The impact of rural residence on multiple hospitalizations in nursing facility residents

Purpose: This study explored issues surrounding hospitalization rates among rural and urban nursing facility (NF) residents. Design and Methods: Data from the Minimum Data Set (MDS+) collected by states participating in the national Multi-State Case Mix Demonstration were used to assess whether rural NF residents experience higher rates of hospitalization compared with urban residents and to understand the extent that resident, facility, and market/area characteristics contribute to these differences. Results: Rural NF residents were more likely than urban residents to have multiple hospitalizations. Further analysis demonstrated that the effect of rural residence on the probability of multiple hospitalizations is greater among newly admitted rural residents than among rural residents not classified as new admissions. In addition to rural residence, other factors associated with an increased likelihood of multiple hospitalizations included state of residence, diagnosis of congestive heart failure, and no discharge planned at the time of NF admission. Implications: The findings of this study have important implications for both clinical care and health policy related to the financing and administration of NFs.