Julie T. Fralich Mba

VARIATIONS IN OUTCOMES OF CARE IN URBAN AND RURAL NURSING FACILITIES IN MAINE

Federal and state regulators and the nursing home industry have accelerated efforts to improve care practices in response to the Institute of Medicines 1986 report on the quality of nursing home care and the federal Nursing Home Reform Act of 1987 (OBRA 1987). Very little is known about the quality of care in rural nursing facilities compared to their urban counterparts. This study describes variations in facility and resident characteristics of urban and rural nursing facilities in Maine and examines differences in outcomes of care. The study estimates rural-urban differences in 11 quality indicators (measured at the facility level) controlling for resident, facility, and market characteristics and other factors that may affect quality. Results reveal few significant differences between rural and urban nursing facilities. Further research is needed to understand whether differences in the characteristics of rural and urban facilities not measured in this study may affect nursing facility quality.

Financing and payment issues in rural long-term care integration

A major concern with fee-for-service reimbursement is that it forces consumers into predefined categories of service, whether or not those services meet their needs. The urban response to these incentives has been to experiment with capitated Medicare and Medicaid payments that integrate acute and long-term care funding. Although the use of capitation payments has conceptual and intuitive appeal, this article analyzes whether it is feasible in rural areas. Integrated financing systems for rural areas must meet the specific goals of people served in the areas and be compatible with local market conditions. Full risk capitation may be most applicable to urban settings where managed-care infrastructures are better developed and where risk can be spread over large numbers of consumers. Alternatives to fully capitated financing are emerging and represent more viable approaches for rural communities.