SPENCER, West Virginia — Dressed in her scrubs, Cassandra Hildreth is giving a tour of the rural West Virginian hospital where she works. It's clear that she knows every corner of Roane General hospital and isn't afraid to jump in on the frontlines, even though she's part of the hospital administration as vice president of nursing.
"If I'm asking my staff to do something that I can't do, then that's not who I am," she said.
Roane General serves Roane County, a secluded, wooded slice of Appalachia. Hildreth's dedication is an example of how rural hospitals are used to being David versus the Goliath of the healthcare system, trying to do so much with the few resources they have compared to hospitals in cities or suburbs.
"One of the things that we do is we try to personalize care because we, whether we know that person or not, we know they're our neighbor," said hospital CEP Doug Benz.
Benz is proud of what his team makes possible but says in the wake of the pandemic's peak, they're up against major obstacles not seen before. He says COVID was a catalyst that lead to debilitating staffing shortages, reliance on higher-salaried travel nurses and layoffs.
"The supply of nurses wasn't enough, so we saw significant increases in compensation, in salaries that coupled with all of the inflationary pressures that weren't expected, the cost of drugs, the cost of medical supplies, the cost of equipment," he said.
"During COVID, because so much funding was sent in that has sort the fear of closure has temporarily lifted, but now, as we're facing the end of the public health emergency and that funding going away, certainly everybody is on alert," said Brock Malcolm, a health care attorney with Bowles Rice.
Since 2010, 140 rural hospitals have shut down nationwide. After there were no closures in 2021, likely thanks to pandemic funding as Malcolm pointed out, we're starting to see closures pick back up again. Four closed already this year.
On December 16th, federal funding to a pair of Medicaid payment programs is set to expire. If these reimbursement programs aren't renewed, rural hospitals may lose out on $600 million of funding.
Brock Slabach is the chief operations officer for the National Rural Health Association. He says 50-80% of patients at rural hospitals are medicare dependent, and if this funding is not renewed, more of the 700 total rural hospitals will close— something that could have deleterious impacts on the surrounding communities.
"They are also the largest, maybe the second or third largest employer in the county or area that they serve, so they become economic lifelines in addition to lifelines, literally for care," he said.
Whatever the future holds, Benz, Hildreth, and their team will continue to do what they have – get creative, get resourceful, and put patients first
"We just wanna make sure that they're very well taken care of and, and that we provide them the best care possible," said Hildreth.