With fewer than 65 rural hospitals left to serve Tennessee's rural communities, and half of those estimated to be at high risk of closure, the health of thousands of Tennesseans is in jeopardy, simply because of where they live. In their 2021 report on RURAL HOSPITAL CLOSURES: The ambulance is our emergency room! The voices of rural Tennesseans, the Tennessee Health Care Campaign draws on the words of rural Tennesseans facing the loss of a treasured and essential local institution as they describe the impact of hospital closures on their communities and recommend solutions to prevent additional closures and repair local health care systems.

Tennessee has the highest per capita rate of hospital closures in US, jeopardizing the health not only of vulnerable residents, but of the local economies and quality of life of the large majority (82%) of counties in our state. Rural residents tend to be older, poorer, and more likely to have the chronic health issues that require steadily available health care, yet their hospitals keep closing. Between 2010 and 2020, 18 rural hospitals have closed, with only 4 offering any remaining health services. Jellico Hospital in east Tennessee was the first to close its doors in 2021, but given the impact of the Corona-19 virus on health services, it will not be the last. Each closure finds thousands of families precious minutes and many more miles away from the help they need to successfully treat stroke, heart attack, overdose, or major trauma. And state and federal response to the trend has been inadequate and limited.

The Tennessee Health Care Campaign report is based on nearly three years of community- based qualitative research conducted in collaboration with researchers at Vanderbilt University Medical Center. Together they have created a Toolkit for communities whose hospitals are vulnerable to closure that offers community, state, and federal level solutions to rural health inequities, and emphasizes the urgency of coordinated action to strengthen rural health access to a continuum of needed services. The Toolkit is available online at the Tennessee Health Care Campaign's website: https://tnhealthcarecampaign.org/rural-equity-report/

"The THCC Toolkit is needed right now, to highlight the experiences of our rural communities and what they can do, and our state can do, to protect rural citizens' health. Recognizing the link between the loss of a rural hospital and the loss of the local economy is long overdue." Says Randall Rice, Board President of the Tennessee Health Care Campaign.

The toolkit is designed to help rural communities facing the loss of their hospitals. It contains lessons learned from communities whose hospitals closed, and a detailed list of Local, State, and Federal policy recommendations for sustaining Tennessee's rural hospitals including:

• Increasing coverage for the disproportionately high number of low-income, uninsured, and chronically ill Tennesseans who live in rural areas
• Increased state planning and financial investment in rural health care, including innovative service options for distressed communities
• State oversight of hospital ownership transfers to assure experience in hospital management and verification of funding
• Prioritizing infrastructure improvements in roads, broadband, and regional emergency call

The report contains a themed analysis of conversations with key community stakeholders in six/seven communities across the state that have recently lost a hospital. These stakeholders--county and city elected officials; first responders; providers primary care and long-term care; former hospital administrators and board members; business leaders; community representatives--share their perceptions of the causes, consequences, and solutions. Here is a sample of some of the insights shared:

• There was no forewarning. Everyone was caught off guard. They made us believe that everybody's jobs were And then [on February 27] they walk in and say, "March 1st we're closed. See y'all later.
• You lose 150 jobs in a small county, it has an economic effect....Without the hospital, fewer people buy gas and groceries. School enrollment went down, so less state assistance... Business and industry eliminate you if you don't have a hospital.
• And then you have [real estate] deals that actually come down to the closing and they

won't go through with it because a local hospital is just so important.

• The poorest in the community are most impacted, especially when they don't have transportation to travel to health care facilities that may be 30, 40, 60 miles
• We have two ambulances in a county of over 500 square
• Many indigent patients and expectant mothers didn't have insurance, but they were all And the bottom line is that the hospitals couldn't get paid.

For additional information on the report and follow-up contact: Judy Roitman, Executive Director, Tennessee Health Care Campaign, director@tnhealthcarecampaign.org. Phone 615- 227-7500 ext. 1.

The Tennessee Health Care Campaign (THCC) is Tennessee's leading non-profit consumer health care advocacy group and a leader in the health care justice movement. Founded in 1989, THCC and its members have worked to assure that state and national policies promote Tennesseans' equitable access to affordable, high-quality health care. THCC's partners include Vanderbilt University Medical Center, the Meharry Vanderbilt Alliance, citizens, elected officials, health care providers, hospital administrators and activists in East, West, and Middle Tennessee.

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