The Regulatory Environment and Rural Hospital Long-Term Care Strategies From 1997 to 2003


  • This study was supported by a grant from the National Institute on Aging, AG13987. We acknowledge and thank Yuwei Cang and Christopher Brostrup-Jensen for their assistance in data management and analysis. We also thank Vince Mor, Bruce Stuart, and 3 reviewers of The Journal of Rural Health for their helpful comments on earlier versions of this article.

For further information, contact: Mary L. Fennell, PhD, Center for Gerontology and Health Care Research, Brown University, Box G-ST211B, Providence, RI 02912; e-mail


ABSTRACT: Context: Since the passage of the Balanced Budget Act of 1997, rural hospitals have struggled with the need to strategically adapt to an abundance of changing reimbursement and regulatory programs, as well as to respond to the needs of an increasingly frail elder population in need of postacute and long-term care (LTC). Purpose: This article has 2 goals: (1) to provide a summary of the many legislative acts and provisions influencing rural hospital LTC strategies during the 1997-2003 period and (2) to track changes in the LTC strategies of a national sample of rural hospitals through this 7-year period. Methods: A 3-wave panel of rural hospital discharge planners in 540 nonfederal community-general hospitals were interviewed in 1997, 2000, and 2003. Questions focused on hospital structure, discharge planning process, and reports of internal and external organizational arrangements for providing LTC services to hospitalized patients, and changes in LTC strategy since the previous interview. Descriptive statistics are presented on LTC strategies in place in 1997 and dropped or added in 2000 and 2003. Findings and Conclusions: The general shape of the regulatory environment confronting rural hospitals and their LTC strategies during the recent past can be described as complicated, rapidly changing, and at times contradictory in intended effects. There has been a large volume of strategy change during this 7-year period, without the emergence of any identifiable pattern or LTC strategy profile, other than swing-bed participation combined with home health agency ownership.