Federal and state regulators and the nursing home industry have accelerated efforts to improve
care practices in response to the Institute of Medicine's 1986 report on the quality of nursing
home care and the federal Nursing Home Reform Act of 1987 (OBRA 1987). Very little is known
about the quality of care in rural nursing facilities compared to their urban counterparts. This
study describes variations in facility and resident characteristics of urban and rural nursing
facilities in Maine and examines differences in outcomes of care. The study estimates rural-urban
differences in 11 quality indicators (measured at the facility level) controlling for resident,
facility, and market characteristics and other factors that may affect quality. Results reveal few
significant differences between rural and urban nursing facilities. Further research is needed to
understand whether differences in the characteristics of rural and urban facilities not measured
in this study may affect nursing facility quality.
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