Statewide Examination of Rural-Urban Differences in Assisted Living Facilities.

Area of Science:

• Gerontology
• Healthcare Management
• Public Health Policy

Background:

• Assisted living facilities (ALFs) provide residential care for older adults.
• Understanding variations in ALF characteristics between rural and urban settings is crucial for equitable care delivery.
• Previous research has not comprehensively compared facility features and services across diverse geographic locations within a large state.

Purpose of the Study:

• To conduct a comparative analysis of facility characteristics between rural and urban assisted living facilities (ALFs).
• To identify differences in service offerings, resident certifications, and bed capacity based on geographic location.
• To inform policy development aimed at improving care quality and addressing disparities in ALFs.

Main Methods:

• A descriptive, cross-sectional study design was employed.
• Data were collected via surveys administered to administrative staff across 517 ALFs in Texas (143 rural).
• Statistical analyses included descriptive statistics, chi-squared tests, and Mann-Whitney U tests to compare groups.

Main Results:

• Rural ALFs had more Type A facilities and fewer Type B facilities (requiring 24-hour attendants) compared to urban ALFs.
• Urban ALFs offered more specialized services like concierge, medical, and nursing care, while rural ALFs focused more on transportation, wound care, and therapy services.
• Alzheimer's disease certifications and licensed beds were significantly lower in rural facilities. Antipsychotic medication use was high (26.6%) across all facilities, with limited implementation of dose reduction strategies (38.5%).

Conclusions:

• Significant rural-urban disparities exist in ALF service availability, dementia care provisions, and facility types.
• High rates of antipsychotic use, coupled with service differences, indicate a pressing need for policy reforms in ALF care.
• Further research is essential to enhance ALF quality measurement and understand factors influencing care quality in both rural and urban environments.