Previous studies suggest that approximately 500 rural nursing homes have closed from 2008-2018 and rural nursing homes have higher rates of residents with behavioral/mental health needs, including depression. The closure of nursing homes in rural areas necessitates the transfer of residents to other nursing homes or other settings of care, potentially affecting resident mental and physical well-being. To date, there exists no comprehensive study exploring the impact of rural nursing home closures on the distance residents must travel to access nursing homes and their physical and mental health. Using advanced difference-in-differences regression methods and resident-level assessment data, this study will evaluate the following two aims:

1. Estimate the causal impact of nursing home closure on distances to nursing homes in rural areas compared to urban areas.
2. Estimate the causal impact of nursing home closure on resident physical and mental health outcomes in rural areas compared to urban areas.