly population in and the utilization rates of nursing homes are higher in rural areas. Overall, problems in rural nursing homes are at a much higher risk for poor outcomes, but it is most apparent in extremely isolated rural areas. -
Rural Implications of Medicare's Post-Acute Care Transfer Payment Policy
NORC Walsh Center for Rural Health Analysis
Date: 06/2004
This study examines the behavioral and financial impacts of the initial 10-DRG policy and projects the likely financial impact of extending the policy to cover additional DRGs or discharges to swing beds.
2001
-
Admission Severity and Mortality Rates Among Rural and Urban Nursing Facility Residents With Dementia (Research & Policy Brief)
Maine Rural Health Research Center
Date: 09/2001
This brief assesses whether the potentially higher use of nursing facility services in rural communities can be tied to differences in use patterns by older adults with dementia. Specifically, it addresses whether residents with dementia are less impaired at the time of their admission to a nursing facility than urban residents with dementia. -
Developing Affordable Non-Medical Residential Care in Rural Communities: Barriers and Opportunities
Maine Rural Health Research Center
Date: 05/2001
This study explores the challenges and opportunities for affordable non-medical residential care development in rural areas. -
Admission Severity and Mortality Rates Among Rural and Urban Nursing Facility Residents With Dementia
Maine Rural Health Research Center
Date: 03/2001
This study assesses whether the potentially higher utilization of nursing facility services in rural communities can be attributed to differences in use patterns by older adults with dementia. Specifically, it examines whether rural residents with dementia are less impaired when admitted to a nursing facility than their urban counterparts. -
Financing and Payment Issues in Rural Long Term Care Integration (Research & Policy Brief)
Policy Brief
Maine Rural Health Research Center
Date: 02/2001
This research and policy brief reviews current research and experience and identifies key policy and program considerations for integrated acute and long-term care financing in rural areas.
2000
-
Financing and Payment Issues in Rural Long Term Care Integration
Report
Maine Rural Health Research Center
Date: 2000
This report reviews current research and experience and identifies key policy and program considerations for integrated acute and long-term care financing in rural areas.