Rural hospital closures and nursing home outcomes

Rural hospital closures since 2005 reached 194 this year, raising concerns for rural health care access. Little is known about the effects of facility closures on the local long-term care sector. This analysis models the relationship between rural hospital closure and nursing homes in the same county. We explore nursing home-level outcomes related to utilization and resident health.

Centers for Medicare & Medicaid Services Healthcare Cost Report Information System, LTCFocus, and NC Rural Health Research Program hospital closure datasets are used to conduct a difference-in-differences study of closures from 2012 to 2019.

We do not find evidence that hospital closure impacted non-hospital-based nursing home occupancy rate, proportion of Medicare paying residents, or average resident ADL score. However, hospitalizations per resident year declined by 0.13 following closure (95% CI: -0.24, -0.02), representing a change of 0.33 standard deviations from the grand mean. It is unclear if reduced nursing home hospitalizations reflect a reduction in emergent, urgent, or elective admissions.

Our results build on the existing body of hospital closure literature by highlighting the understudied role of hospitals in rural postacute and long-term care. To our knowledge, this was the first study examining the impacts of hospital closure on nursing homes. These findings are particularly relevant in the wake of COVID-19 as rural long-term care facilities and hospitals alike navigate exacerbated workforce and funding challenges.