Rural hospitals in US hit by pandemic

Competing for talent

In Montana, the number of COVID-19 cases has surged in recent weeks, with more than 1,000 new infections often reported each day. Over 100 traveling nurses and respiratory therapists arrived last month to help ease staff shortages at hospitals overwhelmed by the disease.

Rich Rasmussen, president of the Montana Hospital Association, told MTN News that a total of 278 additional nurses and respiratory therapists would arrive on a contract with NuWest Group of Bellevue, Washington.

"We're competing with the entire country. Every state is on fire with the COVID surge. Everyone is scrambling to get more workers into their respective states, so we're competing with that exact, same talent," Rasmussen said.

The governor's office in Montana said the state arranged the contract with NuWest and would shoulder the cost through Dec 31, but may be eligible for reimbursement by the Federal Emergency Management Agency. The cost should ultimately be covered by the agency and federal COVID-19 relief funds, the office said.

Rasmussen said major hospitals in Montana have been overwhelmed not only by COVID-19 patients, but also by shortages of staff members, as so many healthcare workers have either contracted the virus or been in contact with someone who has, requiring them to be quarantined.

However, healthcare officials said traveling nurses threaten to shift the supply toward more-affluent areas, leaving rural and urban public hospitals short-staffed as the pandemic worsens.

"That is a huge threat," said Angelina Salazar, CEO of the Western Healthcare Alliance, a consortium of 29 small hospitals in rural Colorado and Utah.

Most rural hospitals cannot afford high payments for traveling nurses, and even if they could, rural communities in states with extreme weather conditions in winter are not as attractive as other areas for them.

Tim Blasl, president of the North Dakota Hospital Association, said: "When you get into the winter season, does it become maybe more of a challenge? It could."

John Henderson, chief executive of the Texas Organization of Rural and Community Hospitals, said fewer than half the rural hospitals in the state perform surgeries or deliver babies. As urban hospitals fill up, this puts pressure on smaller facilities to find beds for patients in crisis.

"When you're a small, rural, isolated hospital and you have a patient that exceeds not just your staffing capability but your scope of services capability, that becomes really hard," Henderson said.

Most rural hospitals are not equipped to handle the most serious COVID-19 cases. Many do not have intensive care units or enough doctors and other staff members to cope with multiple patients who require such care. This means that these patients have to be transferred to bigger hospitals.

Robert Hancock, a doctor working at several hospitals in Texas and Oklahoma, and also president of the Texas College of Emergency Physicians, said one of these hospitals recently admitted a patient with COVID-19 and many other medical problems who needed specialized care.

"We called every hospital in Oklahoma that had the capability we needed and every hospital system in Dallas-Fort Worth, Little Rock, Lubbock, Amarillo and Wichita Falls," Hancock said.

"Over about an eight-hour period, we got told 'no' by everybody. We wound up having to keep the patient and just do the best we could with the resources we had."

With winter arriving, the threat of snow, icy roads and the flu season－coupled with rising infections－could worsen an already bad situation in many states.

Administrators said efforts by hospitals to handle the pandemic and slow its spread have meant a trade-off－the cancellation of elective surgeries, one of the hospitals' most lucrative income streams－which threatens to hasten the closure rate for small hospitals.

Alan Morgan, head of the National Rural Health Association, recently told Kaiser Health News that if the short-term cash needs of rural hospitals were not addressed, hundreds of them would close before the pandemic ended.

Henderson said cash-strapped hospitals in rural Texas are having to make layoffs in order to pay their employees.

Well before the latest surge in COVID-19 infections, the profitability of rural healthcare had collapsed nationwide due to a combination of narrowing Medicare reimbursement and more patients lacking any other form of health insurance, as they were unemployed. More than 120 rural hospitals have been forced to close over the past decade, according to state hospital associations.