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American Journal of Hospice and Palliative Medicine®
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Urban and rural differences in end-of-life pain and treatment status on admission to a nursing facility

Jane Nelson Bolin, PhD, JD, RN

Department of Health Policy and Management, Texas A & M University School of Rural Public Health, Bryan, Texas

Charles D. Phillips, PhD, MPH

Department of Health Policy and Management, Texas A & M University School of Rural Public Health, Bryan, Texas

Catherine Hawes, PhD

Department of Health Policy and Management, Texas A & M University School of Rural Public Health, Bryan, Texas

Individuals receiving end-of-life (EOL) care may have needs that are unrecognized or treated inappropriately. Yet, very little is known about differences in pain and special-care needs of EOL patients admitted to rural nursing facilities compared with urban nursing facilities, and whether the differing payer mix in urban and rural facilities affects the treatment ordered on admission. We examine a nationally representative sample of 6,084 EOL patients upon admission to nursing homes to examine differences in diseases, pain assessments, and treatment orders. We found that rural EOL residents have higher rates of congestive heart failure, cancer, renal failure, and emphysema than urban EOL residents and are significantly more likely to report frequent pain, however, they are less likely to receive treatments such as IV medications, dialysis, and wound care.

Key Words: End of life • nursing facilities • minimum data set • rural • terminal illness

American Journal of Hospice and Palliative Medicine®, Vol. 23, No. 1, 51-57 (2006)
DOI: 10.1177/104990910602300109
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