While struggling rural nursing homes must innovate to survive, their efforts would be bolstered by a federal program similar to one that provides additional funding and staff resources to challenged rural hospitals.

So says Mark McKenzie, CEO of Focused Post-Acute Partners, which operates 30 skilled nursing communities in Texas. Twenty of those are in rural areas, some in towns with as few as 3,000 residents.

McKenzie has spent more than 30 years in long-term care, a period that included nearly eight years at the helm of Senior Care Centers of America. During that time, he has seen a major shift in the costs of operating rural skilled nursing facilities, complicated by reimbursement that has failed to keep up with increased patient complexity. Add in a staffing crisis that has made costs explode, and many of his colleagues are questioning how they’ll keep their doors open.

“When we talk to our legislators and the public, there’s still that assumption that if you’re in a rural market, your cost of doing business is significantly less than what it is in your major metropolitan areas,” McKenzie told McKnight’s Long-Term Care News this month. “That just isn’t true, and our payroll bears that out …To get someone into our rural markets, you have to sweeten the pot and that’s in their pay and their benefits.”

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