Rural Health Information Hub Latest News

Why Hospitals Are Getting Into The Housing Business

DENVER — One patient at Denver Health, the city’s largest safety net hospital, occupied a bed for more than four years — a hospital record of 1,558 days.  Another admitted for a hard-to-treat bacterial infection needed eight weeks of at-home IV antibiotics, but had no home.  A third, with dementia, came to the hospital after being released from the Denver County Jail. His family refused to take him back.

In the first half of this year alone, the hospital treated more than 100 long-term patients. All had a medical issue that led to their initial hospitalization. But none of the patients had a medical reason for remaining in the hospital for most of their stay.

Legally and morally, hospitals cannot discharge patients if they have no safe place to go. So patients who are homeless, frail or live alone, or have unstable housing, can occupy hospital beds for weeks or months — long after their acute medical problem is resolved. For hospitals, it means losing money because a patient lingering in a bed without medical problems doesn’t generate much, if any, income. Meanwhile, acutely ill patients may wait days in the ER to be moved to a floor because a hospital’s beds are full.

“Those people are, for lack of a better term, stranded in our hospital,” said Dr. Sarah Stella, a Denver Health physician.

To address the problem, hospitals from Baltimore to St. Louis to Sacramento, Calif., are exploring ways to help patients find a home. With recent federal policy changes that encourage hospitals to allocate charity dollars for housing, many hospitals realize it’s cheaper to provide a month of housing than to keep patients for a single night.

Click here to access the full article from Kaiser Health News.

Executive Order on Protecting and Improving Medicare for Our Nation’s Seniors

On October 3, 2019, President Trump signed an Executive Order directing HHS to take a number of actions to improve the Medicare program. Secretary Azar issued the following statement:

“President Trump’s Executive Order delivers on the clear promise he’s made to Americans about their healthcare: protect what works in our system and fix what’s broken. America’s seniors are overwhelmingly satisfied with the care they receive through traditional Medicare and Medicare Advantage, and the President is continuing to take action to strengthen and improve these programs. The President has directed HHS to take a number of specific, significant steps that will meaningfully improve the financing of Medicare, advance the care American seniors receive from their doctors, and improve the health they enjoy.

“The steps include expanding options and providing savings for seniors on Medicare Advantage; eliminating unnecessary burdens on providers; focusing Medicare payments on time spent with patients rather than on procedures performed; accelerating access to the latest medical technologies; cutting waste, fraud, and abuse; and expanding freedom and control for seniors on Medicare. All of these steps together will help create a healthcare system that puts patients at the center. These kinds of improvements, rather than a total government takeover of the healthcare system, are the path to our ultimate goal: better health for all Americans. That’s the President’s promise, and that’s what he has been delivering for American patients.”

The full Executive Order can be read here here.

Pennsylvania Governor Wolf’s Administration Releases Ready to Start Task Force Report

During the week of September 23, 2019, the Wolf Administration released a report, “Governor’s Ready to Start Task Force: A Four-Year Framework to Support Pennsylvania’s Infants and Toddlers,” for how best to care for the state’s youngest residents.

Research shows that a child’s brain develops faster in the first three years than at any later period in life, building the foundation for all future learning, behavior and health. The Wolf Administration is an invaluable partner in helping set Pennsylvania’s youngest children on a path for future success in school and life, and we look forward to continuing to advance our shared goal of expanding access to high-quality programs for infants, toddlers, and their families.

Help Spread the Word About the KinConnector Program

As the Pennsylvania Partnerships for Children continues to serve on the Kinship Navigator Oversight Committee, they are pleased to report initial successes with the Department of Human Services’ (DHS) KinConnector Program!

In August alone, the toll-free hotline received more than 140 calls from kin caregivers providing loving homes and basic needs to children who cannot be with their biological parents. Through the program, caregivers connect with compassionate KinConnectors and receive guidance applying for federal, state, and local benefits such as CHIP, Social Security and other services, as well as training and parenting support.

The program was only recently implemented, so please join us and help spread the word by sharing this newly released KinConnector brochure from DHS.

Pennsylvania is 1 of 10 States with An Increased Number of Children Living in Concentrated Poverty

Growing up in a community of concentrated poverty — that is, a neighborhood where 30 percent or more of the population is living in poverty — is one of the greatest risks to child development.

Alarmingly, 1 in 8 children in Pennsylvania live in concentrated poverty according to Children Living in High Poverty, Low-Opportunity Neighborhoods,” a new KIDS COUNT® data snapshot released from the Annie E. Casey Foundation. Other findings from the snapshot show that:

  • In Pennsylvania, 42 percent of Black or African American children live in concentrated poverty, which is worse than the national average of 28 percent. The number of Hispanic children living in concentrated poverty in Pennsylvania is 35 percent, also worse than the national average (19 percent).
  • Additionally, 36 percent of children under 18 in Pennsylvania live in low-income families. Approximately 44 percent of children under 18 in rural counties and 34 percent of children under 18 in urban counties are low income, according to our State of the Child

Federal, state and local governments must act to revitalize impoverished communities and transform them into areas of opportunity.

USDA Publishes Notice on Farm Bill Changes to Rural Population Limits and Other Eligibility Rules for Several Guaranteed Loan Programs

WASHINGTON, Oct. 3, 2019 – U.S. Department of Agriculture (USDA) Deputy Under Secretary for Rural Development Donald “DJ” LaVoy today announced that in accordance with the provisions of the Agriculture Improvement Act of 2018 (the Farm Bill), USDA is changing rural population limits, fees and funding priorities for some loan guarantee programs administered through the Rural Housing Service and the Rural Utilities Service.

USDA will increase the rural population eligibility limit to 50,000 residents for the Community Facilities Guaranteed Loan Program and the Water and Waste Disposal Loan Program.

For fiscal year 2020, projects financed through the Community Facilities Guaranteed Loan Program will receive priority in rural areas of 20,000 or fewer residents. Projects financed through the Water and Waste Disposal Guaranteed Loan Program will receive priority in rural areas of 10,000 or fewer residents.  USDA will increase the Community Facilities Guaranteed Loan Program’s one-time guarantee fee from 1 percent to 1.5 percent. The Agency also will establish an annual renewal fee of 0.5 percent of the loan’s principal balance each year. There are no changes to the Water Waste Disposal Guaranteed Loan Program fee rates.

These changes are effective Dec. 2, 2019. However, applications for Community Facilities or Water and Waste Disposal loan guarantees for projects serving rural areas with populations up to 50,000 may be filed with the Agency starting today. The Agency will not act on any applications received under this notice until the effective date. For additional information, see page 52869 of the Oct. 3, 2019, Federal Register.

USDA encourages applications that will support recommendations made in the Report to the President of the United States from the Task Force on Agriculture and Rural Prosperity (PDF, 5.4 MB). Applicants are encouraged to consider projects that provide measurable results in helping rural communities build robust and sustainable economies through investments in infrastructure, partnerships and innovation. Key strategies include:

  • Achieving e-Connectivity for Rural America
  • Developing the Rural Economy
  • Harnessing Technical Innovation
  • Supporting a Rural Workforce
  • Improving Quality of Life

Appalachia Focus of National Discussion about Health Equity

“When you look at the data [about the opioid crisis], it may be a little sobering.  The reality however is that people in rural communities are not waiting for data to tell them what they should do. They’re implementing their own solutions,” said ARC’s Kostas Skordas, Director of Research and Evaluation during a recent Atlantic Festival panel discussion about Health Equity in America. Moderated by journalist Vann Newkirk, the panel also included comments by Sana Chehimi, Director of Policy and Advocacy, Prevention Institute; and Michael Meit, Co-Director, NORC, Walsh Center for Rural Health Analysis, and touched on a variety of topics including the intersection of health equity and economic development. “Infrastructure, economic and social development, leadership, access to education, jobs and employment.  All of that is definitely related to broader health issues and certainly related to the opioid crisis,” Skordas added.

Last year, ARC published case studies of ten “Bright Spot” counties, each defying predictions for health with better-than-expected outcomes as part of Creating a Culture of Health in Appalachia: Disparities and Bright Spots, a health research initiative to identify and explore Appalachian communities with better-than-expected health outcomes. Among the greatest assets these Bright Spot counties have are their people, who generate collective pride and power through volunteerism, a steadfast commitment to community, and shared values for health. The Bright Spot counties also benefit from “anchor institutions” such as schools, businesses, churches, and hospitals that work to improve community health and the social factors that affect health. A summary of the Bright Spots research, plus other data about health in Appalachia, is available at

National Health Service Corps Students to Service Loan Repayment Program Open to Final-Year Medical, Dental Students

The 2020 National Health Service Corps (NHSC) Students to Service (S2S) Loan Repayment Program (LRP) application cycle is open. Medical and dental students in their final year of school can receive awards of up to $120,000 in exchange for a three-year commitment providing primary care services at NHSC-approved sites in high-need areas. Review the 2020 Application and Program Guidance (PDF – 1.2 MB) for more information on how to apply. The NHSC S2S LRP application cycle closes on October 31, 2019 at 7:30 p.m. EDT.

2018 National Survey of Children’s Health Data to be Released October 7

HRSA will release 2018 data from the National Survey of Children’s Health (NSCH) on October 7. The NSCH provides the latest national and state-level data on the health and health care needs of children as well as information about their families and communities.

Survey topics include children’s:

  • Physical and mental health,
  • Health insurance status,
  • Access and utilization of health care services, including
    • Receipt of preventive and specialty care, and
    • Care in a patient-centered medical home,
  • Services to support transition to adult health care for adolescents,
  • Lifetime exposure to adverse childhood experiences, and more.

The NSCH is funded and directed by HRSA’s Maternal and Child Health Bureau and conducted by the U.S. Census Bureau, which oversees sampling, survey administration, and production of a final data set for public use.

Learn more about the National Survey of Children’s Health.

As Rural Groceries Fade Away, Lawmakers Wonder Whether to Act

Jill Schramm/Minot Daily News via AP

Nancy McCloud did not have any food industry bona fides. She had never worked in a grocery store; not even a restaurant. And yet three years ago, when her local grocery in central New Mexico closed, she wanted to offer the community (population: 863) the fresh foods they otherwise would have to travel 47 miles to get.

Mountainair, New Mexico, is a popular tourist stop because of its proximity to 17th century ruins that harken to the earliest contact between Pueblo Indians and Spanish colonials. It’s known as the “gateway to ancient cities.” But without a grocery store, McCloud feared Mountainair might become another relic of the past.

“When you have a small rural town and the grocery store dies, the town dries up and it just blows away,” said McCloud, who revived B Street Market in 2017 and became its owner. “There are six towns east of here — they just lost the grocery store, then they lost the gas station, and then they lost the bank and now they’re nothing.”

Some states are trying to tackle their rural grocery gaps. Supporters of such efforts point to tax incentives and subsidies at various levels of government that have enabled superstores to service larger areas and squeeze out local independent grocers. Now, dollar stores are opening in rural regions and offering items at lower prices, posing direct competition to local groceries.

Critics see that development as a threat to public health, since dollar stores typically lack quality meat and fresh produce.

But every town and every store is different, making statewide solutions elusive. Some legislators say they are reluctant to intervene too heavily because the market should close the gaps.

In North Dakota, a legislative panel is studying rural food distribution and transportation amid a steep decline in the number of groceries serving rural areas. The committee is considering whether there are public policies that could work, said state Rep. Thomas Beadle, a Republican committee member. But Beadle hopes consumers will organize and solve problems on their own.

“North Dakota is a red-leaning state,” Beadle said. “We’re much more free market than having government intervention. It really would take a drastic instance for the state to step in.”

State Sen. Jim Dotzenrod, a Democratic committee member, said legislators are trying to understand the scope of the problem and whether they can do anything about it.

“One of the things we’re trying to decide is, are there state resources that are currently in place that could be of some value, whether it’s storage or transportation or things like that,” Dotzenrod said. “It may be when we’re done with this, we’ll have to say we don’t have a solution at hand. But I’m hoping that we can come up with some ideas that will help.”

Read the entire article here.