When a rural community loses its hospital, health care becomes harder to come by in an instant. But a hospital closure also shocks a small town's economy. It shuts down one of its largest employers. It scares off heavy industry that needs an emergency room nearby. And in one Tennessee town, a lost hospital means lost hope of attracting more retirees.
Seniors, and their retirement accounts, have been viewed as potential saviors for many rural economies trying to make up for lost jobs. But the epidemic of rural hospital closures is threatening those dreams in places like Celina, Tenn.. The town of 1,500, whose 25-bed hospital closed March 1, has been trying to position itself as a retiree destination.
"I'd say, look elsewhere," says Susan Scovel, a Seattle transplant who came with her husband in 2015.
Scovel's despondence is especially noteworthy given that she leads the local chamber of commerce effort to attract retirees like herself. She considers the wooded hills and secluded lake to hold comparable scenic beauty to the Washington coast — with dramatically lower costs of living; she and a small committee plan getaway weekends for prospects to visit.
When she first toured the region before moving in 2015, Scovel and her husband, who had Parkinson's, made sure to scope out the hospital, on a hill overlooking the sleepy town square. And she's rushed to the hospital four times since he died in 2017.
"I have very high blood pressure, and they're able to do the IVs to get it down," Scovel says. "This is an anxiety thing since my husband died. So now — I don't know."
She says she can't in good conscience advise a senior with health problems to come join her in Celina.
The closure adds delays when seconds count
Celina's Cumberland River Hospital had been on life support for years, operated by the city-owned medical center an hour away in Cookeville, which decided in late January to cut its losses after trying to find a buyer. Cookeville Regional Medical Center explains that the facility faced the grim reality for many rural providers.
"Unfortunately, many rural hospitals across the country are having a difficult time and facing the same challenges, like declining reimbursements and lower patient volumes, that Cumberland River Hospital has experienced," CEO Paul Korth said in a written statement.
Celina became the 11th rural hospital in Tennessee to close in recent years — more than in any state but Texas. Both states have refused to expand Medicaid in a way that covers more of the working poor. Even some Republicans now say the decision to not expand Medicaid has added to the struggles of rural health care providers.
The closest hospital is now 18 miles away. That adds another 30 minutes through mountain roads for those who need an X-ray or blood work. For those in the back of an ambulance, that bit of time could make the difference between life or death.
"We have the capability of doing a lot of advanced life support, but we're not a hospital," says emergency management director Natalie Boone.
The area is already limited in its ambulance service, with two of its four trucks out of service.
Once a crew is dispatched, Boone says, it's committed to that call. Adding an hour to the turnaround time means someone else could likely call with an emergency and be told — essentially — to wait in line.
"What happens when you have that patient that doesn't have that extra time?" Boone asks. "I can think of at least a minimum of two patients [in the last month] that did not have that time."
Residents are bracing for cascading effects. Susan Bailey hasn't retired yet, but she's close. She's spent nearly 40 years as a registered nurse, including her early career at Cumberland River.
"People say, 'You probably just need to move or find another place to go,' " she says.
Bailey and others are concerned that losing the hospital will soon mean losing the only three physicians in town. The doctors say they plan to keep their practices going, but for how long? And what about when they retire?
"That's a big problem," Bailey says. "The doctors aren't going to want to come in and open an office and have to drive 20 or 30 minutes to see their patients every single day."
Closure of the hospital means 147 nurses, aides and clerical staff have to find new jobs. Some employees come to tears at the prospect of having to find work outside the county and are deeply sad that their hometown is losing one of its largest employers — second only to the local school system.
Dr. John McMichen is an emergency physician who would travel to Celina to work weekends at the ER and give the local doctors a break.
"I thought of Celina as maybe the Andy Griffith Show of health care," he says.
McMichen, who also worked at the now shuttered Copper Basin Medical Center, on the other side of the state, says people at Cumberland River knew just about anyone who would walk through the door. That's why it was attractive to retirees.
"It reminded me of a time long ago that has seemingly passed. I can't say that it will ever come back," he says. "I have hopes that there's still some hope for small hospitals in that type of community. But I think the chances are becoming less of those community hospitals surviving."
LULU GARCIA-NAVARRO, HOST:
When a hospital closes in a rural area, the economic shockwaves go beyond lost health care jobs. A closure may scare off heavy industries that need to be near an emergency room. And it makes it harder for rural towns to attract another valuable economic resource - retirees. Blake Farmer of member station WPLN explains.
BLAKE FARMER, BYLINE: It's pretty obvious where the priorities lie in Celina, Tenn., by looking at the humble government complex. Half the building is used as a senior center.
SUSAN SCOVEL: This is part of our retirement committee coming in. We're planning a murder mystery weekend and trying to get people up here and see this gorgeous area.
FARMER: Susan Scovel is a Seattle transplant who leads a Chamber of Commerce effort to bring in retirees like herself. She relocated in 2015 with her husband, who had Parkinson's. They were drawn by a serene lake surrounded by secluded hills two hours from Nashville. While they wanted an escape, they also made sure to scope out the 25-bed hospital near the sleepy town square. Scovel rushed there four times.
SCOVEL: I have very high blood pressure. And they're able to do the IVs to get it down. And this is an anxiety thing since my husband died, so now I don't know.
FARMER: Many towns in the region have pinned their economic futures on retirees to replace dwindling industries. But Scovel says she can't, in good conscience, suggest a senior with health problems come join her in Celina.
SCOVEL: I'd say look elsewhere.
FARMER: Celina's hospital Cumberland River was kept alive as part of a neighboring city-owned medical center. But officials finally decided to shut it down March 1. They blame the same factors that have put one in five rural hospitals at risk of closing - fewer patients and more who can't pay. The closure trend has hit hardest in states like Tennessee that didn't expand Medicaid to cover the working poor. The closest emergency room is now 18 miles away. That adds 30 minutes over mountain roads, which will be annoying for those who need an X-ray or bloodwork. But it could mean life or death in the back of an ambulance. Natalie Boone oversees emergency response in Celina.
NATALIE BOONE: We have the capability of doing a lot of advanced life support, but we're not a hospital.
FARMER: She says the area is already limited in its ambulance service, with half its trucks down because of a tight budget.
BOONE: You know, what happens when you have that patient that doesn't have that extra time?
SUSAN BAILEY: People say, won't - you probably just need to move, or...
FARMER: Susan Bailey hasn't retired yet, but she's close. She's spent nearly 40 years as a registered nurse, including at her hometown hospital. She and others are concerned that the three remaining physicians in town might leave. But even if they stay until retirement, there's little hope of attracting new doctors without a hospital.
BAILEY: That's a big problem. The doctors aren't going to want to come in and open an office and have to drive 20 or 30 miles to see their patients every single day.
FARMER: The cascading effects have residents in a somber mood. One hundred forty-two people lost their hospital jobs, including Dr. John McMichen. He would drive in to work weekends at the ER and give the local physicians a break.
JOHN MCMICHEN: I thought of Celina as maybe "The Andy Griffith Show" of health care.
FARMER: He says the staff knew just about anyone who'd walk through the door. That's why it was attractive to retirees.
MCMICHEN: It reminded me of a time long ago that has seemingly passed. I can't say that it will ever come back. You know, I have hopes that there is still some hope for small hospitals in that type of community.
FARMER: But the chances, McMichen says, are becoming less and less. For NPR News, I'm Blake Farmer in Celina, Tenn.
GARCIA-NAVARRO: This story is part of a reporting partnership with NPR, WPLN and Kaiser Health News. Transcript provided by NPR, Copyright NPR.