Acuity Differences Among Newly Admitted Older Residents in Rural and Urban Nursing Homes

Area of Science:

• Gerontology
• Healthcare Management
• Public Health

Background:

• Assessing healthcare needs and service delivery differences between rural and urban settings is crucial for older adults.
• Nursing home residents present a complex spectrum of functional, cognitive, and behavioral needs.
• Understanding acuity differences is vital for resource allocation and quality improvement in elder care.

Purpose of the Study:

• To compare the acuity of newly admitted, long-stay nursing home residents in rural versus urban facilities.
• To examine how older age (75+) influences rural-urban differences in resident acuity.
• To identify potential disparities in care management capacity between rural and urban nursing homes.

Main Methods:

• Analysis of 209,719 long-stay residents (aged 65+) from 14,834 facilities across 47 states using 2015 Minimum Data Set v3.0.
• Utilized data from Area Health Resources File and Provider of Services File, including Rural-Urban Commuting Area codes.
• Employed difference-in-differences (DID) generalized linear models to assess acuity differences, controlling for covariates and using state-fixed effects.

Main Results:

• Rural admissions showed less functional impairment but higher rates of cognitive and problem behaviors compared to urban admissions.
• While older age predicted higher acuity, functional decline was similar in rural and urban settings.
• Older admissions in rural facilities had significantly lower cognitive (8.0%) and behavioral (8.5%) status compared to urban facilities.

Conclusions:

• Despite rural residents being less complex overall, older rural admissions exhibited greater cognitive and behavioral challenges.
• Findings suggest rural nursing homes may have a reduced capacity to manage older residents with complex care needs.
• Further investigation into rural healthcare infrastructure and specialized care models for aging populations is warranted.