INTERORGANIZATIONAL LINKAGES AND SERVICE AND PERSONNEL SHORTAGES IN RURAL NURSING-HOMES

Increased demands on nursing homes for more diversified and technicall y complex services pose particular challenges for rural facilities. Be cause coordinating mechanisms have been proposed as a management strat egy to deal with these issues, we studied the relationship between int erorganizational linkages and shortages of personnel and services in a sample of 152 rural Pennsylvania nursing homes. Significant shortages of health cam personnel that are central to long-term care were repor ted, as were shortages of services, especially for ventilator-dependen t and demented residents. Although no evidence exists that coordinatio n efforts were effective remedies to these problems in early 1992, it is apparent that managing patient/resident flows between hospitals and nursing homes through contractual agreements and other forms of ''coo rdination'' war identified as a strategy. Further research is required to assess the effectiveness of these types of agreements in terms of ensuring the continuity and quality of long-term care services in rura l areas.