Rural Hospitals Are Caught in an Aging-Infrastructure Conundrum

Published

1 year ago

January 16, 2024

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Kevin Stansbury, the CEO of Lincoln Community Hospital in the 800-person town of Hugo, Colorado, is facing a classic Catch-22: He could boost his rural hospitals revenues by offering hip replacements and shoulder surgeries, but the 64-year-old hospital needs more money to be able to expand its operating room to do those procedures.

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I’ve got a surgeon that’s willing to do it. My facility isn’t big enough, Stansbury said. And urgent services like obstetrics I can’t do in my hospital, because my facility won’t meet code.

Besides securing additional revenue for the hospital, such an expansion could keep locals from having to drive the 100 miles to Denver for orthopedic surgeries or to deliver babies.

Rural hospitals throughout the nation are facing a similar conundrum. An increase in costs amid lower payments from insurance plans makes it harder for small hospitals to fund large capital improvement projects. And high inflation and rising interest rates coming out of the pandemic are making it tougher for aging facilities to qualify for loans or other types of financing to upgrade their facilities to meet the ever-changing standards of medical care.

Most of us are operating at very low margins, if any margin at all, Stansbury said. So, we’re struggling to find the money.

Aging hospital infrastructure, particularly in rural areas, is a growing concern. Data on the age of hospitals is hard to come by, because hospitals expand, upgrade, and refurbish different parts of their facilities over time. A 2017 analysis by the American Society for Health Care Engineering, a part of the American Hospital Association, found that the average age of hospitals in the U.S. increased from 8.6 years in 1994 to 11.5 years in 2015. That number has likely grown, industry insiders say, as many hospitals delayed capital improvement projects, particularly during the pandemic.

Research published in 2021 by the capital planning firm Facility Health Inc., now called Brightly, found that U.S. health care facilities had deferred about 41% of their maintenance and would need $243 billion to complete the backlog.

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Most of todays rural hospitals were opened with funding from the Hill-Burton Act, passed by Congress in 1946. That program was rolled into the Public Health Service Act in the 1970s and, by 1997, had funded the construction of nearly 7,000 hospitals and clinics. Now, many of those buildings, particularly those in rural areas, are in dire need of improvements.

Stansbury, who is also board chair of the Colorado Hospital Association, said at least a half-dozen rural hospitals in the state need significant capital investment.

Harold Miller, president and CEO of the Center for Healthcare Quality and Payment Reform, a think tank in Pittsburgh, said the major problem for small rural hospitals is that private insurance is no longer covering the full cost of providing care. Medicare Advantage, a program under which Medicare pays private plans to provide coverage for seniors and people with disabilities, is a major contributor to the problem, he said.

You’re basically taking patients away from what may be the best payer that the small hospital has, and pushing those patients onto a private insurance plan, which doesn’t pay the same way that traditional Medicare pays and ends up also using a variety of techniques to deny claims, Miller said.

Rural hospitals also must staff their emergency rooms with physicians round-the-clock, but the hospitals get paid only if someone comes in. The facility opened in 1959 after soldiers coming back from World War II decided that Lincoln County on the eastern Colorado plains needed a hospital. Now, management wants to expand it.(Lincoln Health)

Meanwhile, labor costs coming out of the pandemic have increased, and inflation has driven up the cost of supplies. Those financial headwinds will likely push more rural hospitals out of business. Hospital closures dropped during the pandemic, from a record 18 closures in 2020 to a combined eight closures in 2021 and 2022, according to the Cecil G. Sheps Center for Health Services Research at the University of North Carolina-Chapel Hill, as emergency relief funds kept them open. But that life support has ended, and at least nine more closed in 2023. Miller said closures are reverting to pre-pandemic rates.

That raises concerns that some hospitals might invest in new facilities and end up shutting down anyway. Miller said only a small portion of rural hospitals might be able to make a meaningful difference to their bottom lines by adding new services.

Lawmakers have tried to help. California, for example, has loan programs charging low to no interest that rural hospitals can participate in, and hospital representatives are urging Colorado legislators to approve similar support.

At the federal level, Rep. Yadira Caraveo, a Colorado Democrat, has introduced the bipartisan Rural Health Care Facilities Revitalization Act, which would help rural hospitals get more funding for capital projects through the U.S. Department of Agriculture. The USDA has been one of the largest funders of rural development through its Community Facilities Programs, providing over $3 billion in loans a year. In 2019, half of the more than $10 billion in outstanding loans through the program helped health care facilities.

Otherwise, facilities would have to go to private lenders, said Carrie Cochran-McClain, chief policy officer for the National Rural Health Association. More from the Mountain States

Rural hospitals might not be very attractive to private lenders because of their financial constraints, and thus may have to pay higher interest rates or meet additional requirements to get those loans, she said.

Caraveos bill would also allow hospitals that already have loans to refinance at lower interest rates, and would cover more categories of medical equipment, such as devices and technology used for telehealth.

We need to keep these places open, even not just for emergencies, but to deliver babies, to have your cardiology appointment, said Caraveo, who is also a pediatrician. You shouldn’t have to drive two, three hours to get it.

Kristin Juliar, a capital resources consultant for the National Organization of State Offices of Rural Health, has been studying the challenges rural hospitals face in borrowing money and planning big projects.

Theyre trying to do this while they’re doing their regular jobs running a hospital, Juliar said. A lot of times when there are funding opportunities, for example, the timing may be just too tight for them to put together a project.

Some funding is contingent on the hospital raising matching funds, which may be difficult in distressed rural communities. And most projects require hospitals to cobble together funding from multiple sources, adding complexity. And since these projects often take a long time to put together, rural hospital CEOs or board members sometimes leave before they come to fruition.

You get going at something and then key people disappear, and then you feel like you’re starting all over again, she said. Expansion of Lincoln Community Hospital could keep locals from having to drive the 100 miles to Denver for orthopedic surgeries or to deliver babies.(Lincoln Health)

The hospital in Hugo opened in 1959 after soldiers coming back from World War II decided that Lincoln County on the eastern Colorado plains needed a hospital. They donated money, materials, land, and labor to build it. The hospital has added four family practice clinics, an attached skilled nursing facility, and an off-site assisted living center. It brings in specialists from Denver and Colorado Springs.

Stansbury wold like to build a new hospital roughly double the size of the current 45,000-square-foot facility. With inflation easing and interest rates likely to go down this year, Stansbury hopes to get financing lined up in 2024 and to break ground in 2025.

The problem is, every day I wake up, it gets more expensive, Stansbury said.

When hospital officials first contemplated building a new hospital three years ago, they estimated a total project cost of about $65 million. But inflation skyrocketed and now interest rates have gone up, pushing the total cost to $75 million.

If we have to wait another couple of years, we may be pushing up closer to $80 million, Stansbury said. But we’ve got to do it. I can’t wait five years and think the costs of construction are going to go down.

Markian Hawryluk: MarkianH@kff.org, @MarkianHawryluk Related Topics Health Industry Rural Health States California Colorado Hospitals Contact Us Submit a Story Tip

Entertainment

Urdd Eisteddfod: Why Strictly star Amy Dowden is supporting Welsh festival that is ‘like Britain’s Got Talent’

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1 hour ago

May 26, 2025

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Urdd Eisteddfod: Why Strictly star Amy Dowden is supporting Welsh festival that is 'like Britain's Got Talent'

Thousands of people are expected to attend Port Talbot this weekend as the town gears up to welcome an annual Welsh festival.

The Urdd Eisteddfod is a celebration of Welsh culture when children and young people up to the age of 25 take part in a variety of competitions.

There are 400 of them in total, including singing, reciting poetry and dancing.

The Urdd organisation itself was established more than a century ago in 1922, with the aim of giving children and young people in Wales the opportunity to learn and socialise in the Welsh language.

Its six-day Eisteddfod is held during May half-term and in a different part of Wales each year.

The Urdd Eisteddfod broke its own records last year, with more than 100,000 registrations to compete.

Margam Park is home to this year’s event – the first time since 2003 that it’s played host.

Among the main prizes up for grabs this year are the chair (awarded to the main poetry competition winner) and the crown (awarded to the main prose competition winner).

This year’s crown and chair have been made using some of the final pieces of steel produced at Port Talbot steelworks before the closure of the blast furnaces last year.

There are some new additions to this year’s Eisteddfod, including awards for singing, musical theatre and acting, named in honour of Sir Bryn Terfel, Callum Scott Howells and Matthew Rhys.

Another new award – the Amy Dowden award for dance – will also be awarded for the first time this week.

Speaking to Sky News, Strictly Come Dancing star Dowden said it was a “real honour” to be supporting the next generation of dancers.

“The arts and the industry is tough, and I just hope that [the young people] can see that I’ve managed to push myself through it,” she said.

“I’ve worked hard, I’ve had a few challenges along the way. Hopefully I can help inspire them as well.”

‘It’s like Britain’s Got Talent’

As a former competitor herself in what is one of Europe’s largest touring youth festivals, Dowden says she “couldn’t imagine [her] childhood without it”.

“I’ve loved Eisteddfods since I can remember. Every year at school I took part in everything, from the baking to the reciting poems, to the folk dancing, to the creative dancing,” she said.

“The Urdd Eisteddfod is literally like one big talent competition, it’s like Britain’s Got Talent.”

The winner of the Amy Dowden award will get one-to-one sessions with her as part of the prize, as well as masterclasses at the Royal Welsh College of Music and Drama.

They will have the opportunity to perform on an international stage and also win a cash prize.

“I know from my dance training and everything, each of those is so beneficial to getting yourself to that professional level,” Dowden added.

UK

Living beside the UK’s first drug consumption room

Published

1 hour ago

May 26, 2025

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Living beside the UK's first drug consumption room

It’s 8.34am on a Tuesday and Vanessa Paton is taking me on a tour of Glasgow’s east end, where she has lived for almost 50 years.

Half a mile away sits the newly opened taxpayer-funded facility, named The Thistle, where drug addicts can bring their heroin and cocaine, are handed clean needles and invited to inject under NHS medical supervision.

The concept, a UK first, is controversial and costs £2.3m a year.

Authorities believe it provides a safer, cleaner area for users to do their business, away from the dirty, HIV-ridden back alleys of Glasgow city centre.

It opened in January, and around 250 people have used it so far.

But there is a growing feeling among some that a by-product of this bold project is the alleged “war zone” being created in the community around the new building.

Former council worker Ms Paton is one of an ad-hoc group of furious locals who pick up needles as part of desperate efforts to clear their streets.

She says: “It is getting worse. The new room has appeared, and the problems have escalated with it. It’s a no-go war zone every day and night.

“The area’s becoming a toilet. That is the harsh reality of it.”

‘It is disgusting’

Sky News spends the morning being shown areas where it is claimed the issues are getting out of control.

Ms Paton pulls a bloodied, faeces-covered hospital gown out of a bush as we walk along a path behind a row of houses.

We turn the corner to a street where children play and are greeted with syringes filled with blood at our feet, discarded needle packaging and dirty underwear.

Local resident Angela Scott says: “It’s become a lot worse. It’s heightened. I’m scared that if I am picking up my dog dirt am I going to prick a needle.

“Am I going to end up with an infection that a lot of drug addicts tend to have because they are sharing needles? I don’t want to pick up something infectious.”

Adverts installed in known drug dens

Officials have installed a new needle bin in one hotspot in recent days, with posters erected advertising the nearby consumption room.

Ms Paton alleges safety steps are being taken at a nearby nursery.

“There is a nursery that actually uses a metal detector in the morning to scan the sandpits before the children go out because of the concern of the needles being in it,” she claims.

This area is known as Calton and has had its troubles with drug taking and crime for many years.

Ms Paton takes us to a tucked-away, overgrown area opposite social housing and a few metres from where a new school is being built. It is a makeshift drug den.

There are hundreds of freshly used needles. It is like a minefield.

One needle is stabbed into a large tree, there is even a wooden seat which is covered in drug-taking equipment.

Once again, there is a laminated A4 piece of paper pointing users in the direction of The Thistle.

Ms Paton says: “We picked up 50 needles in one minute last week. If we were to pick up every needle that is here today, we’d be talking hundreds.

“We are struggling to find somewhere safe to stand. There are needles between my legs, you’ve got needles behind your head.

“It’s totally soul-destroying. Nobody living here expected it to be this bad.”

Officials deny it is a new problem

Glasgow City Council told Sky News there had not been an increase in reports despite the community alleging the opposite.

Councillor Allan Casey, who is responsible for drug policy in the city, said: “This has been a long-standing issue and that is one of the main reasons why The Thistle has been placed where it is because there has been decades-long discarded needles in public places.

Responding to claims of increasing problems around the new facility, Mr Casey said: “Those reports don’t back that up.

“The council has not seen a rise in reports of injecting equipment and there has not been an increase in crime reports.”

Scotland is ravaged by drugs. The country has the worst drug death rate in Europe.

Scotland’s first minister John Swinney told Sky News the new drug room required time to “see the impact”.

He said: “The Thistle is a safe consumption facility which is designed to encourage people to come off the use of drugs – that’s its purpose. We’ve got to give that venture time to see the impact.

“We need to engage with the local community… and address any concerns.”

It is understood police have logged no calls about the facility since it opened in January, despite some residents suggesting they have contacted officers with concerns.

Inspector Max Shaw from Police Scotland said: “We are aware of long-standing issues in the area and continue to work closely in partnership to address these concerns.”

Sports

Edmonton takes control over Stars: Game 3 grades, takeaways

Published

4 hours ago

May 26, 2025

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Edmonton takes control over Stars: Game 3 grades, takeaways

Multiple Contributors

May 25, 2025, 06:35 PM ET

While fans in Edmonton and Dallas are always singing about how they have friends in low places, only one of them has the high ground in the Western Conference finals. And that’s the Oilers after their 6-1 win Sunday in Game 3 to take a 2-1 series lead.

With the series tied heading into Sunday, the objective for Game 3 was to gain a firm grasp of the conference finals, and the Oilers did just that by having five players with multipoint performances. As for the Stars, losing Game 3 left them trailing a series for the second time this postseason, with the only other such occurrence coming after Game 1 against the Colorado Avalanche in the first round.

Now that the Oilers are in control of the series, what does it mean for them going forward? What must the Stars do differently ahead of Game 4 for them to return home tied rather than a game away from elimination? Ryan S. Clark and Greg Wyshynski examine those questions while delving into what lies ahead for two teams that not only faced each other in the conference finals last season but between them have been involved in every conference final since 2020.

Edmonton Oilers
Grade: A

Much could change between now and whenever the playoffs end. But for now, the argument could be made that this was the most important playoff game the Oilers have had this postseason.

The Oilers have had numerous strong performances, such as Game 3 against the Los Angeles Kings in the first round or their final two games against the Vegas Golden Knights in the conference semifinals. But what made the Oilers’ performance in Game 3 against Dallas arguably their most important was that they found a balance between being difficult in the defensive zone while not relying on a shutout to accomplish that objective.

The Stars finished with 37 shots, 13 high-danger chances in 5-on-5 play and scored only once. Connor McDavid has repeatedly stressed that the Oilers can play defense, and that has been made clear over their past five games. But Sunday proved they didn’t need Stuart Skinner or their defensive structure to blank an opponent to win. — Ryan S. Clark

Dallas Stars
Grade: C+

The final score doesn’t reflect the majority of this game, which Dallas coach Pete DeBoer can mine for positives among the many (many) negatives and some mitigating circumstances. Having Roope Hintz warm up but not be able to go because of the foot injury he suffered from a Darnell Nurse slash in Game 2? That’s deflating. Having the on-ice officials miss a delay of game call on Brett Kulak in the first period only to have Evan Bouchard open the scoring 10 seconds later? Also deflating.

So it’s to the Stars’ credit that they got to their game at 5-on-5 in Game 3 better than they have in any game of the series, at least before Edmonton ran up the score in the third. The results weren’t there and a loss is a loss — and a loss by this margin is difficult to stomach — but their second period and the performances from some of their slumbering depth players give the Stars at least a glimmer.

However, there’s no question Edmonton has this thing in well in-hand and the Stars have to find a way to solve Skinner, which is not something I thought I’d be writing at this stage of the postseason. — Greg Wyshynski

Three Stars of Game 3

Two goals and an assist for his seventh career multigoal playoff game. Hyman’s second goal was the Oilers’ fourth off the rush, the most in one game by any team this postseason. Hyman also was plus-5 Sunday.

Bouchard scored his sixth goal of the postseason and these two were on the ice for the first two Edmonton goals. At 5-on-5 this postseason, the Oilers are outscoring their opponents 7-1, and 5-0 in this series, when Bouchard and Kulak are on the ice.

Connor McDavid restores Oilers’ 2-goal lead

Connor McDavid finds the back of the net to restore the Oilers’ two-goal lead vs. the Stars.

3. Connor McDavid
C, Oilers

For all the talk about the lack of goals from the best hockey player in the world (which was odd because he had 20 points in 13 games and was a plus-7 entering Game 3 despite having only three goals), McDavid punched out a pair of tucks for his sixth career multigoal playoff game. Also, seeing McDavid with the puck barreling toward the net on a 3-on-1 is nightmare fuel for opponents. — Arda Öcal

Players to watch in Game 4

Zach Hyman
LW, Oilers

To go from 16 goals last postseason to just three goals entering Game 3 of the conference finals is one way to assess Hyman. Another is to realize that he’s been the most physical player on a team that is among the tallest and heaviest in the NHL.

Hyman came into Game 3 leading the NHL with 99 hits. He remained physical Sunday by leading the way with six hits in a game that saw the Oilers continue their punishing style with 47. But to then see Hyman score two goals and finish with three points in addition to that physicality? It once again adds to the narrative that the Oilers might not only have more dimensions than last year’s team, they could be better than the team that finished Stanley Cup runner-up in 2024. — Clark

Zach Hyman’s 2nd goal puts Oilers up 4

Zach Hyman taps home his second goal of the game to put the Oilers up 5-1 vs. the Stars.

This is the first two-game losing streak for the Dallas goaltender in the playoffs. A lot of what happened in Game 3 wasn’t necessarily on him — a Connor McDavid beauty and a Zach Hyman breakaway were among the Edmonton tallies — but outside of the third period of Game 1, he’s not been a difference-maker in this series. Oettinger came into the game leading the playoffs with 5.58 goals saved above expected, according to Stathletes. The Stars have been able to depend on him as a slump-breaker. But this is his third game with a save percentage south of .900 in the series. As the Stars try to build on some positives from this game, they need Otter to provide the foundation for it — and in the process, silence those “U.S. backup!” chants from the Oilers fans. — Wyshynski

Big questions for Game 4

Are the Oilers about to do to the Stars what they did to the Golden Knights?

Simply put, the Oilers are where hope goes to die. Teams in a championship window that have yet to win a title are always being judged on their evolution. What the Oilers did to the Stars a year ago in the conference finals by winning the last three games showed that they could close out a series after trailing. This postseason Edmonton has shown a calculated and methodical coldness when it comes to putting away opponents.

The Golden Knights won Game 3 on a last-second goal to create the belief they may have found an opening. They didn’t score again for the rest of the playoffs after being in the top five of goals per game throughout the regular season. Breaking out for six goals to open the series seemed to be a sign the Stars may have found an opening. Since then? They’ve scored only once in the last six periods while facing questions about what’s happened to another team that went from being in the top five in goals per game in the regular season. — Clark

Can Dallas make Edmonton uncomfortable at all?

Our colleague Mark Messier made this point between periods of Game 3: The Stars have yet to do anything to get McDavid or Leon Draisaitl off their games. That extends to the rest of the Oilers. Outside of an anomalous run of three power-play goals in the third period of Game 1, there have been precious few instances of the Stars carrying play for long stretches or putting a scare into Edmonton at 5-on-5.

They had that for a bit in Game 3 with a dominant second period: plus-14 in shot attempts, plus-11 in scoring chances and a 10-1 advantage in high-danger shot attempts. But they were digging out of a 2-0 hole, only managed to get one goal of their own on the board and then McDavid stuck a dagger in them with 19 seconds left in the second.

The Stars need a lead. They need zone time. They need to get their rush game going: Skinner had a .897 save percentage on shots off the rush entering the game. Edmonton is playing with a champion’s confidence. Dallas has to find a way to inject a little doubt into its opponent or this series is going to end quickly. — Wyshynski