Rural hospitals received pandemic aid. What happens when the funds run out?

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Public health leaders in rural communities are sounding the alarm. They're warning of more small-town hospital closures looming in the new year, at a time when the omicron variant poses a very real threat. NPR's Kirk Siegler reports.

KIRK SIEGLER, BYLINE: When the vaccines became widely available this past summer, rural hospitals like the 10-bed Guadalupe County Hospital in eastern New Mexico raced to put on mass vaccination events and other outreach campaigns.

CHRISTINA CAMPOS: We're older, we're sicker, we're poorer.

SIEGLER: The hospital's administrator, Christina Campos, says that even before the pandemic, hospitals like hers had a hard time meeting all the community's needs.

CAMPOS: You know, if COVID were looking for a place to make a huge impact, it would be a community like ours, and that's why we had to fight back with a huge vaccination effort.

SIEGLER: But by midsummer, vaccination rates in much of rural America plateaued, and soon after, unvaccinated patients overwhelmed small hospitals as the delta variant took hold. Most rural systems aren't set up to handle crisis care, let alone a global pandemic. Well, now there's more anxiety with omicron, especially with rural vaccination rates lagging behind cities. Alan Morgan is CEO of the National Rural Health Association.

ALAN MORGAN: We've asked rural hospitals to serve a function they were never designed to serve, and as a result, it's just crushed our rural health safety net out there.

SIEGLER: Twenty-two small-town hospitals have shuttered since 2020. Most federal relief money for rural hospitals is set to run out early next year, so leaders are pressing the Biden administration and Congress for another round to prevent more closures. This aid has helped pay for everything from temporary COVID isolation wards to overtime for staff to hiring more travel nurses. The outlook for the new year is pretty grim.

MORGAN: And you're seeing these communities that are not employing public health measures, such as mask-wearing or vaccinations. It's a perfect storm, setting up, really, kill boxes in many of these rural communities.

SIEGLER: Vaccines and mandates remain pretty polarized in rural America, and frontline workers report morale is low and burnout is high. Matt Shahan, the CEO of a 25-bed hospital in Hettinger, N.D., recently watched with dismay as his staff went from being celebrated as heroes to sometimes now being maligned.

MATT SHAHAN: Now all of the things they're doing are in question, and really all those folks want to do is help the patient in front of them and get them back healthy and back to their family.

SIEGLER: Rural administrators like Shahan have warned that possible vaccine mandates in the new year might lead more health workers to quit, and that could make the already severe staff shortages even worse. Surveys show that upwards of 40% of staff at rural hospitals across the U.S. aren't vaccinated. Drew Dostal runs two small hospitals in rural Michigan.

DREW DOSTAL: And I think sometimes, you know, a government mandate is awful scary, and so people respond to that out of fear, and sometimes fear comes across as anger. And I think that's to be expected.

SIEGLER: But when Spectrum Health, which owns Dostal's hospitals, put in its own vaccine mandate, there weren't actually mass resignations. Dostal is more concerned about people in his community who are continuing to refuse getting the jab. If there's another surge in hospitalizations from omicron, that means it will be harder to get other important preventative care.

DOSTAL: We may not have the people to offer all the things that we used to, which means more centralized care in other areas and traveling for our patients, which we don't want to do. But it's always a possibility.

SIEGLER: That could again set rural America further behind cities. That's why rural leaders are pushing for more emergency funds to keep small-town hospitals open with the two-year anniversary of the pandemic approaching. Kirk Siegler, NPR News.

(SOUNDBITE OF BALMORHEA'S "STEERAGE AND THE LAMP") Transcript provided by NPR, Copyright NPR.