This study explores factors related to post-acute skilled nursing care utilization in rural areas of the U.S. The analyses uses county-level Area Health Resource Files, National Center for Health Statistics Urban-Rural codes, and data from the Flex Monitoring Team database.

We found counties lacking post-acute skilled nursing care were more likely to be noncore, sparsely populated, and less impoverished counties. The elderly population percentage, number of hospitals with high utilization rates, and Hispanic population percentage were not significantly associated with the availability of post-acute skilled nursing care. This research shows that portions of rural America are possibly skilled nursing deserts, thus lacking the physical presence of facilities to provide post-acute skilled nursing care. This potentially affects more than 740,000 rural residents, among them about 127,000 elderly individuals, residing in 153 rural counties.