A real rural crisis

Wednesday, November 16, 2022

To the editor, Do you think if your relative or friend ever needs 24-hour care, they could go to a nursing home? Think again. Ten nursing homes in Montana have closed in 2022, and you can bet more will follow. It’s not just a Montana problem, but rural areas will experience the closures sooner than more populated areas. In Montana, large hospitals are finding they can’t discharge patients because there is no safe place for them to go.

The primary reason is the large predictable demographic shift. In the early 90’s, I was at a presentation about future health care in Montana (which is now the present). The speaker said by 2020 many of the oldest baby boomers would need more health care, while the younger baby boomers would be headed toward retirement, creating a demand for services but not enough workers. Health care would be centered in the larger cities. It was a sobering presentation.

COVID exacerbated the existing shortage of workers while increasing the cost of care. Given the warming of the planet, diseases are likely to increase. Watch any news channel to see the devastation in the world due to many natural disasters and the resurgence of diseases.

Modern medicine also affects health care. Just a few years ago, people needing hip or knee surgery, for example, had a three- or four-day stay in a hospital. Medicare requires a person to qualify for a 3-day medically necessary acute stay before it will pay for rehabilitation services in a nursing home or a rural hospital with transitional beds. Today, these surgeries are often done as outpatient, which is great for lots of folks who are healthy and have family and a means to go to outpatient therapy. But what happens to people who don’t have those luxuries? They must pay for them or go without because they didn’t have a 3-day medically necessary acute stay. What happens to nursing homes and rural hospitals that counted on those patients filling those beds? Don’t count on home care services either as they, too, are affected by the demographic shift.

The governor is talking about big tax cuts. Instead, I’d like to see him, and our Legislature save our rural health care facilities before it is too late. And our elected federal politicians need to come up with a national solution. The 3-day acute stay is antiquated as is the resource limit for Medicaid. Jeanette Prodgers Dillon