Closure of a hospital makes it difficult for a city to attract retirees

When a rural community loses its hospital, health care becomes more difficult to obtain in an instant. But closing a hospital also shocks the economy of a small town. He closes one of his biggest employers. It scares the heavy industry that needs a nearby emergency room. And in a Tennessee city, the loss of a hospital means the lost hope of attracting more retirees.

Seniors and their retirement accounts have been seen as potential saviors for many rural economies trying to catch up with lost jobs. But the epidemic of rural hospital closures threatens those dreams in cities like Celina, Tennessee. The city of 1,500 inhabitants, whose 25-bed hospital closed on March 1, is trying to position itself as a destination for retirees.

"I would say, look elsewhere," says Susan Scovel, a Seattle transplant who arrived with her husband in 2015.

Scovel's discouragement is particularly remarkable in that she leads the efforts of the local Chamber of Commerce to attract retirees like her. She considers the wooded hills and the lonely lake to have a picturesque beauty comparable to that of the Washington Coast – with a considerably reduced cost of living; she and a small committee plan escape weekends for prospects.

When she visited the area for the first time before moving in 2015, Scovel and her husband, who had Parkinson's disease, took care to monitor the hospital, on a hill overlooking the sleepy square of the city. And she has rushed to the hospital four times since her death in 2017.

"My blood pressure is very high and they can do intravenous infusions to reduce it," says Scovel. "It's a disturbing thing since my husband died, so now I do not know."

She says that she can not in all conscience advise a senior with health problems to join her in Celina.

Closing adds delays when seconds matter

Cumberland River Hospital in Celina has been in intensive care for years. The city's medical center, an hour's drive from Cookeville, decided in late January to reduce its losses after trying to find a buyer. The Cookeville Regional Medical Center explains that the facility has had to deal with the sad reality of many rural service providers.

"Unfortunately, many rural hospitals across the country are going through a difficult time and face the same challenges, such as declining reimbursements and declining patient numbers, which the Cumberland River Hospital has experienced," said CEO Paul Korth in a written statement.

Celina has become the eleventh rural hospital in Tennessee to close its doors in recent years – more than in any other state than Texas. Both states have refused to expand Medicaid so as to cover more working poor. Even some Republicans now claim that the decision not to expand Medicaid has added to the hardships of rural health care providers.

The nearest hospital is now 18 miles away. This adds another 30 minutes on mountain roads for those who need an X-ray or a blood test. For those at the back of an ambulance, this lapse of time could make the difference between life or death.

"We have the capacity to do a lot of advanced care, but we are not a hospital," said Natalie Boone, director of emergency management.

The ambulance service is already limited in the region, with two of his four trucks out of use.

Once a crew is sent, says Boone, he's committed to this call. The addition of one hour to the turnaround time means that someone else could probably call in case of emergency and be told – basically – to do the tail.

"What happens when you have this patient who does not have that extra time?" Boone asks. "I can think of at least two patients [in the last month] that did not happen that time. "

Residents prepare for the cascading effects. Susan Bailey has not retired yet, but she is near. She spent nearly 40 years as a registered nurse, including early in her career at Cumberland River.

"People say: 'You probably have to just move or find another place to go,'" she says.

Bailey and others worry that the loss of the hospital will soon lead to the loss of the only three doctors in the city. Doctors say that they plan to maintain their practices, but for how long? And what about when they retire?

"It's a big problem," says Bailey. "The doctors are not going to want to come in and open an office and have to drive 20 or 30 minutes to see their patients every day."

The closure of the hospital forces 147 nurses, aides and office workers to find a new job. Some employees are moved to tears at the prospect of having to find work outside the county and are deeply saddened by the fact that their hometown is losing one of its biggest employers, the second behind the local school system.

Dr. John McMichen is an emergency doctor who traveled to Celina to work on weekends in the emergency room and gave a break to local doctors.

"I thought of Celina as maybe the Andy Griffith Show health care, "he says.

McMichen, who also worked at the Copper Basin Medical Center across the state, said residents of the Cumberland River knew almost whoever would show up at the door. That's why it was attractive to retirees.

"It reminded me that a long time ago, it seems to be over, I can not say it will come back someday," he says. "I hope there is still hope for small hospitals in this type of community, but I think that the chances of survival of these community hospitals are decreasing."