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Medical Barriers to Nursing Home Care for Rural Residents

Henning-Smith C, Casey M, Prasad S, Kozhimannil K

Rural residents with complex medical care needs (including behavioral health problems, obesity, and dementia) may face barriers when seeking placement in a nursing home, especially as rural areas have larger populations of older adults, higher disability rates, and greater health care workforce shortages than urban areas. This brief describes those barriers and identifies potential policy strategies to overcome them.

Key Findings:

  • Interviews with 23 rural discharge planners revealed that complex care needs, behavioral health/psychiatric disorders, dementia, and obesity pose the biggest medical challenges to nursing home placement for rural residents.
  • Of those challenges, behavioral health/psychiatric disorders were the most commonly cited barrier to finding timely, appropriate nursing home care.
  • Respondents’ suggestions to address challenges included:
    • increased funding for staff, training, and equipment;
    • additional nursing home beds;
    • easing administrative burdens associated with placement; and
    • changing Medicare’s three-night hospital inpatient stay requirement.

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