Another national study shows that urban nursing homes give better end-of-life care than small-town and rural nursing homes. The study looked at three measures of end-of-life: pain, in-hospital death, hospice referral. There was no difference for pain in rural or urban nursing homes. In-hospital deaths and low hospice utilization were more likely in rural and small town nursing homes.
This rings true with my experience. The small town nursing homes I worked at in my teen years had poorer staffing and less innovation than those I worked in as an adult in more urban areas. Hospices were few and covered huge territories. As a family member the end-of-life options for family living in small town and rural areas were few. Family members have lacked the palliative care options and choices available in urban settings.
It appears to be a phenomenon, “the only game in town”. That’s the senior care home, the hospital, the funeral home we have always used. It’s the only one. There are no choices or any competition creating a need for innovation.
Those of us in mid-life can use this as information for planning. Families living in different locations can use it to better choose the care for an ailing parent. Being the only game in town appears to work only for the provider.