Are Rural Healthcare Providers Prepared for COVID-19?

Despite a lag in the onset of coronavirus cases, rural communities are now under siege and wonder if their healthcare providers are prepared to deal with the health crisis.

Rural residents are often older, more economically disadvantaged and in poorer health when compared to urban and suburban residents.

As of May 24, rural counties now have some of the highest numbers of COVID-19 cases and rates of death in the U.S.

Rural hospital closures

Rural hospitals are the cornerstone of a community. Not only do rural hospitals provide access to care, but they provide employment opportunities and support the local economy.

Even before the pandemic, many of these rural hospitals were struggling with many challenges including low patient volume, sicker patient populations, and geographic isolation.

These factors have contributed to the decrease in the number of hospitals in rural communities. In the past 10 years, 128 rural hospitals have closed according to the Rural Health Research Program at the University of South Carolina. The pandemic pushed even more hospitals already in perilous economic situations over the edge by cutting off revenue from elective surgeries and routine procedures.

When a hospital closes, secondary impacts are felt throughout the community. The decreased access to care means fewer people receive preventative primary care. Jobs are lost, people move and take their tax dollars with them.

The hospitals that remain are literally few and far between. Rural hospitals labeled “critical access” centers are often long distances apart and difficult to reach. In order to provide routine healthcare during the crisis, rural hospitals have been utilizing telehealth options.

In addition to the logistical challenges, rural hospitals are not designed for pandemics. When patients require more intensive care, they are usually transferred to larger more sophisticated facilities that are better equipped. The same is happening during the pandemic. Critical access centers do their best to delay venting patients until transferring them to a larger facility with an adequate number of ventilators. Needless to say, this isn’t an easy thing to do.

Although the federal Opening Up America Again plan directs hospitals to have a robust testing program in place for at-risk healthcare workers, personal protection equipment and test kits are in short supply in rural counties. To further complicate matters, financially strapped rural hospitals have also had to lay off or furlough staff.

When rural hospitals were initially excluded from the Coronavirus Aid, Relief, and Economic Security (CARES) Act, the National Rural Health Association (NRHA) issued an urgent request to the federal government expressing concerns that “health staff is becoming sick, EMS shortages are extreme, and cash-flow problems are at crisis levels.” The request maintains that rural hospitals are small businesses and therefore qualify to be treated accordingly with cash infusions and loan forbearance. Rural hospitals finally received aid through the $10 billion rural COVID-19 relief fund.

With 20% of Americans receiving their healthcare at rural hospitals, maintaining the viability of these hospitals is critical to the future of rural healthcare.

M. Grano Jun 15, 2020