Rural health in New Hampshire relies on a community-based approach to address the challenges of providing services in sparsely populated areas.
Andy Lowe
The New England Rural Health Association, which shares best practices and health care models, represents the six New England states.
The nonprofit has more than 550 members and a mailing list of more than 5,000 rural health professionals and stakeholders.
“Those people come from a wide variety of rural health professions, including critical access hospitals, rural health clinics, federally qualified health centers or community health centers,” says Andy Lowe, the nonprofit’s executive director.
The association encompasses behavior health, primary care, oral health and human services and has close relationships with universities in the region, including schools of medicine, nursing and public health.
The association is the only one of its kind; most states have their own rural health association.
“We are unique in that we’re the six-state regional association, but we feel like that gives us some leverage, as we often share best practices across state, share learning and challenges,” said Ann Marie Day, chief operating officer.
Ann Marie Day
Lowe and Day recently appeared on NH Business Review’s “Down to Business” podcast with managing editor Amanda Andrews and editor Mike Cote. This article was adapted from that interview.
Q. What are some of the special challenges of health care in rural communities?
Lowe: Access to care is No. 1, certainly.
We all know that it can be hard to get a doctor. And how often do we see that once you have a doctor or a primary care provider, the next thing you know, they’ve moved on somewhere else, and you have to get another one. Access to care, the more rural you are, the harder it is.
We are seeing the challenge of our critical access hospitals that are in danger of having to close entirely or to reduce services. They’re under tremendous pressure. They are doing such wonderful work.
But critical access hospitals, we’re talking about an organization probably with 25 beds. Think about them in the North Country, in Coös County, or wherever it might be.
There are rural areas throughout New Hampshire and throughout New England. People think Connecticut and Rhode Island, that’s not rural. Well, they are. They’re sprinkled around. One of the things about New England is that our rural communities can be actually quite close to an urban center.
But our critical access hospitals are really in crisis right now. Workforce is such an issue. That’s what’s making it hard for them to provide all the services they need to provide. And it also makes it challenging for them to be able to do all the things you have to do. There are things people think of doctors and nurses, certainly, but (then) they’re the people that do the billing and coding. There’s the front desk staff, there’s facility staff, there’s management, there’s leadership. All of these people are very increasingly difficult to recruit and retain.
We have what we call ambulance deserts. EMS services are scarce and getting scarcer. It’s extremely difficult for some of these small communities to keep their ambulance crews, their first responders. And we have OB deserts. Obstetric services are in extremely short supply. It’s very hard to get OBGYN providers in some of our small hospitals and clinics around the rural areas.
Day: The thing we love about rural is they often do more with less. They’re usually the innovators of solutions, because things that work in urban don’t necessarily work in rural. You can’t just say, well, catch the bus line to get to your appointment.
We’ve really been in support of differing models. New Hampshire has done great with their community paramedicine program, which allows maybe more experienced or older paramedics to really still be involved and have a less chaotic schedule. We’re just trying to utilize these models that provide quality care in the patient’s home, don’t require a transfer but still allow them to provide some support and services to the rural communities and patients.
Andrews: I’m also thinking, too, of telehealth and how broadband is slowly but surely getting its way up into rural communities in New Hampshire. And I know that sometimes is a barrier for a lot of patients who need to have telehealth visits often. But I’m hoping that New Hampshire is going in the right direction of getting more broadband out to rural communities.
Day: I think each state, too, is having connectivity plans and meeting to address these issues because it really is a challenge. Even where I live, not too far outside of Portland, Maine, I don’t have cell service; you have to do the Wi-Fi calling, and sometimes the internet’s a little shaky.
We’ve also just really highlighted the importance of those community hubs, whether it’s a public library that folks can get to, and (the hubs’) role in the health care system in being able to provide that connectivity or helping an older adult who maybe doesn’t know how to really access the technology or even to sign on to their telehealth visits. So it really is a community-based approach.
