The Impact of Living in a Rural County With No Nursing Home on Utilization Rates and Admission Mobility Patterns

Abstract

This article uses long-term care data from one state (Virginia) to examine four hypotheses: (a) Rural counties are more likely than urban counties to have no nursing facility, (b) counties without a nursing facility will have lower nursing home utilization rates than counties having a nursing facility, (c) individuals admitted to nursing facilities who originate in counties with no facility will tend to experience moves of greater distance than their counterparts originating in counties having a facility, and (d) those admitted to nursing facilities originating in counties with no facility will tend to move to more urban settings. These hypotheses were supported by the analysis. The findings suggest that access to nursing home care may be more limited for individuals who live in counties without nursing facilities. Long-term care policy makers should give careful consideration to access in their methods for determining need for nursing home care and long-term care services in rural areas.

The Influence of Rural Location on Utilization of Formal Home Care: The Role of Medicaid

“…Within these very rural counties, Medicare home care may sometimes be a necessary substitution for other forms of health and long-term care that would normally be reimbursed through Medicare but that are less available, such as hospitals or advanced medical services (Dalton et al, 2002;Kenney, 1993a;Kenney & Dubay, 1992), or for sources of care, such as nursing homes, are very unevenly distributed across the most rural areas (McAuley et al, 2002). Because, by definition, Medicare home care is delivered in the client's home, it may be the only readily available care option for older people in these communities.…”

“…Nursing home admissions and home care may substitute for one another, and national figures suggest that there are more nursing home beds per capita in rural counties (Shaughnessy, 1994). However, nonmetropolitan counties tend to have much greater variation in beds and bed rates than metropolitan counties, because larger percentages of them have no facilities at all (McAuley, Pecchioni, & Grant, 2002). The supply and types of home health agencies also differ across rural and urban counties, with rural counties having fewer agencies per county and per square mile (Kenney & Dubay).…”

Barriers to Nursing Home Care for Nonelderly Rural Residents

“…These issues are felt most acutely in rural areas, which experience higher disability and mortality rates and poorer health behaviors than the rest of the country (Garcia, 2017; Matthews et al, 2017; Rural Health Information Hub, 2017a), and have particularly affected nonelderly rural residents (Matthews et al, 2017). Meanwhile, rural areas have unique barriers to accessing health care in general, and long-term care, including nursing home care, in particular (Coburn & Bolda, 2001; Douthit, Kiv, Dwolatzky, & Biswas, 2015; Hutchison, Hawes, & Williams, 2005; McAuley, Pecchioni, & Grant, 2002). Rural areas have fewer nursing homes and home health agencies and also face historic shortages in the long-term care workforce at all levels, from certified nursing assistants to specialty care like psychiatry (Lee, Dooley, Ory, & Sumaya, 2013; D.…”