Small-Town Hospitals Are Closing Just As Coronavirus Arrives In Rural America Small-town hospitals were already closing at an alarming rate before COVID-19, but now the trend appears to be accelerating just as the disease arrives in rural America.

Small-Town Hospitals Are Closing Just As Coronavirus Arrives In Rural America

  • Download
  • <iframe src="" width="100%" height="290" frameborder="0" scrolling="no" title="NPR embedded audio player">
  • Transcript


Now, many of America's rural hospitals were already on the brink of bankruptcy before the COVID-19 crisis. Eight small-town hospitals have closed since January alone. This week, Decatur County, Tenn., will lose its only hospital, bringing that number to nine. As NPR's Kirk Siegler reports, the trend of closures is accelerating just as the virus is taking hold in rural America.

KIRK SIEGLER, BYLINE: A hundred miles west of Nashville, Decatur County General Hospital has served the town of Parsons and its surroundings along the Tennessee River since 1963. In a county with about 12,000 people, the hospital is one of the largest employers. Now dozens of staff, including HR director Melinda Hays-Kirkwood, will soon be out of work.

MELINDA HAYS-KIRKWOOD: It's hard on these employees that have been here a long time. You know, I've got people that have been here 30 years. Some people, this has been really their only job out of college.

SIEGLER: The closure will have a huge economic toll locally. Due to the COVID-19 crisis, most essential businesses in the area were already closed.

HAYS-KIRKWOOD: It's a difficult time to be shutting down a hospital, of course, in the middle of the coronavirus.

SIEGLER: Small-town hospitals were closing at an alarming rate before the coronavirus pandemic. A recent report by the Chartis Center for Rural Health shows that nearly half of all of them were operating in the red before this crisis. And now they're ironically losing more business as patients cancel elective procedures.

ALLAN JENKINS: That idea of the perfect storm - that gets overused. But that's exactly what's happened.

SIEGLER: Allan Jenkins is an economics professor at the University of Nebraska at Kearney. He says the perennial challenges facing rural America are largely to blame here. Many places, like in his home state, are depopulating. And then there's the demographics.

JENKINS: Because rural communities tend to be older and poorer and sicker and less likely to be insured.

SIEGLER: He says hospitals lose a lot of money when they treat these patients. And COVID-19 is going to make the problem worse. Lawmakers from rural states say they're working to ensure federal aid from the recent and future stimulus packages goes to rural hospitals. Here's Wyoming Senator John Barrasso.


JOHN BARRASSO: Small physician hospitals, rural communities aren't able to tolerate that sort of loss of flow, just as any business is not able to tolerate that sort of cash-flow loss.

SIEGLER: Health policy experts say a rural hospital's ability to stay open through the coronavirus pandemic may also depend on whether the state it's in has expanded Medicaid. Rural hospitals in states that have are seeing significantly more federal money. Tennessee has not expanded Medicaid. A recent proposal to do so introduced by Republican state lawmakers there is stalled. It may not have prevented the closure of Decatur County General anyway, though, which has been in debt for years.

HR director Melinda Hays-Kirkwood says Decatur County and its watersports and off-road trails are a beacon for recreation enthusiasts. And her hospital's emergency services have saved a lot of lives over the years.

HAYS-KIRKWOOD: From a health care perspective, there'll be many that won't be able to get to a hospital in time. It's just going to be a tough situation.

SIEGLER: There is some hope that the hospital's closure could be temporary. But for now, anyone needing care is going to have to drive at least 20 miles in either direction from Parsons, Tenn. Kirk Siegler, NPR News.

Copyright © 2020 NPR. All rights reserved. Visit our website terms of use and permissions pages at for further information.

NPR transcripts are created on a rush deadline by Verb8tm, Inc., an NPR contractor, and produced using a proprietary transcription process developed with NPR. This text may not be in its final form and may be updated or revised in the future. Accuracy and availability may vary. The authoritative record of NPR’s programming is the audio record.