Reliance on nursing homes has declined across Oregon for decades as people turn to assisted living, residential care, and foster homes.

In rural Oregon, however, nursing homes remain a key fixture in health care, providing what no other residential facility can — around-the-clock nursing care. Yet nursing home operators say state policies are to blame for weakening rural nursing homes, which by virtue of their location face higher costs.

Some nursing home operators say state workers steer consumers away from nursing homes or press residents to move out sooner than they should. Administrators now worry about lack of access to care outside urban areas.