Q&A: Rural hospital closures

Q: Healthcare in rural communities remains an issue. Hospitals in rural areas continue to close at an alarming rate, creating problems for many communities across the U.S. How can these communities respond, and what role can case managers play in this response?

A: Without federal government interventions, the solutions must be grounded in the community. It's a good idea to appeal to state senators to see what can be done on the local level, says June Stark, RN, BSN, MEd, adjunct instructor at HCPro and an adjunct professor at Regis College in Weston, Massachusetts. Another consideration is creating more school clinics for preventive care and accommodating all family members at a wellness center. One rural hospital prevented its closing by creating a wellness gym and charging patients a monthly fee, Stark says. Another successful approach aims to build a relationship with ambulance and helicopter companies to transport critically ill patients across the state to the closest hospital. A training program for a large team of EMTs enhances the service value of this endeavor.

Community case management programs are an innovative option, too. Chronically ill patients, such as complex cardiac patients dealing with difficult-to-control diabetes and morbid obesity, comprise the high-risk populations in many rural communities. Case managers are experts in managing these patient populations, as well as others. Working singly or in teams, case managers can coordinate preventive care and minimize acute episodes of patient care. Their goal is to maintain these patients in the communities, limiting their need to be hospitalized. The nurse case manager is an asset in this situation.

For more on this topic, see the March issue of Case Management Monthly.