Statewide Examination of Rural–Urban Differences in Assisted Living Facilities

OBJECTIVES: To compare facility characteristics between rural and urban assisted living facilities (ALFs). DESIGN: A descriptive, cross-sectional study. SETTING AND PARTICIPANTS: A convenience sample of 517 ALFs (143 rural) that included facilities from all public health regions in Texas. METHODS: analysis, and Mann-Whitney U tests. RESULTS: Overall, rural areas had relatively more Type A and fewer Type B facilities (the latter require 24-hour attendants) than did urban areas. Rural facilities (vs urban) also had significantly fewer Alzheimer's disease certifications and licensed beds. Provided services differed significantly between rural and urban facilities: urban facilities more often offered concierge, medical, and nursing services, whereas rural facilities more often provided transportation, wound care, and physical/occupational therapy. Antipsychotic use was high across all facilities (26.6%), but only 38.5% reported initiating gradual dose reductions. CONCLUSIONS AND IMPLICATIONS: Findings highlight rural-urban differences in service availability and dementia care. Combined with high rates of antipsychotic use, these findings suggest a need for policy reforms, especially as resident acuity in ALFs increases. Additional research is needed to improve ALF quality measurement and to better understand factors influencing care quality in rural and urban settings.