The last two decades have seen a general decline in the availability of both acute and long term care services in rural areas of the US.  The numbers of community general hospitals available in rural towns have continued an earlier downward slide, the size of those hospitals has significantly declined, and post-acute care for the elderly, whether in the form of nursing home beds or home health assistance, has become more difficult to access.  The “safety net” of services for the country’s rural elderly has never been very strong;  today that fabric has become even thinner, with a considerable number of tears.

This research project has focused on an important aspect of that safety net:  the organizational connections between acute-care facilities (hospitals) and long-term care services.  We have built this project on a longitudinal dataset of information about community characteristics, changes in regulatory policies, and rural hospital structures and strategies to either link to long-term care (LTC) providers in the community or provide those services in-house.  Our project goals have emphasized a number of questions:  1) What leads some rural hospitals to link in a meaningful way to local providers of LTC?  2) What impact do different linkage strategies have on the cost and patterns of care in rural areas?  3) How have such LTC strategies changed over time either as a result of federal changes in regulation and reimbursement, or because of characteristics of the rural hospital itself? 

At the launch of this website, we have finished all data collection, but we are still involved in analysis of our data to answer the questions above, as well as others.  To find out more about our project history, methods, and findings, use the menus at either side of this page.

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Brown University | Brown Medical School | Department of Community Health
© 2006 The Center for Gerontology & Health Care Research.  Last edited October 26, 2006.
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