Abstract:

Home health nursing has experienced phenomenal growth throughout the last decade, and often serves as an alternative to institutionalized care. There is a paucity of information describing the dynamics of home health nursing in rural areas, despite the potential for an accelerated demand stemming from an aging population and the closure of rural hospitals. The purpose of this study was to describe the home health nursing services offered in the rural state of North Dakota as well as to identify barriers to the delivery of these services. The study also explored the functional status of rural and urban nursing home residents in counties providing varying levels of home health services. Anderson's "Facilities Use Health Services" served as a theoretical framework for a three-stage, multi-method study. Stage one relied on secondary data to describe demographic and health beliefs which predispose the use of home health services in the setting. Stage two employed Dillman's Total Design Method for mail services as a data collection procedure for surveying all directors of nursing in North Dakota home health agencies. The response rate was ninety-four percent. Stage three utilized the Functional Assessment Inventory to describe a purposive sample of rural and urban nursing home residents. Stratification of data by population density of the respondents revealed marked rural-urban discrepancies. The number of home health nursing services offered decreased with decreasing population density, while the number of barriers to service increased. Rural frontier areas reported the greatest numbers of barriers to the delivery of home health services. In addition, the specific barriers to home health services vary with rurality of the delivery area. Nursing home residents from the North Dakota rural county providing the greatest number of home health services were older and had higher levels of functioning than nursing home residents from the county providing the fewest services. Implications for nurses and policy are discussed.