Rural Health
Research Gateway

Long-term care

Completed Projects

Listed by project completion date. You can also view these projects alphabetically.

2023

  • Availability of Healthcare Infrastructure in Minoritized Racial/Ethnic Groups
    This analysis compared the likelihood that selected healthcare infrastructure elements are available within rural and urban ZIP Code Tabulation Areas that contain versus do not contain a high proportion of historically disadvantaged minority residents.
    Research center: Rural and Minority Health Research Center
    Topics: American Indians and Alaska Natives, Health disparities and health equity, Healthcare access, Hispanics, Home health, Long-term care, Minority health
  • Quality Measures for Skilled Nursing Care in Rural Swing Beds: What Works and What Doesn't?
    This project provided a systematic review of skilled nursing facility quality measures and how these measures apply to skilled nursing facility-level care provided in rural swing beds in both critical access hospitals and prospective payment system hospitals.
    Research center: Southwest Rural Health Research Center
    Topics: Hospitals and clinics, Long-term care, Medicare Prospective Payment System (PPS)
  • The Direct Care Workforce in Rural Areas
    In this study, we measured the supply of long-term care services and supports (LTSS) direct care workers relative to older adult populations in rural and urban areas and measure employer and industry turnover among LTSS direct care workers. We also explored how compensation levels – including wages and employer-based health insurance – are related to and predict worker turnover in the LTSS direct care workforce in rural and urban areas.
    Research center: University of Minnesota Rural Health Research Center
    Topics: Aging, Allied health professionals, Health services, Home health, Long-term care, Post-acute care, Poverty, Rural statistics and demographics, Social determinants of health, Workforce

2022

  • Aging in Place in Rural America: What Does It Look Like and How Can It Be Supported?
    In general, people want to age in place. This project looked at the structures in place to help them do so and how those structures vary by rurality. Federal, state, and local policy implications for improving health outcomes and quality of life for rural older adults aging in place were also be identified.
    Research center: University of Minnesota Rural Health Research Center
    Topics: Aging, Disabilities, Health disparities and health equity, Healthcare access, Home health, Long-term care, Social determinants of health
  • Factors Predicting Swing Bed Versus Skilled Nursing Facility Use
    This project updated our 2014 brief: Discharge to Swing Bed or Skilled Nursing Facility: Who Goes Where? In addition to examining health conditions of patients discharged from rural Prospective Payment System hospitals and Critical Access Hospitals to swing beds and skilled nursing facilities, this project also looked to see what has changed over time and whether race and ethnicity, sex, or age explain differences.
    Research center: North Carolina Rural Health Research and Policy Analysis Center
    Topics: Hospitals and clinics, Long-term care, Medicare
  • Healthcare Use and Expenditures Among Rural and Urban Medicare Beneficiaries Aged 85 and Over
    The proportion of U.S. residents ages 85+ is expected to grow substantially in the coming decades with the impact of this growth in rural areas likely to be pronounced. This project used data from the Medicare Current Beneficiary Survey to examine rural-urban differences in healthcare use and expenditures among Medicare enrollees ages 85+.
    Research center: Maine Rural Health Research Center
    Topics: Aging, Healthcare access, Long-term care, Medicare
  • Location and Characteristics of Nursing Homes in the Rural and Urban U.S.
    This project examined rural and urban nursing home availability; assessed the nursing home bed supply relative to the elderly population in rural and urban counties; summarized resident and nursing home characteristics; and analyzed the relationship between the rural location of nursing homes and resident and nursing home characteristics.
    Research center: RUPRI Center for Rural Health Policy Analysis
    Topics: Aging, Health services, Healthcare access, Healthcare financing, Long-term care, Medicare

2021

  • How Do Costs for Rural Medicare Beneficiaries Using Swing Beds Compare to Those Using Skilled Nursing Facilities?
    This study estimated and compared total Medicare expenditures for episodes of care that include post-acute stays in either swing beds or skilled nursing facilities (SNFs). Results informed federal and state agencies, rural providers and communities as to how post-acute care in swing bed versus a SNF affects the trajectory of costs and utilization for rural Medicare beneficiaries.
    Research center: North Carolina Rural Health Research and Policy Analysis Center
    Topics: Long-term care, Medicare, Post-acute care
  • Rural Nursing Home Closures - Trends, Characteristics, and Impact on Access
    This project built a database of nursing home closures across rural and urban areas in the U.S. and evaluated the changes in access to post-acute and/or long-term care providers. It also described the differences in organizational, financial, and market characteristics between open vs. closed nursing homes in rural vs. urban areas.
    Research center: RUPRI Center for Rural Health Policy Analysis
    Topics: Aging, Healthcare access, Long-term care, Medicare

2020

  • Acuity Differences Among Newly Admitted Rural and Urban Nursing Home Residents
    This study used nursing home assessment data to examine rural-urban differences in resident acuity upon admission; whether differences persisted among newly admitted Medicare and non-Medicare residents; and whether and how nursing home, local health system, and market characteristics were associated with differences in resident acuity.
    Research center: Maine Rural Health Research Center
    Topics: Aging, Long-term care
  • Community Context and Rural Strategies to Support the Oldest Old
    This project developed a chartbook profiling older adults (65 and older) in rural areas and assessed where rural residents ages 85 and older were most likely to live, what rural counties had experienced the fastest growth of those 85 and older, and what strategies were in place or were possible for supporting this population in aging in place.
    Research center: University of Minnesota Rural Health Research Center
    Topics: Aging, Hospice and palliative care, Long-term care, Rural statistics and demographics
  • Disaster Planning, Preparedness, & Response for Rural Long-Term Care Providers
    This project collected and analyzed data that captures how disasters affect long-term care services and patient experiences in rural areas. We developed and pilot test long-term care provider survey, and conducted case studies of disaster-impacted, rural communities with respect to implications for long-term care services.
    Research center: Southwest Rural Health Research Center
    Topics: Emergency preparedness and response, Health disparities and health equity, Long-term care

2019

  • Financial Impact of Reimbursing CAH Swing Bed Days at the SNF PPS Rate
    This study assessed the financial impact of changing Critical Access Hospital (CAH) swing bed reimbursement from the cost-based system to the skilled nursing facility (SNF) prospective payment system (PPS).
    Research center: North Carolina Rural Health Research and Policy Analysis Center
    Topics: Critical Access Hospitals (CAHs), Healthcare financing, Long-term care, Medicare, Post-acute care

2018

  • Caring for Caregivers: Available Support for Unpaid Caregivers in Rural Areas
    This project describes rural-urban differences in the prevalence and intensity of informal caregiving for older adults and associated socio-demographic correlates and as well as identifies potential policy interventions to improve the quality of life and health outcomes of rural caregivers.
    Research center: University of Minnesota Rural Health Research Center
    Topics: Aging, Home health, Long-term care
  • Post-Acute Care for Rural Medicare Beneficiaries
    This project described the variation in the volume, mix and financial importance of post-acute services to rural hospitals; identified hospital and community characteristics associated with variation in post-acute services provided by rural hospitals; and determined where rural Medicare beneficiaries receive post-acute services.
    Research center: North Carolina Rural Health Research and Policy Analysis Center
    Topics: Hospitals and clinics, Long-term care, Post-acute care

2017

  • Provision of Skilled Nursing in Rural America: Skilled Nursing Facilities and Swing Beds
    This project will allow researchers and policy makers to understand the nature of swing bed and skilled nursing facility care provision in rural areas of the U.S. Our national comparison will include indicators such as service mix, length of stay, discharges, volume and census, and certifications and provider characteristics.
    Research center: Southwest Rural Health Research Center
    Topics: Aging, Hospitals and clinics, Long-term care, Medicare
  • Skilled Nursing Facility Care for Rural Residents with Complex Care Needs
    This project will examine barriers to skilled nursing facility placement for rural residents with complex care needs, including obesity, dementia, and behavioral health problems, and explore potential implications for access to and quality of care.
    Research center: University of Minnesota Rural Health Research Center
    Topics: Health services, Hospitals and clinics, Long-term care

2016

  • Access To and Use of Home and Community-Based Services in Rural Areas
    This study will use data from the 2010 Medicaid Analytic eXtract (MAX) file and in-depth policy reviews and interviews in four states to examine differences in the use of institutional and home and community-based service (HCBS) use by older adults across urban and rural areas, and the policy and community factors that contribute to differences or comparability in use.
    Research center: Maine Rural Health Research Center
    Topics: Aging, Home health, Long-term care

2013

  • Challenges and Opportunities for Improving Rural Long-Term Services and Supports under the Affordable Care Act
    This project will examine strategies, models, and policy options for improving access to, and quality of, rural long-term services and supports. Through focused policy analyses, we will highlight the rural options, opportunities, and barriers of implementing the coordinated care, health home, and long-term services and supports provisions in the Affordable Care Act.
    Research center: Maine Rural Health Research Center
    Topics: Aging, Care management, Long-term care

2007

  • Rural-Urban Differences in Nursing Home Admissions, Service Usage and Discharge
    An in-depth examination of rural-urban differences in recent nursing home first admissions, their service utilization patterns, and their discharge status over 12 months will be conducted to determine whether persons from rural areas admitted to rural nursing homes have higher functioning, receive fewer special nursing home services, and remain in care longer than rural admissions to urban nursing homes, urban admissions to urban nursing homes, or urban admission to rural nursing homes.
    Research center: FORHP-funded Individual Grantees
    Topic: Long-term care
  • Tribal Long-Term Care: Barriers to Best Practices in Policy and Programming for a National Sample of Rural Tribes
    This project will examine barriers experienced by rural American Indian and Alaska Native (AI/AN) tribes in developing long term care policy and service provision, identify tribes which exemplify best practices in the area of long term care policy, and document what other tribes would need to know to develop successful long term care programs (i.e., lessons learned).
    Research center: FORHP-funded Individual Grantees
    Topics: Aging, American Indians and Alaska Natives, Long-term care, Minority health

2005

  • Disability Burdens Among Rural and Urban Older Americans
    This project will use the 1994-2000 Second Longitudinal Study of Aging to develop detailed estimates of healthy, disabled, and total life expectancy among rural and urban populations. We will develop and compare the estimates between women and men, by race/ethnicity, and across differing levels of education.
    Research center: Rural and Minority Health Research Center
    Topics: Aging, Disabilities, Health disparities and health equity, Long-term care, Rural statistics and demographics
  • Medicaid Budget Cuts: Effects on Rural Nursing Homes and Rural Elderly and Disabled
    This project will investigate whether nursing home quality and access to nursing home care have eroded in rural areas as a result of changes in Medicare payments or reductions in Medicaid nursing home payments from 2000-2003.
    Research center: Southwest Rural Health Research Center
    Topics: Aging, Disabilities, Long-term care, Medicaid and CHIP
  • Native Elder Care Needs Assessment: Development of a Long Term Care Planning Tool Kit
    A long term care planning tool kit will assist tribes with interpreting long term care data obtained through a national Native Elder Care Needs Assessment. It will also assist tribes in using the data to develop long term care infrastructure and comprehensive services that respond to local needs and services.
    Research center: FORHP-funded Individual Grantees
    Topics: Aging, American Indians and Alaska Natives, Long-term care, Minority health
  • Post-Acute Care: A Rural and Urban Comparison
    This multi-phase analysis examines whether discharge patterns for and use of post-acute care services by rural and urban hospitalized Medicare beneficiaries differ and, if they do, what are the sources of these different patterns.
    Research center: NORC Walsh Center for Rural Health Analysis
    Topics: Home health, Long-term care, Medicare, Post-acute care
  • Rural and Urban Differences in Utilization of Formal Home Care
    This project uses the Medical Expenditure Panel Survey and other data sources to examine rural and urban differences in the utilization and costs of formal home care, including changes in utilization patterns and costs across residence types over time.
    Research center: FORHP-funded Individual Grantees
    Topics: Home health, Long-term care
  • Trends in Swing Bed and Skilled Nursing Facility Use in Rural Hospitals, 1996-2003
    This study will examine trends in the distribution of skilled nursing facility (SNF) services in rural hospitals during a period of dramatic change in Medicare reimbursement, most notably the transition from cost-based reimbursement to SNF prospective payment system (PPS).
    Research center: North Carolina Rural Health Research and Policy Analysis Center
    Topics: Aging, Hospitals and clinics, Long-term care, Medicare Prospective Payment System (PPS)

2004

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2002

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1999