The Urban-Rural Disparity in Nursing Home Quality Indicators: The Case of Facility-Acquired Contractures


Address correspondence to John R. Bowblis, Ph.D., Department of Economics and Scripps Gerontology Center, Farmer School of Business, Miami University, 800 E. High Street, Oxford, OH 45056; e-mail:



To identify and quantify the sources of the urban-rural disparity in facility-acquired contracture rates in nursing homes.

Data Sources

Survey inspection data of U.S. nursing homes from 1999 to 2008 and standardized national rural definition file from the Rural-Urban Commuting Area Codes.

Study Design

We estimated regressions of facility-level contracture rate as a function of urban-rural categories (urban, micropolitan, small rural town, and isolated small rural town) and other related facility characteristics to identify size of the urban-rural disparity. We used Blinder–Oaxaca decomposition techniques to determine the extent to which the disparity is attributable to the differences in facility and aggregate resident characteristics.

Principal Findings

Rural nursing homes have higher contracture rates than urban nursing homes. About half of the urban-rural disparity is explained by differences in observable characteristics among urban and rural nursing homes. Differences in staffing levels explain less than 5 percent of the disparity, case-mix explains 6–8 percent, and structure and operational characteristics account for 10–22 percent of the disparity.


While a lower level and quality of staffing are a concern for rural nursing homes, facility structure and funding sources explain a larger proportion of the urban-rural disparity in the quality of care.