Differences in Care Provided in Urban and Rural Nursing Homes in the United States: Literature Review.
Denise D Quigley, Leah V Estrada, Gregory L Alexander and 2 others
PMID 34846259WHAT IT FOUND
Rural nursing homes generally had poorer access to hospice and mental health care, more resident pain, and more hospitalizations than urban homes.
The review is descriptive and uses varied, older measures.
Key findings
01Most included studies found that, after controlling for resident and facility characteristics, rural nursing homes had poorer access to care and lower quality than urban nursing homes.
02Rural nursing homes had lower hospice use, higher in-hospital death prevalence, more hospitalization, and more moderate-to-severe pain than urban facilities.
03Rural facilities were less likely to have on-site mental health services and less likely to discontinue acetylcholinesterase inhibitors for residents with severe dementia.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
Only 10 studies were included, and many used data from 1995 to 2016, so current nursing home care may differ. Rural areas were defined differently across studies, from simple urban/rural labels to multiple rural categories, making comparisons hard. Quality of care was measured with different outcomes, so there was no single common quality metric. The included studies were non-randomized and facility-based, so they describe differences but do not prove why rural homes have poorer care. The CMS 5-star difference was small, with urban mean 3.5 and rural mean 3.4, and the authors said it may not be meaningful. Four articles were excluded as poor quality because they studied rural homes without urban comparison, so some rural observations were not included in the main synthesis.
Declared interests
All authors reported no conflicts of interest.
The easy way to misread this
Do not conclude that rural nursing homes cause worse care or that these patterns are current. The included studies are observational, many used data through 2016, and rural definitions and quality measures varied.