Rurality and Nursing Home Quality: Evidence from the 2004 National Nursing Home Survey

Research has linked rural geographic location with higher demand for nursing home care. However, little is known about the relationship between rurality and nursing home (NH) quality of care.

The objective of this study is to examine the impact of rurality on NH quality and to identify which individual and facility level factors influence NH quality for facilities with different levels of rurality.

We studied 12,507 residents in 1,174 NHs from the 2004 National Nursing Home Survey. We estimated multilevel regression models to predict risk-adjusted rates of restraints, hospitalizations and falls.

Compared to urban NH residents, rural NH residents were older, more likely to be female and White. Rural NH residents also had lower average ADL disability level and were less likely to have had cardiovascular disease and dementia diagnoses upon admission. At the facility level, rural residents were less likely to be admitted to facilities that were for-profit or operated in chains. On average, rural facilities had lower occupancy rate, lower proportion of Medicaid beneficiaries, and were less likely to offer special care programs, cluster beds, and end-of-life care programs. In addition, residents located in rural facilities had lower risks of falls (OR 0.84, 95% CI [0.72, 0.99]) and hospital admissions (OR 0.76, 95% CI [0.58, 0.99]).

Results from this study will facilitate NH quality improvement by identifying individual and facility level factors associated with better quality of care in nursing homes, and by informing policymakers of potential policy innovations on payment reforms in rural and urban areas.