title: Differences between newly admitted nursing home residents in rural and nonrural areas in a national sample.
abstract: OBJECTIVE
  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.
  
  
  METHODS
  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.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: 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. jbolin@srph.tamhsc.edu
authors.forename: Jane Nelson
authors.initials: JN
authors.lastname: Bolin
authors.forename: Charles D
authors.initials: CD
authors.lastname: Phillips
authors.forename: Catherine
authors.initials: C
authors.lastname: Hawes
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D002675:Child, Preschool; D003953:Diagnosis-Related Groups; D005260:Female; D006707:Homes for the Aged; D006801:Humans; D007223:Infant; D007902:Length of Stay; D008297:Male; D006278:Medicare; D008875:Middle Aged; D009735:Nursing Homes; D010343:Patient Admission; D012424:Rural Population; D014481:United States; D014505:Urban Population