Long-term care: Rural Health Research Products & Journal Articles

2023

Distribution of Direct Care Workforce COVID-19 Funding Between Rural and Urban Counties in Minnesota and Illinois
Policy Brief
University of Minnesota Rural Health Research Center
Date: 05/2023
The purpose of this policy brief is to examine trends in the distribution of federal Coronavirus Aid, Relief, and Economic Securities Act of 2020 (CARES Act) funding designed to support the direct care workforce between rural and urban counties in Minnesota and Illinois.
Access to Health Services Across Rural and Urban Minoritized Racial/Ethnic Group Areas
Policy Brief
Rural and Minority Health Research Center
Date: 03/2023
This brief summarizes selected results from a series of reports documenting disparities in geographic access to health services for rural and urban places that have a relatively high proportion of residents from minoritized racial and ethnic groups. "Areas" were examined at the ZIP Code Tabulation Area level.

2022

Who Will Care for Rural Older Adults? Measuring the Direct Care Workforce in Rural Areas
Policy Brief
University of Minnesota Rural Health Research Center
Date: 11/2022
The policy brief examines disparities in the supply of home health aides and nursing assistants in rural areas compared to urban areas. Researchers estimate the ratio of home health aides and nursing assistants relative to the population of adults (age 65+) across rural and urban areas in the U.S.
Availability of Nursing Homes in Minoritized Racial/Ethnic Group Areas
Policy Brief
Rural and Minority Health Research Center
Date: 09/2022
This brief is one of a series of findings briefs documenting disparities in geographic access to health services for ZIP code tabulation areas (ZCTAs) containing a high proportion of minoritized racial/ethnic residents. This report looks at the availability of nursing homes at the ZCTA level.
Availability of Home Health Services in Minoritized Racial/Ethnic Group Areas
Policy Brief
Rural and Minority Health Research Center
Date: 08/2022
This brief is one of a series of findings briefs documenting disparities in geographic access to health services for ZIP code tabulation areas containing a high proportion of minoritized racial/ethnic residents. This report looks at the availability of home health services in minoritized racial/ethnic areas.
Availability of Pharmacies in Minoritized Racial/Ethnic Areas
Policy Brief
Rural and Minority Health Research Center
Date: 08/2022
This brief is one of a series of findings briefs documenting disparities in geographic access to health services for ZIP code tabulation areas containing a high proportion of minoritized racial/ethnic residents. This report looks at access to pharmacies.
Spatial Access to Hospital-based Obstetric Units in Minoritized Racial/Ethnic Areas
Policy Brief
Rural and Minority Health Research Center
Date: 08/2022
This brief is one of a series of findings briefs documenting disparities in geographic access to health services for ZIP code tabulation areas containing a high proportion of minoritized racial/ethnic residents. This report looks at spatial access to hospital-based obstetric units in minoritized racial/ethnic areas.
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.
The Problem of the Color Line: Place, Race, and Access to Health Care in America
Journal Article
Rural and Minority Health Research Center
Date: 02/2022
Using ZIP Code Tabulation Area boundaries and associated rural-urban commuting area codes, urban and rural places with the largest share of minoritized racial and ethnic groups were identified. A StoryMap was then created to illustrate disparities experienced based on where Indigenous populations and people of color reside spatially.

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.
Challenges to Admitting Residents: Perspectives From Rural Nursing Home Administrators and Staff
Journal Article
University of Minnesota Rural Health Research Center
Date: 03/2021
This study uses a survey of rural nursing home administrators (n=209) to assess perceptions of difficulty rural nursing homes encounter in admitting and serving individuals with dementia, obesity, mental and behavioral health conditions, and medically complex conditions.
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

Perspectives on Rural Caregiving Challenges and Interventions
Policy Brief
University of Minnesota Rural Health Research Center
Date: 08/2018
This brief presents findings from key informant interviews describing challenges and opportunities related to supporting informal caregivers in rural areas.
Resources for Caregiving in Rural Communities
Policy Brief
University of Minnesota Rural Health Research Center
Date: 08/2018
This policy brief describes resources that are being used across the country to support caregivers in rural communities.
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.
Medical Barriers to Nursing Home Care for Rural Residents
Policy Brief
University of Minnesota Rural Health Research Center
Date: 05/2017
This policy brief describes barriers rural residents with complex medical care needs may face when seeking placement in a nursing home and identifies potential policy strategies to overcome them.

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.

2015

Nurse Staffing Levels and Quality of Care in Rural Nursing Homes
Policy Brief
University of Minnesota Rural Health Research Center
Date: 01/2015
This study's purpose was to examine the relationship between nurse staffing levels and care quality in rural nursing homes and to assess potential differences between hospital-based and freestanding rural nursing homes.

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

Assisted Living in Rural America: Results From a National Survey
Southwest Rural Health Research Center
Date: 03/2005
This article examines the assisted living industry in metropolitan and rural areas. Results indicate that assisted living was largely a private-pay form of long-term care and was more common in metropolitan than rural areas. Findings suggest that assisted living will make only a marginal contribution to meeting the needs in rural areas.
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.
A National Study Comparing Resident Medication Use in Rural and Non-Rural Assisted Living Facilities
Southwest Rural Health Research Center
Date: 02/2005
In addition to comparing rural and non-rural assisted living residents' medication utilization, this study examined the prevalence of inappropriately prescribed medications and drug-to-drug interactions among residents of rural and non-rural assisted living 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.
Nursing Homes in Rural And Urban Areas, 2001
Southwest Rural Health Research Center
Date: 06/2004
This chartbook provides descriptive data on the entire population of longer-stay nursing home residents in the country in 2001 and categorizes them according to the rurality of the nursing homes in which they receive care in an effort to address questions related to residents' characteristics and quality of care.are.
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.
Assisted Living: Is It an Option for Rural Areas?
Southwest Rural Health Research Center
Date: 05/2004
The key findings of a national survey on assisted living are highlighted, including supply, services, and affordability of assisted living facilities in rural areas.
Expanding Residential Care and Assisted Living in Rural America
Southwest Rural Health Research Center
Date: 05/2004
There is an undersupply of assisted living facilities in rural areas. This policy brief provides options for state policy makers and advocates to consider in expanding the availability and nature of assisted living and other types of housing with supportive services in rural areas.
Rural Healthy People 2010: A Companion Document to Healthy People 2010. Volume 3
Southwest Rural Health Research Center
Date: 04/2004
This report includes the overview of research and accompanying models for practice on five new focus areas in Rural Healthy People 2010, along with the more detailed literature reviews for each.
Rural-Urban Issues in the Wage Index Adjustment for Prospective Payment in Skilled Nursing Facilities (Brief Report)
North Carolina Rural Health Research and Policy Analysis Center
Date: 01/2004
Hourly wage data from Medicare-participating nursing homes were used to examine urban/rural patterns in average hourly nursing home wages and wage variation within the statewide rural labor markets defined by CMS. The data were also used to examine the adequacy of the hospital wage index as an adjuster for skilled nursing facility rates.

2003

Rural-Urban Issues in the Wage Index Adjustment for Prospective Payment in Skilled Nursing Facilities (Full Report)
North Carolina Rural Health Research and Policy Analysis Center
Date: 11/2003
Hourly wage data collected were used to examine urban/rural patterns in average hourly nursing home wages and pattern variation within the statewide rural labor markets. The data were also used to examine the adequacy of the hospital wage index as an adjuster for skilled nursing facility rates.
Background Paper: Rural-Urban Differences in Nursing Home and Skilled Nursing Supply
North Carolina Rural Health Research and Policy Analysis Center
Date: 02/2003
This paper examines characteristics of nursing facilities and the supply of certified skilled nursing beds as the new PPS is being phased in, with particular reference to differences between urban and rural settings.
Nursing Homes in Rural America
Southwest Rural Health Research Center
Date: 2003
This policy brief discusses the main findings of a 2000 survey of 17,000 nursing homes related to rural elderly.

2001

Rural Hospitals' Ability to Finance Inpatient, Skilled Nursing, and Home Health Care
University of Minnesota Rural Health Research Center
Date: 10/2001
This study surveys 448 rural hospitals to see how they are restructuring in light of the Balanced Budget Act of 1997.
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.