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. 2025 Mar;41(2):e70026.
doi: 10.1111/jrh.70026.

Rural hospital closures and nursing home outcomes

Emmaline Keesee  1 , Tyler Malone  2 , Susie Gurzenda  2   3   4 , George Pink  2   3
Affiliations

Rural hospital closures and nursing home outcomes

Emmaline Keesee et al. J Rural Health. 2025 Mar.

Abstract

Purpose: Rural hospital closures since 2005 reached 194 this year, raising concerns for rural health care access. Little is known about the effects of facility closures on the local long-term care sector. This analysis models the relationship between rural hospital closure and nursing homes in the same county. We explore nursing home-level outcomes related to utilization and resident health.

Methods: Centers for Medicare & Medicaid Services Healthcare Cost Report Information System, LTCFocus, and NC Rural Health Research Program hospital closure datasets are used to conduct a difference-in-differences study of closures from 2012 to 2019.

Findings: We do not find evidence that hospital closure impacted non-hospital-based nursing home occupancy rate, proportion of Medicare paying residents, or average resident ADL score. However, hospitalizations per resident year declined by 0.13 following closure (95% CI: -0.24, -0.02), representing a change of 0.33 standard deviations from the grand mean. It is unclear if reduced nursing home hospitalizations reflect a reduction in emergent, urgent, or elective admissions.

Conclusions: Our results build on the existing body of hospital closure literature by highlighting the understudied role of hospitals in rural postacute and long-term care. To our knowledge, this was the first study examining the impacts of hospital closure on nursing homes. These findings are particularly relevant in the wake of COVID-19 as rural long-term care facilities and hospitals alike navigate exacerbated workforce and funding challenges.

Keywords: hospital closure; hospitalizations; long‐term services and supports; nursing homes; rural health.

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Conflict of interest statement

The authors report funding from the Federal Office of Rural Health Policy (FORHP), Health Resources and Services Administration (HRSA), US Department of Health and Human Services (HHS) under cooperative agreement # U1CRH03714‐10‐00. The information, conclusions, and opinions expressed in this manuscript are those of the authors and no endorsement by FORHP, HRSA, HHS, or The University of North Carolina is intended or should be inferred. Susie Gurzenda was supported by the NICHD of the National Institutes of Health under award number T32 HD091058.

Figures

FIGURE 1
FIGURE 1
Authors' visualization of conceptual framework relating hospital closure to non‐hospital‐based nursing home outcomes. ADL, activities of daily living; NHB, non‐hospital based.
FIGURE 2
FIGURE 2
Figure includes results of authors' analysis relating hospital closure to nursing home level outcomes. ADL, Activities of daily living.
See this image and copyright information in PMC

References

    1. Rural Hospital Closures: Affected Residents Had Reduced Access to Health Care Services. Report to the Ranking Member, Committee on Homeland Security and Governmental Affairs, United States Senate. 2021:1‐40. GAO‐21‐93. https://www.gao.gov/products/gao‐21‐93
    1. Rural Hospital Closures. Cecil G. Sheps Center for Health Services Research. Accessed April 16, 2025, https://www.shepscenter.unc.edu/programs‐projects/rural‐health/rural‐hos...
    1. Croll Z, Gale J. community impact and benefit activities of critical access, other rural, and urban hospitals. University of Southern Maine, Flex Monitoring Team. 2020;2022:1‐6.
    1. Rural Hospitals. Rural Health Information Hub . Updated 2/10/2022. https://www.ruralhealthinfo.org/topics/hospitals
    1. Health Care Capsule: Accessing Health Care in Rural America 2023 GAO‐23‐106651. Accessed November 26, 2024, https://www.gao.gov/products/gao‐23‐106651

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