Rural Kansas towns cope with aging hospital facilities
By Phil Cauthon
Construction on a new $8.2 million hospital is scheduled to begin early next year in this small, south-central Kansas community.
The project is in response to conditions common in many parts of rural Kansas where an increasingly aging population often is treated in outdated hospital facilities.
A quarter of Kiowa's approximately 1,000 residents are age 65 or older, more than half the town is at least 45 years old, and 80 percent of the critical access hospital's business is from Medicare patients, said Alden Vandeveer, chief executive of the Kiowa District Hospital.
"It's definitely an aging population and we are going to need in the future some pretty good resources for the seniors," he said. "The (hospital) board is real interested in making sure we have the facilities and equipment to serve the community, that the people here have what they need right here at home. We're 20 miles from anywhere."
The current hospital simply wasn't filling the community's needs, he said.
"For example, right now we have shared bathrooms--the old 50s-style bath at the end of the hall, two rooms share one toilet. And the toilet space is so small that if you have a heavy patient, they could get trapped in there--and we have 100-pound nurses who would have trouble getting them out," Vandeveer said.
The hospital's operating room "is unbelievably small--I've never seen one this small. It is the original O.R.--61 years old," Vandeveer said. "It might be 200 square feet, if you're stretching it."
The new operating room will be 450 square feet, and the entire facility will be 25,500 square feet--about 40 percent larger than the existing hospital. In the new hospital, there will be eight rooms for patients, each equipped with a private restroom.
Hill-Burton era hospitals
Many rural hospitals were built with Hill-Burton Act funds in the 1940s and 1950s, said Melissa Hungerford of the Kansas Hospital Association. The 1946 act, part of an initiative by President Harry Truman to improve the nation's hospital capacity in the aftermath of World War II, provided grants and guaranteed loans for hospital construction.
The majority of Kansas' 83 critical access hospitals might have been built during that era, Hungerford said, though an exact count is not available.
"There's only so far you can improve on those older structures," Hungerford said. "So many of them have added a wing, remodeled this, changed the front, done those kinds of things over the years. A lot of our hospitals are faced with not being able to just fix what they have. It makes sense that they have to address larger problems like wiring or fire safety."
The need for new wiring, fire sprinklers, accessibility for disabled patients, and sufficient space for modern health care equipment were all behind the construction project now underway at Medicine Lodge Memorial Hospital--another critical access facility 24 miles north of Kiowa--said administrator Kevin White.
Medicine Lodge is renovating half of the existing 36,000 square feet and adding on 17,000 square feet. Some of the new space is aimed at attracting part-time specialists who keep multiple offices around the region.
"We have some areas built in to make it a little more attractive to specialists, for them to have a place to come to for a clinic a day, a month or every two weeks. We had trouble getting that kind of participation," with the space they have now, White said.
Given the recent recession, the hospital's board expressed concern about the timing of the project, but decided to move forward after the county's voters approved a bond to support the project.
A yard sign supporting a $10 million bond for Kiowa and Medicine Lodge hospitals, eventually approved by Barber county residents.
"The board always has that fiduciary concern. With things are like they are now, (the concern was) how are you going to pay for it. With the county picking up a big tab, that helps. As long as the critical access cost reimbursement continues for at least a few years, we should be ok," White said.
Funding for the construction in both Medicine Lodge and Kiowa came, in part, from a $10 million bond approved by Barber County in 2011. About $4 million was slated for Kiowa, and about $6 million for Medicine Lodge. The hospitals are each owned and operated by their respective municipalities, and the bond marks the first funding to come from the county for the hospitals, White said.
"Before that, the hospitals weren't supported by the whole county, they were just supported by their respective districts. Operationally, we still operate from tax support from our local hospital districts," White said.
Funding for the projects also came via loans from the U.S. Department of Agriculture Rural Development Center. Medicine Lodge borrowed $4.5 million from the USDA, and Kiowa borrowed $4.2 million.
Vandeveer, Kiowa's administrator, said the hospital and its nursing home also formed a non-profit organization--the Friends of Kiowa District Hospital and Manor Foundation--to solicit donations for facility improvements. So far, it has collected nearly $500,000, he said.
"That's how we are expecting to fund a good portion of the equipment and everything for the new hospital," Vandeveer said. "Going forward it will help fund additional facilities."
He said building the new hospital on 12 acres at the edge of town would give it flexibility for future growth. Soon, he said the hospital district also would need to do something about its aging, 36-bed nursing home facility, which was built in 1964.
"It's well maintained. We--knock on wood--don't have many problems. But I'm trying to interest the board in some sort of new nursing facility at some point." Vandeveer said.
"That's 'blue-skying', not carved in granite yet, but that's what's on the horizon. We've got to get this (hospital) built first," he said.