Health care access in
As mines close and populations decline, the story of small-town economies here also are reflected in their health care system. In northern
A history of health
Mining was not the safest job, and doctors stayed busy throughout the 20th century in
Public hospital districts in the state of can levy taxes on property up to
Voters easily approved funding to build a hospital in
Construction began, and the new
Evans gave birth to her son in that hospital, after walking there to see if she was in labor.
But as in many mining and rural towns across the country, the good economic times in
Just five years later, in 1988, things got drastically worse when the last remaining physician in the region, Dr.
Without a physician in the area to refer patients, the hospital faced closure, and the
Hanson owned the clinic, and he sold it and most of the equipment to the still-active
"When the government got involved and had all to do with Medicaid and HMOs (health maintenance organizations) ... that's when the little rural hospitals went kaput," Evans said.
"They didn't pay enough," she said. "You were only allowed to be in the hospital for so many days, and we couldn't afford to keep doctors."
The district sold the hospital building, which was converted to a motel for awhile. Now its light blue and brick exterior is overrun with plants and greenery. Evans envisions the building as a nursing home.
After the hospital closed, the
This summer, history repeated itself.
As the last mine closed, save for a skeleton crew, the physician in the
"So, rural is very different. Even within rural, there's layers of rural: rural, remote, frontier," Sweeney said.
"The communities are very different. The patients have a unique perspective, and the providers have to match that," she said.
Rural medicine practitioners face incredibly slow days as well as high-stakes days. When Hanson left
"Many times I wish I had someone to talk to," he told
Sweeney said her organization watches the school district numbers when it comes to looking at patient populations.
"We're not seeing a huge pediatric population, and that's what's going to feed your pediatric, middle age and geriatric population, so we see a very heavy geriatric population," Sweeney said. "They really rely on our clinic for a higher level of acuity than most clinicians are even trained for whether they are a physician or not, so that brings in the problem of recruiting."
If a patient needs to see a physician or go to a hospital, they can go in one of two directions:
'We can't afford to lose this service'
Wilbur and his team started to integrate behavioral and primary care long before state mandates took effect to do so. Care coordinators, who work to ensure that a person's physical, mental and substance-related health needs are met, are available to patients inside the primary care clinic in
"Some of the stuff we've done historically, no one does. (On) care coordination, we are way, way far ahead," Wilbur said. "As we go around to local communities, we have five to six care coordinators that work on different populations, different chronic diseases. We think we've made a difference."
In a smaller health care ecosystem, care coordination can work to improve patient outcomes, but Wilbur noted that hospitals are not reimbursed based on making patients better.
"This is the whole dilemma we face: When we start this, if I get my care coordinators in there to go out to your home, get you to a subspecialist, you stay out of my emergency department and hospital and you stay relatively healthy. What did I do?" he said. "I just cut my reimbursement is what I did. So my revenue stream out of the ordinary course is now gone, but my client is better."
"There's a lot of people that want to get out of the urban grind, so we're pretty close," he said. "So in that regard it's a blessing. The bane is what services should you provide or do you need to provide when you're 45 minutes to an hour (from) downtown?"
Not all hospital districts in the state run hospitals, and state law gives the taxing authorities broad leeway to run health care-related programs. Nationally, rural hospitals are in a tough spot, and while no
"They are really able to use that levy to keep their doors open and make up that margin, and that's true of over a dozen hospitals in the state," she said. "They are covering their losses on the backs of that local tax base."
"It means families will stay here," Manus said. "We can't afford to lose this service."
Two years after the bond passed, the new advanced care assisted living facility sparkles like a new hotel just a few blocks away from the hospital. In August, residents were wheeled down and across the street, in a kind of parade, with some holding handmade signs as they moved.
When the last part of the facility, opens, River Mountain Village Advanced Care Assisted Living will have the capacity to house 72 residents. Currently, it houses 44 residents, including those in the memory care wing. There are 10 spots open.
The old skilled nursing facility resembled a hospital wing. Its faint pink walls show their 1968 construction well. Rooms typically housed two to four residents, with a few lucky single bedroom suites. Hallway bathrooms had curtains because the doors could not close with wheelchair or walkers inside. The hospital district has yet to decide what to do with the old building.
Each section of River Mountain Village Advanced Care Assisted Living has its own full kitchen, dining area and living room-like common space. There is a sitting room with a television and tables for playing cards or games; and meals are served here for residents of each "neighborhood." The wide halls are carpeted and well-lit, with high ceilings, and each room has its own bathroom. Some have showers, too.
"It allows them to retain that local community autonomy," she said. "They still have a local board, but it allows them to figure out the right size of health care for them."
Wilbur said having a board with invested community members has been awesome.
"My job is to make sure we have a plan, and my job is to make sure they're educated on what the environment is, what's going on in the world (of health care)," he said.
"We can afford to run the services and afford care, but I'm not sure we'll make a profit," she said.
"We do accept Medicaid, and we don't have a cap on it," Smith said. "We're not going to do that."
In rural areas of the state, where hospice care is essentially nonexistent, advanced and long-term care assisted living facilities fill this role.
Flying for care
A line of maple trees, ablaze with the orange and reds of fall, surround a grassy field in
"If we can't have a hospital here, we need a nursing home and assisted living, and I think the old project area in
Options for assisted living in the northern region are primarily in
Living in rural parts of
She wasn't at the assisted living facility but was with her grandson coloring when, as she tells it, she started "speaking in tongues." She was rushed by ambulance to the
Life Flight flew her to
The various health care systems coming together to save her life is indicative of how rural health care sectors must coordinate, with emergency services, critical access hospitals (and hospital districts) and the proximity to a larger medical hub like
Life Flight bills a person's health insurance plan to help cover costs, but not all insurance companies fully cover a flight, leaving a person liable to a very large medical bill. Life Flight offers memberships to avoid these types of bills, for a household at the cost of
Bishop had a Life Flight membership, which she was grateful for.
"Look at me: If it hadn't been for Life Flight, I wouldn't be here," she said.
Providing primary care to residents living in far rural areas of the state is challenging, and the physicians
Residents and care providers alike in the northeast part of the state hope that with both the
Sweeney said that rural physicians, even if they are general practice doctors, need a vast skill set and are able to deliver babies, treat lacerations and perform tracheotomies. With no emergency departments or urgent care clinics, communities often treat their clinics as one-stop shops out of necessity.
"When we have these satellite locations, it just magnifies an aging population, high acuity (cases). We have lots of lacerations," Sweeney said. "People aren't trained for that anymore. Health care has really changed."
She hopes that with the potential for new residencies in rural areas, students will be trained in actual rural health care. Sweeney said sometimes potential physician candidates ask about how much they will be simply "air traffic controlling" or just referring patients out in
This story has been updated to correct the name of the dam on the
(c)2019 The Spokesman-Review (Spokane, Wash.)
Visit The Spokesman-Review (Spokane, Wash.) at www.spokesman.com
Distributed by Tribune Content Agency, LLC.