Researchers at Minnesota's Rural Health Research Center interviewed 23 rural discharge planners about the biggest medical challenges to nursing home placement for rural residents. More than half of those interviewed pointed to behavioral health problems as the leading barrier.
Why it matters: With long-term care moving toward home- and community-based settings, nursing homes are taking on more medically complex residents. Rural America is aging faster than non-rural areas, so the barriers to nursing home care will only become more entrenched.
To learn more, researchers conducted telephone interviews with 23 rural hospital discharge planners from Georgia, Idaho, Minnesota, Pennsylvania, and Wisconsin. Discharge planners came from nursing or social work backgrounds. 22 of them worked in a Critical Access Hospital, and one worked in a rural Prospective Payment System hospital.
What medical conditions are the greatest barriers in nursing home placement for rural residents?
- 52% of discharge planners stated behavioral health/psychiatric disorders, due to shortage of skilled staff, lack of beds for geriatric psychiatric care, and bureaucratic hurdles.
- 24% stated complex care needs such as feeding tubes, dialysis, and tracheostomies – time-intensive staffing needs that rural nursing homes often can't fulfill.
- 19% stated dementia due to scarcity of rural nursing homes with memory care units.
- 5% stated obesity due to nursing home weight limits (usually 350 lbs) as well as equipment, transportation, and facility access issues.
Across all four medical conditions, rural discharge planners recommend:
- additional training requirements for nursing home staff
- new processes for approving nursing home placement at the state and county level
- reducing Medicare's three-night hospital inpatient stay requirement
- increased rural nursing home capacity, especially for residents with behavioral health problems and/or dementia.
Cited Work: Henning-Smith C, Casey M, Prasad S, Kozhimannil K. Medical Barriers to Nursing Home Care for Rural Residents. Rural Health Research Center at University of Minnesota; 2017.