Although many skilled nursing facilities face the challenge of increasing and maintaining their census, rural facilities are against some fairly steep odds in doing so. They also face other unique problems that many skilled nursing facilities don’t. Despite this, there are some interesting opportunities for skilled nursing facilities that are far from urban or suburban areas.
Rural Nursing Home Residents: A Snapshot
To better understand the challenges and opportunities faced by rural nursing homes, it’s good to get an overall picture of the residents who live in them.
1. Older and Sicker
On average, rural residents are older than urban residents and they have greater underlying health conditions or comorbidities. They also have higher rates of disability, requiring more one-on-one care, especially with activities of daily living like bathing, eating, and dressing.
2. Fewer Resources
Residents from rural America have fewer resources including lower incomes, higher poverty rates, and little to no health insurance. Characteristics like these are generally associated with poorer health outcomes, more chronic illness, increased rates of obesity and dementia.
Organizational and Operational Challenges
Companies operating in rural areas are faced with greater challenges than those in urban/suburban areas.
1. Smaller Talent Pool
Due to lower population density in these areas, facilities face recruiting, hiring, retaining and training difficulties far more than those in bigger cities around the country. Many younger people leave and move away for greater financial opportunities, leaving an aging-in-place population behind.
2. Census Struggles
Relying on smaller populations to build and maintain census leads to constant financial strains on the facility’s budget and profitability. Rural residents with less income and resources generally rely on state funds to pay for their stay, which are very low in certain rural areas of the country.
3. Fewer and Smaller Rural Hospitals
To make matters worse, hospital corporations have either down-sized or completely shut down small rural hospitals across the country. Generally speaking, hospitals are one of the most important sources of referrals to nursing homes and without them, fewer admissions will take place leading to more empty beds.
4. Care Coordination Issues
Having fewer to no hospitals and other care options including mental health, social services and medical specialists creates incredible challenges in coordinating care between facilities and other needed services. Driving distances and lack of transportation make the challenges even greater. Most rural nursing homes have been found to be at least twice as far from a hospital than those in cities.
Challenges in Providing Care
Besides the many issues faced by facilities, staff working in rural nursing homes are faced with a unique set of challenges in providing high quality and consistent care.
1. Special Care Needs
Care staff are challenged to provide high quality care to residents who are older, frail, have multiple chronic health conditions, and are diagnosed with dementia. Training in these areas may be lacking due to fewer resources or specialists in the area. Other areas presenting unique challenges to rural care staff include residents with:
- Memory loss
- Mental and behavioral health issues
- Wound care needs
- Trach care needs
- IV antibiotics or tubing requirements
- Cardiac problems
- Obesity
- COPD
- Cancer
- Diabetes
- Parkinson’s disease
2. Quality and Consistency in Care
Employee turnover in any nursing home can be disruptive to the team as well as quality of care. In rural facilities, it can be particularly troublesome. Many rural nursing homes are working short-staffed as is, and any loss will make matters worse. Quality and consistency in care can suffer with turnover. It can also decrease morale, lead to greater staff stress and burnout and higher turnover.
3. Equipment and Space
Another challenge to care staff is a lack of specialized equipment needed to provide necessary care and enhance the quality of care they provide to their residents. For instance, providing care to residents who are considered obese requires a variety of bariatric care equipment as well as the physical space to provide care and services. Examples of bariatric care equipment include larger beds, wheelchairs, scales, and clothing which are all more expensive than average-sized items. Bariatric residents may also require larger bathrooms, commodes and a single room.
Opportunities
While there is no shortage of problems, issues and challenges facing today’s rural nursing home, there are some unique and promising opportunities to make care and life better. Thankfully there are trends in combining services that will provide more options, better coordination, and greater continuity across care settings.
1. Unlikely Care Partners
Leading the way to improve rural nursing home care are churches and other faith-based groups, community colleges and rural community hospitals. Services provided by these collaborators include providing:
- Management and financial expertise and resources
- Training for direct care staff
- Sharing evidence-based practices (fall prevention and medication compliance)
2. Integrated Care Approaches
Experts around the country are working to create a better system that will provide much needed resources and services to rural nursing homes. They are building on both formal and informal partnerships to deliver what these facilities need the most. New models of care are being developed and include:
- Resource and referral services
- Care management programs
- Fully integrated care delivery systems
- Home- and facility-based services
Keys to Success
In order to successfully develop and sustain care and services in rural elder care settings, a few key components are required to accelerate the process. Many experts agree that a strong community infrastructure, community-based providers, care coordination systems, informed consumers and families, and partnerships can all be helpful in lifting today’s rural nursing home to a better place.
Final Thoughts on Life in Rural Nursing Homes
While there are certainly a number of challenges facing rural nursing homes, their staff and residents, there are a number of creative solutions that can attract better prepared staff, increase census, enhance quality and consistency of care, and ultimately make these rural places a good place to live for older rural Americans.