Differences Between Newly Admitted Nursing Home Residents in Rural and Nonrural Areas in a National Sample

Department of Health Policy and Management, School of Rural Public Health, The Texas A&M University System Health Sciences Center, College Station, TX 77843-1266, USA.
The Gerontologist (Impact Factor: 3.21). 03/2006; 46(1):33-41. DOI: 10.1093/geront/46.1.33
Source: PubMed


Previous research in specific locales indicates that individuals admitted to rural nursing homes have lower care needs than individuals admitted to nursing homes in urban areas, and that rural nursing homes differ in their mix of short-stay and chronic-care residents. This research investigates whether differences in acuity are a function of differences in resident payer status and occur for both individuals admitted for short stays, with Medicare as payer, and those needing chronic care.
We used a representative 10% sample of national resident assessments (Minimum Data Set) for calendar year 2000 (N = 197,589). We conducted statistical analyses (means, percentages, and logistic regression) to investigate differences in Medicare and non-Medicare admissions to facilities in metropolitan and nonmetropolitan areas.
Non-Medicare residents admitted to rural nursing facilities have lower acuity scores than non-Medicare residents admitted to metropolitan nursing homes. However, individuals admitted under Medicare were similar in rural and urban areas.
Differences in resident acuity at admission among facilities in different locales were largely a function of lower acuity levels for individuals admitted to rural nursing homes for long-term or chronic care, although differences in Medicare census also played some role in facility-level differences in acuity. Other factors must be explored to determine why this lower acuity occurs and whether higher use of rural nursing homes by less impaired older persons meets their needs and preferences and represents good public policy.

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    • "This hypothesis is consistent with the literature, which suggests that H&CC capacity may be especially limited in rural and remote areas due to distance (Sims-Gould and martin-matthews 2008), low population density and a lack of service infrastructure (Bolin et al. 2006), including shrinking informal support networks (i.e., family and friends who leave rural areas to secure employment in more prosperous urban areas) (Skinner et al. 2008). As a result, the risk of institutionalization may increase outside urban centres (Bolin et al. 2006). "
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    ABSTRACT: Objectives: Across the developed world, wait lists for facility-based long-term care (LTC) beds continue to grow. Wait lists are primarily driven by the needs of aging populations (demand-side factors). Less attention has been given to system capacity to provide community alternatives to LTC (supply-side factors). We examine the role of both demand- and supply-side factors by comparing the characteristics of individuals who have been assessed and deemed eligible for LTC in urban and rural/underserviced parts of northwestern Ontario, Canada. Methods: Home care assessment data were analyzed for all individuals waiting for LTC in northwestern Ontario as of March 2008 (n=858). For the analysis, the sample was separated into urban and rural groups to account for geographical differences in wait list location. Characteristics between these two groups were compared. Results: Individuals on LTC wait lists in the rural areas were significantly less impaired in activities of daily living and cognition than their counterparts in the urban area. However, in both areas, impairments in lighter-care activities appeared to be a key wait list driver, and few people had an informal caregiver living in the home. Conclusions: Our data suggest that LTC wait lists reflect, at least to some extent, insufficient community capacity, not just need for LTC.
    Full-text · Article · Aug 2012 · Healthcare policy = Politiques de sante
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    • "Additionally, limitations in communication, limitations in behaviour, age, sex, the length of stay since admission, the reason for admission (rehabilitation versus long term care) and whether the resident was staying on a somatic or psycho-geriatric ward, were used as independent variables [24,25]. On the level of the nursing home characteristics the volume of available PT, measured as full time equivalents (FTE) per bed with 1 FTE being 36 hours a week, the type of nursing home, the presence of a stroke unit and the degree of urbanisation were taken into account [26,27]. "
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    ABSTRACT: Although physiotherapy (PT) plays an important role in improving activities of daily living (ADL functioning) and discharge rates, it is unclear how many nursing home residents receive treatment. Furthermore, there is a lack of insight into the determinants that influence the decision for treatment. In this study, we investigated how many nursing home residents receive PT. In addition, we analysed the factors that contribute to the variation in the provision of PT both between nursing homes and between residents. A random sample of 600 elderly residents was taken from a random sample of 15 nursing homes. Residents had to be admitted for rehabilitation or for long-term care. Data were collected through interviews with the nursing home physician and the physiotherapist. Multilevel analysis was used to define the variation in the provision of PT and the factors that are associated with the question whether a resident receives PT or not. Furthermore the amount of PT provided was analysed and the factors that are associated with this. On average 69% of the residents received PT. The percentage of patients receiving treatment differed significantly across nursing homes, and especially the number of physiotherapists available, explained this difference between nursing homes. Residents admitted to a somatic ward for rehabilitation, and male residents in general, were most likely to receive PT. Residents who were treated by a physiotherapist received on average 55 minutes (sd 41) treatment a week. Residents admitted for rehabilitation received more PT a week, as were residents with a status after a total hip replacement. PT is most likely to be provided to residents on a somatic ward, recently admitted for rehabilitation to a nursing home, which has a relatively large number of physiotherapists. This suggests a potential under-use of PT for long-term residents with cognitive problems. It is recommended that physiotherapists reconsider which residents may benefit from treatment. This may require a shift in the focus of physiotherapists from 'recovery and discharge' to 'quality of life and well-being'.
    Full-text · Article · Feb 2007 · BMC Geriatrics
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    ABSTRACT: In this study,we investigated how many nursing home residents receive physiotherapy and which factors relate to the provision of treatment. Data were collected from a random sample of 600 residents admitted for rehabilitation or long-term care, through interviews with nursing home physicians and physiotherapists. On average 69% of the residents received PT, however, this percentage differed significantly across nursing homes. Especially the number of physiotherapists available explained this difference. Residents admitted to a somatic ward for rehabilitation were most likely to receive physiotherapy. This suggests a potential under-use of PT for long-term residents with cognitive problems. (aut. ref.)
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