Glenwood’s malaise

If you want to watch a rural community die, kill its hospital.

After the Lower Oconee Community Hospital shut down in June 2014, other mainstays of the community followed. The bank and the pharmacy in the small town of Glenwood shuttered. Then the only grocery store in all of Wheeler County closed in the middle of August this year.

On Glenwood’s main street, building after building is now for sale, closing, falling apart or infested with weeds growing through the foundation’s cracks.

Opportunity has been dying in Wheeler County for the last 20 years. Agriculture was once the primary employer, yet the Wheeler Correctional Facility, a privately run prison, is now the biggest source of jobs. With 39 percent of the central Georgia county’s population living in poverty, there aren’t enough patients with good insurance to keep a hospital from losing money.

The hospital’s closure eliminated the county’s biggest health care provider and dispatched yet another major employer. Glenwood’s mayor of 34 years, G.M. Joiner, doubts that the town will ever recover.

“It’s been devastating,” the 72-year-old mayor said, leaning on one of the counters in Glenwood’s one-room city hall. “I tell folks that move here, ‘This is a beautiful place to live, but you better have brought money, because you can’t make any here.’ “

Rural hospitals are in danger across the country, their closures both a symptom of economic trouble in small-town America and a catalyst for further decline.

Since 2010, 82 rural hospitals have closed nationwide. As many as 700 more are at risk of closing within the next 10 years, according to Alan Morgan, the CEO of the National Rural Health Association, a nonprofit professional organization that lobbies on rural health issues.

The reasons are complex, woven into the fabric of a changing economy and an evolving health care system. But these rural hospital closures are hitting the southern United States the hardest.

“The Southeast of the U.S. is where things are going horribly wrong. You’ve got higher levels of obesity, diabetes, hypertension

you pick up any health disparity or measure and it’s there,” Morgan said. “And again this is where now we are shutting down rural hospitals.”

One in five adults in the South report having poor health. Fifteen percent of nonelderly residents are uninsured, according to the Kaiser Family Foundation, and that’s 5 percent higher than the rest of the country. The South also has the largest cluster of states that have not expanded Medicaid under the Affordable Care Act: Alabama, Florida, Georgia, Mississippi, North Carolina, Oklahoma, South Carolina, Tennessee, Texas and Virginia.

“Those most in need of health services have the fewest options available, and we are closing rural hospitals,” Morgan said. “From a policy standpoint, we are going in the wrong direction.”

Georgia is “ground zero” for rural hospital closures, he said.

Six rural hospitals in the state have closed their doors since the beginning of 2013. Two of those have been reopened as modified medical facilities, but no longer function as full-fledged hospitals. And more than half of the state’s remaining rural hospitals are vulnerable to closure, according to a 2016 report on rural hospital strength by iVantage Health Analytics for the National Rural Health Association.

Problems over time

The troubles with Glenwood’s hospital became apparent about a decade ago.

First there were management problems at Lower Oconee Community Hospital as the facility grappled with cash flow difficulties, stemming in part from the county’s uninsured rate of 20 percent. Then