Variations in nursing home discharge rates for urban and rural nursing facility residents with hip fracture.

Context: The more limited availability and use of community-based long-term care services in rural areas may be a factor in higher rates of nursing home use among rural residents.

Purpose: This study examined differences in the rates of nursing home discharge for older adults receiving posthospital care in a nursing facility.

Methods: The study sample was comprised of a cohort of rural and urban residents newly admitted to nursing home care in Maine following surgery for hip fracture.

Findings: The results indicated that rural residents who were hospitalized for hip fracture and subsequently admitted to a nursing facility for rehabilitation were significantly less likely than urban residents to be discharged within the first 30 days of their admission. Rural residents who stayed in the nursing facility beyond 30 days were also less likely to be discharged in the first 6 months. These geographic differences were not explained by service use and resident characteristics such as age, health, or functional status.

Conclusions: The finding of lower discharge rates among rural nursing facility residents appears to be consistent with previous studies demonstrating higher rates of nursing home use among rural residents. There continues to be a need for a better understanding of the role that service supply and accessibility and other factors play in the patterns and outcomes of rural long-term care.