8 Ideas to Improve Rural Healthcare Delivery

Rural hospitals are facing a crisis in the United States. In 2020, 20 rural hospitals closed, making it a record year for rural hospital closures. Across the country, 138 rural hospitals have closed since 2010.

These closures are creating gaps in important emergency transit times and leaving residents without access to medical care in their community. This is devastating to the approximately 60 million people — nearly one in five Americans — who live in rural areas and depend on their local hospitals for care. Today, many residents of towns with populations of 1,000 can’t receive emergency, orthopedic physical therapy, or OB-GYN services without making a two-hour trek. Concepts of micro-hospitals or freestanding emergency departments are worthwhile stopgaps, but they are finite at best.

A recently completed HDR research initiative explored how design might positively impact the intersection of some of these elements to help improve the quality of health and well-being in rural towns throughout the country. We studied a number of rural towns — investigative work that was subsequently documented in the book "Rural Resolve" — and then asked ourselves: What small changes can make a big impact? Here are eight ideas that, when considered together, may help reverse this damaging trend.

1. Reimagine Main Street

Numerous studies show that an enlivened town center is key to fostering the economic and social well-being that provides small towns with long-term viability. An essential element to an energized town center is population density. A reimagined main street bustling with activity is the economic engine that can potentially save thousands of small rural communities.

So, in keeping with the “if you build it, they will come” philosophy, healthcare services delivered on main street, not outside of town in a remote development, will attract larger numbers of people who need access to healthcare services — which will, in turn, attract other businesses seeking concentrated numbers of potential clients. By relocating the critical access hospital (often a community’s largest employer) away from its isolation on the edge of town and transforming it into the new civic anchor ultimately provides both convenient access to healthcare services and greater financial security for the provider.

2. Redefine Healthcare

What if a healthcare system isn’t defined by its monolithic hospital or medical facility as much as a series of social supports? With the healthcare provider at the center, other related product and service suppliers (such as fitness centers, pharmacies, yoga studios) located on a main street will create a hub where fitness and wellness become part of everyday life, not simply an occasional activity. By adjusting the town program to cluster wellness with other town services, a more successful and sustainable community could be designed. In many cases, existing main street structures can be used and/or repurposed, and new spaces added within the footprint to further activate the space and attract residents and visitors.

3. Revisit Outdoor Amenities

Access to high-quality parks and recreation spaces is critical to live a healthy life. Studies have linked the presence of an attractive park to increases in aerobic exercise; one study indicated that having a green space nearby resulted in a 25.6% increase in people getting active at least three times a week. Wellness benefits of spending time outdoors also extend to encouraging better mental health and an increase in people’s general sense of well-being. Simply viewing savannah-like settings led to one study’s participants reporting less fear and anger and more considerable attention and peacefulness.

Centering a park within a town center and adjacent to healthcare and related services will also draw additional pedestrian traffic to the area. A bus route could also connect neighborhood areas, main street and the town’s parks to further promote movement in and around the town.

4. Rethink Indoor Amenities

Parks are far from the only community resource missing from small towns. Many that lack quality park space tend to lack other community-supporting services and amenities like human and social services, libraries, and others. New elements, such as an auditorium, meeting or theater space, community hall, swimming pool and basketball courts can be introduced to attract increase visitor and community engagement, which further incentivizes traditional retail services like pharmacies, cafés and restaurants to return to the town’s main artery.

Communities may be able share facilities and pool staffing with neighboring communities in a regionalized approach where activity centers are created in existing buildings or they develop shared-use agreements with schools, community non-profits, and faith organizations.

5. Repurpose Existing Infrastructure

Once upon a time, our streets used to be a primary place to gather — a practice cities and towns of all sizes began to reclaim during the pandemic. Rural communities can benefit from transforming their streets to meet growing open space demands for community activities like dining, farmer’s markets, or art shows. Business owners on many recently closed streets have requested they remain closed, illustrating that these transformed streets have both social and economic value.

6. Refocus on Education and Tourism

Although many small towns lack access to higher education opportunities, alternatives do exist that could help bring education and even tourism to the town. One option is to bring in guest lecturers from nearby state universities or other colleges to speak to residents. These lecturers could visit the town’s elementary and high schools and give interesting presentations about their fields or research, much like a TED Talk. They could also visit the senior living facility and speak there or lead workshops. The goal is to create a stronger sense of community in small towns via the provision of health services and to create stronger ties between towns and their neighboring cities.

7. Reinforce Intergenerational Connections

Relocating (and integrating) the town’s retirement facility to the town center helps older residents stay engaged in community activities, provides access to these new amenities and helps them remain independent longer. Alternatively, connecting senior homes with the main street area and parks via a bus route would enable seniors to move more freely between areas, getting exercise, fresh air, and a chance to interact with their friends in town.

These are the kind of ideas that have the potential to generate renewed activity that thousands of small rural communities need to create population gravity, help save their medical centers and, importantly, improve the quality of life for an important component of our national population.

8. Reconsider What Constitutes a Healthcare Facility

Like many small towns, the one constant source of community engagement and activity remaining in high numbers are places of worship. These community hubs can be used as gathering places that provide opportunities for patient education about healthy living and disease prevention through seminars and bulletin posts. Places of worship can also provide free health screening.

Additionally, worship communities could be a real asset in organizing the town around a design solution where its main street could be reimagined and redeveloped into a community hub for health, recreation, and culture.

Celebrating the Culture of Community

For the millions of people who live in rural areas, it is a culture of community that has kept their small towns alive for many centuries — and kept many of these towns’ rural hospitals open despite a cocktail of geographic, economic, political, and demographic issues that make healthcare access more challenging. The very essence of this culture is woven throughout the eight ideas explained here.