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.
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