ENNIS, Mont. - Rural hospitals are the backbone of many small communities and experts say quite a few are in danger of closing if the government cuts reimbursements any further.

That's one of the main topics at the Rural Health Summit today in the town of Ennis, southwest of Bozeman.

Senator Jon Tester has invited decision-makers from multiple agencies in Washington, D.C., to meet with executives from Montana's rural hospitals to discuss the challenges they face.

Dick Brown is president and CEO of the Montana Hospital Association.

"There are a number of hospitals in this state that are in the balance. They are, month to month, trying to make things work," says Brown. "And with the pressure of payment reform, delivery system reform, aging population, lack of population, they're struggling with a lot of different issues."

Montana has 48 critical-access hospitals in small towns, serving about 450,000 people, which is 44 percent of the total population.

Many hospitals would like to see more federal funding for telemedicine, which would allow specialists in larger communities to treat patients in rural areas.

Brown says the biggest threat to rural hospitals is the specter of additional cuts to federal programs such as Medicare and Medicaid, and to systems run by Indian Health and the Veteran's Administration.

"Whenever there's a change at the federal level, it seems health care has a target on its back; that there's an easy way to take a few more cuts out of their payment," he says. "And these small communities cannot afford any cuts so, we really need to end that part of the conversation."

He says supporters of rural hospitals are also pressing for improvements in federal programs to attract more physicians and nurses to work in small-town hospitals.


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Amid a nationwide shortage of respiratory therapists, an "earn while you learn" initiative is underway to build a skilled workforce in Virginia to meet growing respiratory care demands.

Sentara Health and Tidewater Community College have launched a respiratory therapy apprenticeship program, which covers educational expenses of nearly $18,000 over two years, while providing hands-on experience at Sentara Norfolk General Hospital.

Kristian Vasconcellos, one of the program's first apprentices, likes the linking of the classroom to the workspace.

"You know, us cleaning the vents or cleaning the machines or the equipment, I do get that experience of being in school and saying, 'Oh my gosh, I know what that is, I know how this works,'" Vasconcellos explained.

Students spend 32 hours each week in academic and clinical training and an additional eight hours working at the hospital, where they encounter a range of real-world medical situations involving asthma, sleep apnea and others. Industry experts have noted a growing need for respiratory therapists, especially following the COVID-19 pandemic, which has led to increased worker burnout and hospital staffing shortages.

Tara Almony, manager of respiratory care and pulmonary diagnostics at Sentara Norfolk General Hospital, expressed enthusiasm about the program's potential to ease the staffing shortage and prepare students for the realities of the job.

"We were looking and thinking outside the box of how we could be creative and how to bring respiratory therapists in, help them," Almony outlined. "Then also, how we as a Norfolk General could help them grow and kind of create a pipeline for ourselves in a way. "

The demand for respiratory therapists has surged, with the U.S. Bureau of Labor Statistics projecting a 14% increase in job openings by 2031. The median annual salary for a respiratory therapist is currently $77,960.


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A Wyoming helpline connects callers to a variety of health and human services, including help with health insurance during open enrollment.

Olivia Schon, deputy director of Wyoming 211, said the service fields 20 to 30 calls a day. Specialists then connect callers with appropriate resources from a database of nearly 3,000 options, ranging from small nonprofits to state and federal programs.

Schon pointed out the top issues people call about are rent and utility payment assistance programs, food insecurity and transportation to health providers. She noted initial conversations often unveil more areas in which the caller can use assistance.

"We average four times the amount of referrals going out based on phone calls coming in," Schon reported. "They call with what their first issue is and then they leave with more than one solution to other problems that they also have going on."

When callers need assistance enrolling in health insurance, they're connected with Wyoming 211's "sister program," Enroll Wyoming. Open enrollment starts Friday.

The rate of health insurance enrollment in Wyoming through the marketplace has increased 75% since 2020, according to KFF. In a round of federal funding announced in September for health insurance navigators, Enroll Wyoming received a $1.5 million grant to continue offering its services for free.

Caleb Smith, marketing director for Enroll Wyoming, said making important decisions around health care can be intimidating.

"It doesn't hurt to have somebody who's on your side," Smith explained. "Who's willing to act as an advocate for you to make sure that you have your questions answered, that you have what you feel like you need to be able to make an informed, empowered decision."

Wyoming 211 is available by dialing 211 from any phone in the state.

The Northern Virginia Dementia Care Consortium will host its annual conference on Saturday - bringing together caregivers, medical experts, and community organizations to address the growing needs of dementia caregivers.

The conference in Fairfax titled "Navigating the Journey: Adjusting the Sails in Dementia Caregiving" is billed as the region's largest event of its kind.

Dr. Nicole T. Rochester is keynote speaker and founder of Your GPS Doc.

She said she knows the challenges of caregiving firsthand, and reflects on her experience caring for her father - alongside her two sisters - during the last three years of his life as he battled vascular dementia.

"It literally, to this date, is the hardest thing that I've ever done, and I've done a lot of difficult things in my life," said Rochester. "But it was also a very beautiful and meaningful and transformational experience for me."

Rochester said she hopes her talk will offer "hope and inspiration" to other caregivers. Anyone interested can register for the conference on the Northern Virginia Care Consortium website.

The event will also feature Dr. Jennifer Pauldurai, a cognitive behavioral neurologist at Inova Parkinson's and Movement Disorders Center, who will address common misconceptions about dementia.

"There is no one algorithm, no one picture of dementia," said Pauldurai, "one person who gets dementia is going to look completely different one hour, one minute, one year, than they did the year before."

Her presentation will offer practical strategies for managing the complexities of dementia care. Both presenters emphasize the importance of caregivers taking care of themselves.

Attendees will also hear from financial and legal planning experts, hospice care providers and nutrition experts.

Amber Nightingale, associate state director for community outreach with AARP Virginia - whose organization is a long-time conference supporter - said every attendee will receive a copy of The 36-Hour Day, a comprehensive guide to dementia care.

"If we can help support the family caregivers who are looking for up-to-date information and resources, and information on treatment, support services," said Nightingale, "then we're happy to support such a conference."

According to the Virginia Department of Health, 150,000 people aged 65 and older are living with Alzheimer's in the state, and around 10% of people aged 45 and older have subjective cognitive decline.