Rural healthcare continues to be a key policy focus, and rural areas face greater nutrition risks, too. More than 1 in 5 older Americans live in rural areas and 9 out of 10 of the top 10 U.S. counties with the highest food insecurity rates are rural. People in rural communities are as diverse as the places they call home. However, they have several common barriers to good health and nutrition. A new article in OBM Geriatrics outlines how quality malnutrition care can help improve rural health outcomes and health equity for older Americans.
Rural hospitals provide essential care. More than half of all U.S. hospitals are in rural areas and a large portion of primary care occurs in rural hospitals as there are only three quarters as many rural primary care providers as in urban areas. Many rural residents may have fewer choices to buy fresh and affordable food due to more limited transportation options compared to their urban counterparts. Older adults in rural communities are at a higher risk of malnutrition because they have higher rates of poverty, multiple chronic health conditions and more disabilities compared to older adults in urban communities. It is not surprising then that the highest rates of hospitalization for malnutrition have been in rural areas.
Opportunities for Quality Measurement
Many of the health and nutrition obstacles faced by rural healthcare providers and their patients are unique, but addressing malnutrition through quality measurement can yield benefits in health outcomes and health equity. Last year the Centers for Medicare & Medicaid Services (CMS) adopted a Global Malnutrition Composite Score in its Hospital Inpatient Quality Reporting Program as a health equity– focused measure to help address healthcare disparities in the hospital and beyond. The Composite measure will be available for hospital reporting in 2024.
In addition, the National Quality Forum included the Composite measure in its most recent key rural health measures list to advance rural health priorities. The Composite measure also could help rural hospitals meet The Joint Commission’s new requirements to reduce healthcare disparities.
Community partners can help address malnutrition, particularly if a rural hospital creatively improves access for elders.
The Global Malnutrition Composite Score measure was developed by the Academy of Nutrition and Dietetics and Avalere Health to measure quality malnutrition care delivered to patients ages 65 and older in the inpatient setting. It is made up of four components of the nutrition care process—malnutrition screening, nutrition assessment, malnutrition diagnosis, and a nutrition care plan, and is supported by the Malnutrition Quality Improvement Initiative tools and resources. Implementation of the Composite measure starts with initiating malnutrition quality improvement. In a rural setting this process can be enhanced by taking a collaborative approach, gaining administration buy-in, education, and tackling care transitions.
Community Partnerships for Action
Community partners can help address malnutrition, particularly if a rural hospital takes a creative approach in seeking solutions to overcome access limitations. One possible approach is to partner with other organizations that may include a focus on community health and wellness.
For example, Cooperative Extension professionals have identified the need to work with hospitals and doctor’s offices to support improved health and local county Cooperative Extension Offices may have staff available to help provide public education on healthy eating and nutrition. There also could be opportunities for rural healthcare providers to establish stronger partnerships and referral systems with local food banks. Other programs that can help support improved nutrition for older adults in the community include:
- Commodity Supplemental Food Program (provides food packages to income-eligible older adults through local agencies)
- Older Americans Act (OAA) congregate/home delivered meals programs (not income specific)
- Medicare Advantage programs that may offer coverage of home-delivered meals for specified time periods after hospital discharge
- Rural PACE (Program of All-inclusive Care for the Elderly) programs that may include meals in the services provided
With the many pressures rural healthcare providers must address, it may seem there is limited bandwidth for improving malnutrition quality care. However, using established frameworks and building community partnerships can help make the process less daunting. The MQii and the Global Malnutrition Composite Score measure can help provide a framework for developing malnutrition quality improvement programs in rural healthcare. With the unwinding of the Public Health Emergency and the reduction of SNAP benefits, these frameworks will be essential to identifying those at risk.
The Defeat Malnutrition Today coalition is developing a range of resources in 2023, to help enhance community partnerships to improve malnutrition quality care. Look for more news about these opportunities in the coming months.
Suzanne Fleming, MS, RDN, LD, is clinical dietitian at McPherson Hospital in McPherson, Kan. Bob Blancato, MPA, is national coordinator at Defeat Malnutrition Today in Washington, DC.
Photo: Mark A. Lee
Photo caption: Palouse, Wash., Steptoe Butte State Park.
