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LWV of South Central Texas
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From the President

An Eye-Opening Inside-Out Look at Rural Healthcare
By Janis Richardson
Posted: 2021-11-20T19:54:00Z

unsplash royalty free imageThe National Organization of State Offices of Rural Health sets aside the third Thursday of every November to celebrate National Rural Health Day – a day to celebrate the “Power of Rural”. This is a day to showcase efforts of our rural healthcare providers, and other rural stakeholders to address the unique healthcare challenges that rural citizens face today and into the future.

When I spotted this day – and thought about the unusual and expected set of challenges that our rural healthcare systems are currently facing – I invited my colleagues with two sister Leagues who work in rural areas to brainstorm with me about something we could do on this evening – Cathy Learoyd, President of LWV Hill Country Texas, and Kathleen Stein, President of LWV of St. Lawrence County in rural upstate New York. The three of us developed a program we shared on Zoom and Facebook Live on November 18, 2021’s National Rural Health Day. Our program was titled Rural Health Care in 2021: An Inside Perspective.

We invited three people who are uniquely positioned to share their perspective on rural healthcare to be our guest speakers for this event:

John Henderson

President of the Texas Organization of Rural & Community Hospitals

Reginald Q Knight, MD MHA FAAOS

Senior Vice President and Chief Physician Executive, Basset Healthcare Network, Cooperstown, NY.

Jayne Pope

CEO of Hill Country Memorial in Fredericksburg, Texas

We asked our presenters to talk about to these four questions:

  • What is the state of rural healthcare in your area now?
  • What challenges did COVID-19 add to your system? How are you coping with them?
  • What are the biggest challenges and opportunities you see for the future?
  • How are individuals within your system coping?
  • How can community residents help? What can local Leagues do to support our rural healthcare systems?

They were united in what they named as the biggest challenge – retaining staff – everyone, doctors, nurses, and other support staff. Jayne Pope summed up the problem by saying that everyone is really tired and said that rural hospitals are in the midst of “The Big Quit”.

COVID-19 is stretching already stretched systems who are accustomed to doing more with less – and the systems are doing a good job of maintaining quality of care. The burden, however, has fallen on the shoulders of staff. No days off, no vacations, and day and after day of challenging situations is taking its toll. Reginal Knight mentioned that he spend the day working to keep three staff people on board – and that losing these people would mean that the hospital where they are employed would have to cease offering OB services. That remark brought the grim reality of their work home to me.

John Henderson noted that rural hospitals in Texas were facing challenges before COVID-19. Once again, this year the Texas legislature chose to pass on Medicaid expansion, leaving billions of dollars in federal incentives on the table that supporters say would not only pay for the expansion but add money to state coffers and lower costs for hospitals that care for large numbers of uninsured patients.

As reported in the Texas Tribune (May 7, 2021) “Texas has the largest number of uninsured residents in the nation, many of them working adults who can’t afford private or subsidized insurance but don’t qualify for Medicaid because they earn too much. Roughly 20% of the state’s population lacks health insurance — a number health officials say has grown since more than a million Texans lost jobs and, in many cases, health coverage because of the COVID-19 pandemic.”

John Henderson mentioned that ten years ago, roughly 40% of rural and community hospitals did not offer OB services – meaning that women could not go to their local hospital for the birth of their baby. Today, however, roughly 60% do not offer those services, meaning that Texas has OB deserts. The Lavaca Medical Center in my town is one of those that does not offer this service, but the drive to another facility that does is less than an hour. John said that we are more fortunate than communities like Alpine, where the drive could be more than twice as long or longer.

Jayne Pope mentioned that hospital systems are now working more closely with other healthcare providers such as home health agencies. Reginald Knight said that he is seeing a return to the age-ol practice of house calls. All agreed about the potential for tele-health – but alas, telehealth depends on broadband coverage, and currently, many rural communities do not have uniform access to high-speed affordable broadband.

When asked what we – community members and Leagues – can do to support our rural hospitals, all agreed that speaking out is essential. Medicaid expansion in Texas could help tremendously, as could uniform broadband access. More availability of mental health services for medical system employees would be helpful.

As we concluded, we were reminded about how essentials our hospitals are for our rural communities. With more opportunities to work remotely, and better broadband in the picture, more people may opt to chose rural communities as home, but those communities without hospitals, and other basic healthcare services will be at a disadvantage. We need good healthcare, and our rural communities need good healthcare systems!

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