Rural residents face more barriers in finding long-term care

Henning-Smith

Rural residents tend to be poorer, older, and have more health issues, such as obesity, dementia, substance-abuse, and other behavioral and mental health problems. On top of that, they have less access to long-term care for those conditions, a phenomenon explored by Carrie Henning-Smith, an assistant professor at the University of Minnesota School of Public Health.

"Not being able to secure timely, appropriate nursing home care can lead to patients languishing in hospital settings for much longer than is necessary or appropriate," Henning-Smith told Charlie Plain of the university's public-relations office. "This can come at a high cost to individual patients, state and federal programs, and individual hospitals. The lack of choices can also lead to people being placed in settings far from their homes, which can make it difficult for loved ones to visit."

Henning-Smith's first study, published in the Journal of Applied Gerontology, looked at the barriers rural hospital discharge planners reported in finding nursing home care for non-elderly adults. A second study, published in the Journal of Aging & Social Policy, examined non-medical barriers that rural hospital discharge planners reported in finding nursing home care for rural residents.

Henning-Smith found that planners had trouble placing patients in long-term care mainly because of finances, lack of transportation, infrastructure, the availability of nursing homes, and timeliness in responding to referral requests. Some patients couldn't afford a nursing home because they made too much money to qualify for public assistance but too little money to pay for treatment. Also, some younger patients felt they wouldn't fit in well at a nursing home full of seniors. Some patients had to be placed in a long-term care facility because they didn't have a family member able to act as a caregiver. And discharge planners had a hard time finding rural placements for patients with complex medical problems that required specialized care.

"There are a variety of ways to improve access to appropriate long-term care for rural residents, including addressing long-term care workforce shortages — especially for people without loved ones to care for them," Henning-Smith said. "They also need to look at addressing infrastructure in rural areas — including the availability of non-emergency transportation — and support ways to provide long-term services and assistance in settings other than nursing homes if a patients’ medical and psychosocial needs can more appropriately be met at home."