A Hospital for All Seasons
MARGOLIS, RJCHARD J.
States of the Union A HOSPITAL FOR ALL SEASONS BY RICHARD J. MARGOLIS The caring part is at least as important as the curing part. —a former patient at People's Memorial Hospital When...
...I intend to pay you back every cent...
...Since this is Iowa, however, some patients object to the hospital's generosity...
...Lots of them had no health insurance—the farmers couldn't afford it, and quite a few of the workers in plants around here got laid off, so they were unprotected, too...
...Do the right conditions now favor the citizens of Independence, Iowa...
...Our social mission is paramount...
...This is our first big fund-raiser," Richard says...
...We're very much a pari of this farm community...
...As a housewife who has lived all her life in Independence reminded me recently, "Having our hospital right here gives us all a feeling of self-respect...
...It has also been politicized...
...We're keeping our fingers crossed...
...At some of those bigger places like the Mayo I felt I was just a number...
...Of the2,638 rural hospitals still extant—most with fewer than 50 beds— a substantial number are verging on bankruptcy and some 40 each year are going belly-up...
...They may be busy but they still find time to stop and chat...
...I know I couldn't...
...For the most part, though, the residents of this hard-pressed community are displaying an unaccustomed optimism...
...specific skills such as fund-raising are revived, and the community begins to think better about itself...
...At night there's always a pretty nurse looking in to make sure you' re all right...
...I don't mean to be disrespectful," a farm hand, the father of three small children, wrote to Richard after the hospital had written off a $300 charge for his stay there, "but I don't know how you could do what you did to me...
...Actually, the blessings of People's Memorial extend well beyond the town's limits...
...We emphasize wellness...
...M any small communities nowadays are having to face the indignities of subtraction...
...People depend on us to keep track of their health charts from childhood," says Donna Duffy, who is in charge of all the medical records...
...In a transient society it may be true that you can't go home again, but at least you can send cash...
...A heart condition has landed Mrs...
...No questions were asked and no bills were submitted...
...In the interim each family at some point is likely to make use of the hospital's 36-bed infirmary, or its new, $1 million outpatient clinic (which imports part-time medical specialists from Waterloo and Cedar Rapids), or the nursing home that accommodates 59 elderly residents and is always full...
...Maybe the residents think so too...
...This fall the hospital opened its new outpatient clinic, financed almost entirely with the extra earnings it had been frugally squirreling away each year...
...Because overhead costs are mistakenly thought to run lower in rural areas, hospitals there get paid less by third-party insurers, both Federal and private...
...a former patient at People's Memorial Hospital When residents of Independence, Iowa (population: 2,300) reach theage of 65, some find it necessary to use People's Memorial Hospital—not to get well but to get their Social Security benefits...
...The staff even holds "sibling classes" for tots who are about to become older sisters and brothers and may be uneasy at the prospect...
...Its financial statement for fiscal 1988 puts "Excess of Revenues Over Expenses" at slightly more than $112,000...
...A cholesterol check, for instance, costs just $3...
...By pausing briefly to examine the way a single emblematic institution functions—namely People's Memorial of Independence, Iowa—we can begin to appreciate some of the unheralded advantages that small-town residents realize from their hospitals, advantages most city-dwellers would find altogether remarkable...
...Well,wemadeit a point to accept every patient who needed care...
...The nurses in Independence, furthermore, "are simply wonderful...
...Patients can't be expected to remember the details of illnesses they had 50 or 60 years ago...
...for many a citizen seeking to establish her age and eligibility, those yellowing folders—neatly stacked inside a mansion that housed the town's very first hospital—contain the only documentary evidence within hailing distance...
...Richard and his colleagues view members of this group as loyal alumni who may consider the hospital something to write home about...
...Not just for Social Security reasons, of course...
...But to folks thereabouts it is an institution for all seasons, starting with prenatal care at the outpatient clinic and ending, perhaps, with pre-dying care in the hospice program, one of the first to be undertaken in rural America...
...the institution belongs to all 22,000 residents of Buchanan County, a farming area in the state's northeast corner...
...What I find at People's," she says, "is that you get personal care...
...For there is something about a rural hospital that can cure more than physical ailments, that can go a long way toward restoring to citizens their sense of civic consequence...
...A decline in the rural economy nationwide is only one reason for the widespread pessimism...
...And he did...
...In fact, they come even when you don't ring...
...Such services are either offered gratis or for a nominal charge...
...The money will go toward construction of a new nursing home...
...To a citified eye the hospital's main facility may not look like anything special—merely a modest, one-story building plunked down in the middle of corn country...
...Thus does the hospital serve as a particularized mirror of the town'spast...
...Their occupancy rate, says the American Hospital Association, was only 55 percent, compared with almost 70per cent for urban hospitals...
...At People's everybody knows your name...
...I think sooner or later we touch just about everyonein the county," says Robert J. Richard, the hospital's bearded and energetic director...
...Bentsen Promises Program to Retain Rural Hospitals," proclaimed a New York Times headline in mid-September...
...But the psychological effects—the erosion of community morale and confidence—can only be imagined...
...The medical impact of small hospital attrition has been publicly calculated and justifiably lamented...
...Because it remembers, the residents exist— or so the Social Security Administration seems to think...
...A town that loses its hospital has one less thing to take pride in...
...When you ring the bell, they come running...
...Last year, according to tallies made in Washington, small-town hospitals suffered a 20 per cent drop in "patient utilization...
...It cost us a bundle," Richard says, "maybe a quarter of a million dollars, but that was okay...
...Hoping they are on a roll, hospital officials are planning a half-million dollar fund-raising campaign for 1989...
...They point to the lingering farm recession, to the baneful effects of last summer's drought and to the recent demise of the Rath Packing Company, aWaterloo firm that provided jobs to many in Buchanan County...
...There is yet another way People's Memorial differs from its urban counterparts, and that is in its treatment of those who are down on their luck...
...The managers of rural hospitals are understandably gloomy...
...In pursuit of wellness, staffers and volunteers crisscross the county, taking people's blood pressure, checking their cholesterol count, screening the sugar content in their blood—in short, spreading the gospel of nutrition, prevention and mental health...
...We want those touches to be positive...
...We did it because it was right...
...Believe me, when you're lying awake in the dark with worry and pain, a friendly word can really help...
...This column aims to prod our imaginations...
...By forging ahead they may be unintentionally following ? scenario that sociologist Richard A. Couto outlined several years ago in a book called Streams of Idealism and Health Care Innovation...
...The doctors need to know their patients' medical histories...
...Under the right conditions," Couto claimed, "a process may occur where the leaders of health fairs and clinics become recognized as 'doers...
...A bigger reason is the peculiar way that Medicare and Blue Cross reimburse rural hospitals—in a word, stingily...
...In a recent survey of hospital administrators taken by the accounting firm of Ross Touche, 63 per cent of those heading small institutions thought they would fail in the next five years...
...Withal, and contrary to the bleak predictions concerning rural hospitals, People's Memorial in recent years has been turning a profit...
...When the farm crisis hit us," Richard recalls, "we tried to make things easier for the families who were hurting most...
...Brockling in all sorts of highpowered urban medical centers, including the Mayo Clinic, but People's Memorial is her healer of choice...
...I don't think wecould survive without the hospital," says Esther Brockling, a grandmother who publishes a weekly newspaper in nearby Winthrop...
...Its medical archives go back three-quarters of a century...
...There are some in Independence who warn that People's Memorial has grown too ambitious, that it will be unable to sustain its current pace of expansion...
...A major target in the campaign will be the thousands who once lived in Buchanan County and have moved on...
Vol. 71 • November 1988 • No. 19
