Acuity Differences Among Newly Admitted Older Residents in Rural and Urban Nursing Homes.

Document Type


Publication Date



long term services and supports, LTSS, rural, nursing homes, older adults, disability, home- and community-based services

Publication Title

The Gerontologist


BACKGROUND AND OBJECTIVES: Our primary objective was to assess rural-urban acuity differences among newly-admitted older nursing home residents.

RESEARCH DESIGN AND METHODS: Data included the 2015 Minimum Data Set v3.0, the Area Health Resources File, the Provider of Services File, and Rural-Urban Commuting Area codes. Activities of Daily Living, the Cognitive Function Scale, and aggression/wandering indicators were used to assess functional, cognitive, and behavioral status, respectively. Excluding assessments for short stays (less than 90 days), assessments for 209,719 newly-admitted long-stay residents age 65 and older across 14,834 facilities in 47 states were evaluated.Difference in differences (DID) generalized linear models with state fixed effects and clustering by facilities were used to assess the interaction effect of older age (75 plus) on rural-urban acuity differences, controlling for socioeconomic factors, admission source, and market characteristics.

RESULTS: Residents admitted to rural facilities were less functionally impaired (IRR: 0.973-0.898) but had more cognitive (OR: 1.03-1.22) and problem behaviors (OR: 1.19-1.48) than urban. Although older age was predictive of higher acuity, in DID models, the expected decline in functional status was comparable in rural and urban facilities, while cognitive and behavioral status for older admissions was 8.0% and 8.5% lower in rural versus urban facilities, respectively.

DISCUSSION AND IMPLICATIONS: Although the higher prevalence of cognitive impairment and problem behaviors among rural admissions were attributable in part to older age, rural facilities admitted less complex individuals among older age residents than urban facilities. Findings may reflect less capacity to manage older, complex individuals in rural facilities.


For more information on this study, please contact Dr. Jonk at yvonne.jonk@maine.edu

This work was supported by the Federal Office of Rural Health Policy, Health Resources and Services Administration [Grant Number U1CRH03716].

Funding Organization

Federal Office of Rural Health Policy, Health Resources and Services Administration, U.S. Department of Health and Human Services

Grant Number