The healthcare crisis in rural areas is growing. As the COVID-19 pandemic spreads, urban hospitals are struggling to keep up with an influx of patients, but in rural areas many hospitals are sitting nearly empty.
“Obviously for rural areas that were already vulnerable, this pandemic has certainly further exposed a lot of the vulnerabilities of a health care safety net system that was struggling before the pandemic hit,” says Amy Elizondo, VP of program services at National Rural Health Association.
Elizondo says as the situation worsens, and outpatient procedures are put on hold, already struggling hospitals may be a causality of COVID-19.
“This year alone, 10 hospitals have already closed, which is higher than the rate of closure for 2019,” she says. “2019 had been the record year of hospital closures, but we’ve already surpassed that and we're only in the month of May.”
Rural hospitals from Oregon to Virginia are feeling the impact of COVID-19. The local healthcare systems are often the only medical lifeline for residents and now are becoming even more financially fragile.
"It's been devastating,” says Dr. Donovan Beckett, Physician, Williamson Memorial Hospital. “I mean, having COVID on top of an already struggling healthcare system has been quite burdensome."
After filing for bankruptcy late last year, the hospital was hoping a future partnership could save it. Then COVID-19 hit, and it changed.
“It was the last straw the current owners decided that they would go ahead and pursue closing the hospital,” he says.
Elizondo says Beckett’s hospital isn’t alone as many rural hospitals are financially breaking.
“There were 453 hospitals that were already vulnerable to closure prior to this and over 200 were extremely vulnerable,” she says. “Those are the ones that we're really trying to monitor going forward.”
Wendy Apland is the CFO of a hospital 80 miles east of Portland, Ore. She says their hospital is “fiercely independent,” and have been that way for more than 100 years. And with just over 900 employees, Mid-Columbia Medical Center in The Dalles, Ore. is the area’s largest employer.
“Our first patient presented with possible COVID-19 diagnosis on March 2nd,” she says.
That diagnosis came in the beginning of March, and was in the very early stages of the pandemic in the U.S. She says the hospital stepped up to answer the need.
“We had 33 staff that we were paying to basically quarantine,” she says. “Then, of course, our regular staff, too, so we've had double the expenses.”
The hospital saw those expenses double as the cost of supplies was also going up.
“At one point, we were down to about three days of masks,” Apland adds.
She says in order to respond to what they thought would be a surge of COVID-19 cases, the hospital erected temporary shelters, which also added to their costs. With only 13 confirmed cases in their county today, the rural hospital is now forced to furlough a portion of its workforce.
“We've been in the process of asking staff to take time off without pay,” she says. “We effectively went on a furlough of about 25 percent of all of our team for the month of May.”
She says the biggest hit came in the form of the state’s executive order restricting elective surgeries, which is a large portion of the hospital’s business.
“We’re about 25% inpatient and 75% outpatient, so it's significant,” she says.
It’s an issue rural hospitals in Texas are also facing.
“We're still, still doing what we can to keep these rural hospitals open, and it's a real struggle,” says Sid Miller, the Texas Agriculture Commissioner.
He says rural healthcare was already struggling in Texas before COVID-19 hit, and now it’s even worse.
“The supplies have gone up from these rural hospitals cost wise; we've got to keep the doors open,” says Miller.
He says keeping the doors open is becoming even more of a challenge but hopes recently announced funding will help.
“We were at the point where 60 of these rural hospitals only had two week’s worth of cash left,” he says.
The relief package Congress passed last month provided temporary relief to rural hospitals, with $100 billion in funds for hospitals and other healthcare providers, as well as other waivers.
“We're hopeful that going forward that some of these waivers can become permanent so that it does help hospitals succeed in the long term, but also because we don't see the pandemic going away anytime soon until there's a vaccine and better treatments,” says Elizondo. “In that regard, we're hopeful that we can look at some of these changes and that have been used to help ease some of the burden on rural hospitals can become more permanent in the future.”
More help may be needed, as healthcare providers say the current relief isn’t enough.
"We were a vulnerable and remain a vulnerable and are probably now a more vulnerable rural hospital because there's no foundational change,” says Dr. Randy Tobler, CEO and Physician, Scotland County Hospital.
As rural residents know, access to healthcare is key and some are now reaching out and doing whatever they can to make sure their local hospital is permanently planted.
“One lady called me in to see if she wanted the address of the clinic in Calhoun County, Texas,” says Miller. “She wanted to donate her stimulus check to keep that clinic open. That's powerful stuff.”