Editor’s Note: This post is from our data newsletter, the Rural Index, headed by Sarah Melotte, the Daily Yonder’s data reporter. Subscribe to get a weekly map or graph straight to your inbox.
This edition of the Rural Index was produced and written by Helen-Margaret Onuorah, a recent graduate of the MD/MPH program at the University of Texas Medical Branch. The following analysis was a partnership between the Daily Yonder and Onuorah, who will begin attending the University of Texas Austin Dell Medical School for her Neurology residency this summer.
Across Texas, rural nursing homes rank slightly better on health inspection and staffing ratings compared to urban nursing homes, according to a Daily Yonder analysis of data from the Centers for Medicare and Medicaid Services (CMS).
The CMS Provider Information database provides information on quality inspections for the more than 1,100 nursing homes across Texas and the country. In this edition of the Rural Index, we examined the urban and rural differences in staffing and health inspection ratings for nursing homes in Texas.
People living in rural communities often face limited healthcare access due to fewer healthcare providers and longer distances to higher-level care. These challenges are an even greater threat to the aging population, who require more complex and long-term care due to a higher burden of chronic disease and multimorbidity.
These rural healthcare challenges illustrate the importance of tracking the quality of care in nursing facilities. We zoomed in on Texas because I was born and raised in Texas, and I will complete my medical training here. It was important for me to get a better understanding of the rural landscape of medicine in Texas.
The following map shows all the nursing homes in Texas, alongside their quality ratings. The CMS assigns their quality ratings on a 5-star scale, with a 5-star rating indicating the highest quality and a 1-star rating indicating the lowest rating. Click here for an interactive version of the map to toggle back and forth between the inspection ratings.
Click here for the interactive map.
Urban Nursing Homes Fare Worse on Staffing Ratings
Nearly 70% (818) of the 1,176 nursing homes in Texas are located in metro areas. One might assume that these urban-located nursing homes meet or exceed staffing capabilities in order to meet the demand of the high population, especially in Texas, which also faces a rapid growth of its aging population. But that’s not necessarily the case. Populous areas do not guarantee fully-staffed medical facilities.
CMS assesses staffing based on six metrics, including things like hours that nurses work per resident per day and staff turnover, among other factors.
Nearly 90% (760) of the 851 urban nursing homes that provide data on staffing have a 3-star rating or less. Most urban nursing homes in Texas (71%) have a 2-star staffing rating or less, further highlighting the shortcomings in nursing home staffing across the state.
Eighty-four percent of rural nursing homes, on the other hand, have a 3-star staffing rating or less.
The Covid-19 pandemic exacerbated these staffing shortages by increasing the already-high turnover rates, causing illness among staff, and increasing the demand for employment competition in hospitals.
Despite the better staffing ratings in rural nursing homes, reporting by the Texas Tribune revealed that nearly two-thirds of the nursing homes that have closed since 2018 were located in rural areas.
Texas state officials have recognized the plight of rural nursing homes, evidenced through the enactment of the Texas Rural Nursing Recruitment & Retention Program (RNRR), which offers $15,000 stipends in an effort to incentivize the recruitment and retainment of nurses in rural medical establishments, including nursing homes and assisted living facilities.
But these stipends are only short-term; once the stipend runs out, nurses in rural areas are still left with facilities that are paying uncompetitive wages and that have less-equipped infrastructure compared to nursing homes in urban areas.
Health Inspection Ratings Were Higher in Rural Facilities
While the better staffing ratings in rural areas compared to urban areas was unexpected, the health inspection data is what really stood out to us. We observed that rural nursing homes tended to have higher health inspection ratings compared to urban nursing homes in Texas.
As seen in the figure above, rural nursing homes tend to have smaller percentages of 3-star or fewer health inspection ratings compared to urban nursing homes. This equates to a greater percentage of 4- and 5-star health inspection ratings for rural nursing homes compared to urban nursing homes, 48% and 27% respectively.
The CMS reports health inspection ratings based on nursing home surveys and complaint surveys, as well as major health deficiencies and infection control. The CMS database does not go into detail in terms of the types of the health deficiencies identified. Whatever the reason, it is nice to see that rurality has a rare edge in at least one area of the healthcare system.
Overall, things are not so black and white; nursing homes in Texas urban areas do not guarantee stellar staffing ratings, and Texas rural nursing homes, while they face their persistent issues with staffing, perform better on inspections.
Our mapping project shows that where you live in Texas not only affects access to healthcare, but it also can influence the quality of care you receive. For the aging population, this is also a matter of quality of life, independence, and dignity. The preservation of these things requires more sustainable solutions that directly address the infrastructural disparities between rural and urban healthcare facilities, ensuring a healthier and secure future for aging Texans.
The post In Texas, Rural Nursing Homes Outperform Urban Facilities on Some Key Metrics appeared first on The Daily Yonder.
