Increased demands on nursing homes for more diversified and technically complex services pose
particular challenges for rural facilities. Because coordinating mechanisms have been proposed
as a management strategy to deal with these issues, we studied the relationship between
interorganizational linkages and shortages of personnel and services in a sample of 152 rural
Pennsylvania nursing homes. Significant shortages of health care personnel that are central to
long-term care were reported, as were shortages of services, especially for ventilator-dependent
and demented residents. Although no evidence exists that coordination efforts were effective
remedies to these problems in early 1992, it is apparent that managing patient/resident flows
between hospitals and nursing homes through contractual agreements and other forms of
"coordination" was identified as a strategy. Further research is required to assess the effectiveness of these types of agreements in terms of ensuring the continuity and quality of long-term
care services in rural areas.
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