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Assessment of Dependence in Activities of Daily Living Among Older Patients in an Acute Care Unit

Assessment of Dependence in Activities of Daily Living Among Older Patients in an Acute Care Unit

Published on: September 30, 2020

Rural hospital closures and nursing home outcomes.

Emmaline Keesee¹, Tyler Malone², Susie Gurzenda^2,3,4

¹Department of Health Policy, Vanderbilt University Medical Center, Nashville, Tennessee, USA.

The Journal of Rural Health : Official Journal of the American Rural Health Association and the National Rural Health Care Association

|April 26, 2025

Summary

Rural hospital closures did not affect nursing home occupancy or resident health scores. However, hospitalizations per resident year decreased after closures, indicating potential shifts in care.

Keywords:

hospital closure hospitalizations long‐term services and supports nursing homes rural health

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Area of Science:

Health Services Research
Rural Health Policy
Long-Term Care Management

Background:

Rural hospital closures are increasing, impacting healthcare access.
The effects on the long-term care sector remain understudied.
This research investigates the link between hospital closures and nursing home outcomes.

Purpose of the Study:

To model the relationship between rural hospital closure and nursing homes within the same county.
To explore nursing home utilization and resident health outcomes post-closure.

Main Methods:

Utilized data from CMS, LTCFocus, and NC Rural Health Research Program.
Conducted a difference-in-differences analysis of hospital closures from 2012-2019.

Main Results:

No significant impact found on nursing home occupancy, Medicare payer mix, or resident ADL scores.
Hospitalizations per resident year declined by 0.13 post-closure (a 0.33 SD change).
The reason for reduced hospitalizations (e.g., emergent vs. elective) is unclear.

Conclusions:

Hospital closures have an understudied role in rural post-acute and long-term care.
This is the first study to examine hospital closure impacts on nursing homes.
Findings are relevant given current workforce and funding challenges in rural healthcare.