Rural Hospitals Are Caught in an Aging-Infrastructure Conundrum

Published

2 years 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

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Three die and a fourth in serious condition in hospital after helicopter crash on Isle of Wight

Published

18 mins ago

August 26, 2025

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Three die and a fourth in serious condition in hospital after helicopter crash on Isle of Wight

Three people have died following a helicopter crash during a flying lesson on the Isle of Wight.

A fourth person is in hospital in a serious condition following the incident, according to Hampshire Police.

Officers were called to the scene of a “helicopter that had come down” off Shanklin Road near Ventnor at 9.24am on Monday, the force said.

A spokesman for the aircraft’s owner Northumbria Helicopters said G-OCLV – which is listed as a Robinson R44 II helicopter – was involved in the accident during a flying lesson.

Four people, including the pilot, were on board the aircraft, which departed nearby Sandown Airport at 9am, the company also said in a statement.

A critical care team, including a doctor and specialist paramedic, was also sent to the crash site, Hants and Isle of Wight Air Ambulance added, alongside fire engines and other emergency vehicles.

The Air Accidents Investigation Branch confirmed it was alerted to the incident and was sending a team to investigate. A major incident was declared but has since been stood down.

A spokesperson for Hampshire and Isle of Wight Air Ambulance said in a statement: “We have treated and airlifted one patient to the Major Trauma Centre, University Hospital Southampton. Our thoughts are with them, and everyone involved in today’s incident.”

Darren Toogood, editor and publisher at the Island Echo, told Sky News presenter Kamali Melbourne the helicopter crashed on a “significantly busy, high-speed road” between the village of Godshill and the seaside town of Shanklin.

“It was on one of the first flights of the day,” he said.

“It’s a bank holiday weekend in August on the Isle of Wight. It’s an incredibly busy area. Lots of tourists down at the moment. It appears no vehicles were involved, which is incredible, given how busy this road would have been this morning.”

A witness, Leigh Goldsmith, told the Isle of Wight County Press she saw the helicopter “spiralling” before crashing into a hedge as she drove along the road.

Police have closed Shanklin Road, blocking it off with several emergency vehicles, and are warning people to avoid the area.

Northumbria Helicopters said it is “giving its full cooperation to the authorities investigating this incident”.

Joe Robertson, the MP for Isle of Wight East, said the local community was in shock.

“My heart goes out to the families of those who lost their lives in the helicopter crash outside Shanklin today,” he said in a statement. “It is very sad and tragic news during what should have been a happy Bank Holiday helicopter flight from Sandown Airport. The whole community is in shock.

“My sincere thanks to all the emergency services personnel who have been involved and to the investigators for their work ahead.”

UK

‘Tamed’ algorithms and plummeting porn views: Impact of new online safety rules revealed one month on

Published

18 mins ago

August 26, 2025

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'Tamed' algorithms and plummeting porn views: Impact of new online safety rules revealed one month on

Sweeping new rules designed to deal with the “total Wild West” young people were experiencing online have now been in place across the UK for a month.

Ofcom’s Children’s Codes require pornography and other harmful content to be kept away from young people, either through age verification or algorithm changes.

More than half a million people have signed a petition calling for the Online Safety Act to be repealed, while ministers insist the legislation’s been a success.

So what difference have these controversial new regulations made?

‘I feel more clean’

In the days before they were enforced, Sky News spoke to a group of teenagers at a youth club in Warrington, and their experiences online were stark.

They told us about frequently stumbling across violence, pornography and harmful mental health content in their social media feeds.

One 17-year-old described seeing more harmful and inappropriate content online “than I can count”. Even a 12-year-old described being shown language that “can be quite explicit for children my age”.

So, one month later, we spoke to some of the teenagers again. The difference in what they reported was remarkable.

Ryan, 17, told us previously that the internet was a “very, very malicious” place and described frequently seeing inappropriate content.

Just one month on, he says his algorithm now seems “tamed” – although he’d still describe the internet as malicious.

“[My] algorithms have been quite tame in comparison to what they were. I haven’t seen any sort of advertisements and stuff that can be alluding towards anything inappropriate,” he said.

Liam, 16, also said Instagram felt “tamed” compared to what it was like before.

He was previously being served a lot of eating disorder content but “in the time that the rules have been in place I don’t actually think I’ve seen any”.

“I used to see them every few scrolls so it’s very much gone down.”

Seventeen-year-old Indie said she now feels like she “can actually scroll on the internet worry-free of what’s going to pop up”. Abbey, 17, also said she feels less worried about scrolling now.

“I feel really good about [the new rules] because now I don’t have to worry about seeing things I don’t want to see,” she said.

Ryan, 15, previously told us he was frequently being shown violent content that would ruin his day. Now, “when I’m scrolling TikTok, I’m free from violence”, he said.

“It feels better, to be honest. I feel more clean, in a sort of way, because like, I’ve not seen it.”

Of the six teenagers we re-interviewed, only one – 15-year-old Oliver – said he hadn’t really noticed a change.

However, harmful content is still sometimes being shown to teens, we soon found out.

Self-harm content on TikTok

We decided to test the social media platforms ourselves, inspired by an experiment run by the Molly Rose Foundation (MRF) in the weeks running up to the rules being enforced.

At that time, MRF found their teen Instagram and TikTok accounts were bombarded with self-harm and suicide content.

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One month later, we created TikTok and Instagram accounts belonging to a 15-year-old and searched for terms relating to suicide and self-harm.

On Instagram, all three search terms took us to a mental health support page, signposting to helplines and advice.

On TikTok, however, that wasn’t the case.

One search term took us to a mental health support page, similar to Instagram’s.

Another search term showed the message “no results”.

But a third, relating to a specific type of self-harm, brought up numerous posts that should no longer be shown to young people under Ofcom’s guidance.

Some posts used euphemisms, others were more explicit about their content. None of it should be available to children in the UK now.

In response to our experiment, a TikTok spokesperson said:

“TikTok has designed 70+ features and settings that support the safety and well-being of teens and families on our app, and we partner with organisations such as Samaritans and the International Association for Suicide Prevention to bring well-being resources directly to our community.

“We continually enforce comprehensive Community Guidelines, with over 99% of violative content proactively removed by TikTok.

“This single account does not reflect the real experience of a teen on our platform.”

Pornography views plummet…

But a lot of the controversy about these rules hasn’t come from children. Adults use the internet too and the new age verification rules seem to have impacted the way they surf the web.

Not everyone’s happy about it.

In the days after the new rules came in, hundreds of thousands of people signed a petition to repeal the Online Safety Act, the legislation that underpins Ofcom’s regulations.

Despite the government responding to that petition to say it had “no plans” to repeal the act, the number of signatories has now passed half a million.

“We all want children to be safe online, but I don’t think those benefits outweigh the significant costs, not just to millions of low-abiding children and adults in the UK, but also the effect this is having elsewhere around the world,” said Matthew Feeney, advocacy manager at Big Brother Watch.

He brought up privacy concerns before the rules were introduced and says he’s still concerned, having seen them in action.

“It’s doing the UK no favours internationally,” he said. “No other liberal democracy has taken steps like this in this kind of way.

“There are ways to talk about child safety online without embracing this approach to the internet, which treats everyone as a child by default.”

In Westminster, the rules proved controversial too; when Reform leader Nigel Farage said his party would repeal the act if elected, Technology Secretary Peter Kyle responded on Sky News by saying Mr Farage was “on the side of predators”.

“Anybody who thinks this legislation is going to be perfect in this moment must think again,” said Baroness Beeban Kidron, founder of 5Rights and a longtime supporter of the new legislation.

“It should not be a conversation about attackers, detractors, defenders. What we have to do is go again, and again, and again until we get the balance right.”

One of the most obvious ways general internet use has changed since the rules came in is through pornography.

According to a recent report by the Children’s Commissioner, the world’s four largest pornography sites received nearly 11 billion visitors each month in 2020; more than the number of visitors to Amazon, LinkedIn, Netflix, Zoom and eBay combined.

But within a day of the new regulations, the number of UK visitors to pornography sites plummeted – and has stayed low.

Data given to Sky News by Similarweb showed that between 19 July and 15 August, there was a 45% drop in the number of UK users to Pornhub, the country’s most popular pornography site.

Across the top 100 sites, there was a 33% drop.

Even pornography-based forums took a hit – Subreddits linked to bondage, discipline, sadism, and masochism (BDSM), for example, are experiencing 12% fewer visits from the UK than before the rules were introduced.

But that doesn’t necessarily mean the UK has lost its appetite for adult content.

But VPN use seems to be up

At the same time as UK porn visits were plummeting, the use of virtual private networks (VPNs) was rocketing, as people bypassed new age verification pages altogether.

VPNs mask their users’ location and may mean that plenty of people were accessing porn… they just didn’t look like they were in the UK.

The number of people searching for VPNs on Google spiked dramatically in the days after the rules were introduced.

Although the interest has waned, it is still higher than pre-regulation levels.

Five out of Apple’s top 10 downloaded apps were VPNs just one day after the rules started being enforced.

Baroness Beeban doesn’t believe it is children using VPNs to bypass age verification.

“I’ve actually found it extraordinary that the assumption is that all of the VPN surge is children. Think about it carefully.

“A lot of it will be adults who are actually trying to hide their own behaviour now that you actually have to be a bit more transparent.”

Anyone feeling emotionally distressed or suicidal can call Samaritans for help on 116 123 or email jo@samaritans.org in the UK. In the US, call the Samaritans branch in your area or 1 (800) 273-TALK

UK

‘Headphone dodgers’ targeted by new TfL campaign

Published

18 mins ago

August 26, 2025

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'Headphone dodgers' targeted by new TfL campaign

A campaign encouraging people to use headphones when playing music on public transport is being rolled out in London from today.

Posters will begin appearing on the Elizabeth line on Tuesday reminding travellers not to play music out loud or to have conversations on speaker mode, as it may disturb other passengers.

It is the latest part of Transport for London’s Travel Kind campaign, which is being rolled out across the wider transport network.

Rules around train travel already make playing music out loud an offence. But like other issues, such as fare evasion, this is subject to being enforced by the British Transport Police or the train operators themselves.

People using their phones for loud content has become a political issue in recent months, with both the Liberal Democrats and Conservatives urging ministers to take action on it.

Earlier this year, the Lib Dems called for fines of up to £1,000 for “headphone dodgers” who play music out loud on buses and trains, while Tory shadow transport secretary Richard Holden said passengers should not have to “endure somebody else’s choice of crap music”.

Seb Dance, deputy mayor of London for transport, said the small minority who “play music or videos out loud can be a real nuisance to other passengers and directly disturb their journeys”.

“However Londoners spend their journey, whether catching up on their favourite series or listening to music, we want everyone to have a pleasant journey.”

Posters will also encourage people to look up from their phones and to be aware that others travelling may be in need of a seat.

Previously, the Travel kind campaign included calls for vigilance about sexual harassment and urged travellers to move down inside London’s Tube carriages to ensure others can get on.