By Ilana Newman for The Daily Yonder.
Broadcast version by Eric Galatas for Colorado News Connection for the Public News Service/Daily Yonder Collaboration
In Colorado, a new online database hopes to bring attention and collaboration to rural businesses, primarily those in the outdoor industry.
Rural is Rad was started by Kelly Mazanti, TJ Smith, and Robin Hall, who all own small businesses based in rural Colorado. They discovered a shared interest and mutual frustration over growing businesses in rural communities.
The group met during West Slope Startup Week, a conference that brings together startups based in the rural Western Slope of Colorado for a week of networking, lectures, and discussions. They wanted to build something that would continue to bring together rural brands in the outdoor industry and create a space where customers could find these brands in one place.
“We have to support each other because I have found that the people who live in these [rural] places are the most courageous and creative people that I’ve ever met,” Mazanti said in a Daily Yonder interview.
Mazanti runs Buttnski, an apparel brand based in Summit County, Colorado. She sees her role as a business owner in the community as a way to support economic development in a rural county and contribute to a thriving community.
“As a founder, my goal is to build this headquarters of operation for Buttnski in Summit County so that we can employ people and contribute to economic development and become not only an industry hub in our community but also a place where we can help develop how this community grows,” she said.
Rural counties with outdoor recreation opportunities can attract more residents who have more money than non-recreational rural counties. However, recreational economies also tend to have lower wages and can drive up housing prices in a community, which pushes lower-income people to other areas.
Mazanti hopes that Rural is Rad can connect rural business owners and communities to help solve challenges like this.
It can be harder for small brands and businesses in rural communities to gain traction. Rural small business owners struggle with the lack of access to financing, broadband speeds, and increasing cost of doing business.
The Rural is Rad database hopes to address this by bringing rural brands to a larger audience outside of their home communities.
Colorado has a plethora of opportunities for rural businesses through their Rural Opportunity Office including the Regional Resiliency & Recovery Roadmaps Program, the Rural Data Dashboard, and the Rural Technical Assistance Program.
“I think if I was trying to do this in any other state, I wouldn’t have this kind of support or the type of resources and community around me,” Mazanti said.
She sees collaborations with everyone from the statewide governmental organizations to nonprofits like Startup Colorado to small-town chambers of commerce as vital for the success of the Rural is Rad movement. “Colorado is an example, and it’s a great place to start this kind of a movement.”
Rural is Rad plans to host events and workshops for business owners. The second Rural is Rad week is scheduled to start on Small Business Saturday (November 30th, 2024). This week will highlight rural brands and offer consumers a way to support rural small businesses during the holiday shopping season.
“We can utilize that directory year-round to point people toward these to discover new brands. But then during Rural is Rad shopping week, which happens once a year, that can be an opportunity to further promote these smaller, more unique brands and founders that people may never have heard about,” Mazanti said.
Currently, Rural is Rad’s database features 17 brands from jewelry makers to backcountry bathroom kits to campgrounds. Brands and service providers can join Rural is Rad by filling out a survey on the website.
Mazanti hopes to expand the database to eventually include all of rural America.
Ilana Newman wrote this article for The Daily Yonder.
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By Liz Carey for The Daily Yonder.
Broadcast version by Mark Richardson for Minnesota News Connection for the Public News Service/Daily Yonder Collaboration
When rural patients incur medical bills they can’t pay, the impact of the debt reaches far beyond their own personal pocketbooks, a new study has found.
Medical debt also impacts the hospitals that can’t collect on the debt and the communities they serve, according to a research brief from the Rural Health Research Center at the University of Minnesota. Although medical debt is something all communities have, it hits rural communities harder, Carrie Henning-Smith, co-director for the center, said.
Researchers interviewed rural hospital administrators in seven states – Arkansas, California, Illinois, Texas, Vermont, Washington and West Virginia – to look at the implications of medical debt on rural communities at large.
“We know how widespread medical debt is,” Henning-Smith said in an interview with the Daily Yonder. “We weren’t particularly surprised by anything we heard, but I think one thing that stands out to me is that this is not just an issue of healthcare facilities passing on big bills to patients and then patients shouldering that burden.”
“This is really an issue that impacts individual patients, whole communities, and healthcare facilities, and I think smaller rural facilities that have a more tenuous bottom line are some of the most impacted,” she said.
Research indicates that about 44% of all U.S. adults are affected by medical debt, and that $88 billion in outstanding medical bills is currently in collections across the country. Researchers found the debts impact a rural hospital’s ability to continue paying their employees. With fragile bottom lines, rural hospitals are less likely to absorb the debt, respondents said.
A respondent from a Midwestern state said to the researchers, “One of the statistics that I think is really relevant is that we are about a $150 million organization… and 65% of those dollars go back in the form of compensation and benefits to our employees. So when we have medical debt that becomes excessive and we’re struggling to collect on the work that we do, it impacts our ability to employ [providers] and to serve our patients.”
With less revenue coming in, most respondents said, they are less likely to invest in equipment upgrades and their facilities, as well as less likely to hire more staff. Additionally, respondents said it’s harder to collect on that debt.
“It’s a non-recourse issue. We can’t go back and take back what we’ve done,” a Southern state administrator told researchers. “You can’t repossess anything medical like you can with a car or a home or anything like that when there’s financial troubles. We end up really just getting unpaid, mostly.”
Researchers found that much of the blame for the debt issue is not solely because of patients who are underinsured. In many cases, insurance companies and other payers – including Medicare, Medicaid and Medicare Advantage – are not covering the cost of care that the hospitals provide.
“They need to have their cost recouped for the care that they provide,” Henning-Smith said, “and when they have patients who are uninsured or underinsured or when they are dealing with insurance companies and payers that are not providing a sufficient amount to pay for the cost of the care, then the facility suffers and the patients and community suffer too.”
“It’s clear that our payer system is broken and that we have people whose care is not compensated at all or not at the rate that it needs to be to keep these facilities financially thriving,” she said.
Even if a patient is insured, some hospital administrators surveyed pointed out that underinsurance can create problems for patients and hospitals as well. High deductibles and plans with limited coverage options shift the responsibility for payment from the insurance company to the patient.
An administrator from the Midwest told the researchers, “Even the people who have the ability to pay, when you have more things like a high deductible health plan, no matter what your income is, it’s not easy for very many people if you have a $5,000 deductible. When that bill comes, that’s a difficult thing.”
Alan Morgan, CEO of the National Rural Health Association, said when rural hospitals don’t get paid, the impact is far reaching. Hospitals are typically among the largest employers in rural communities, and if a hospital fails because it can’t pay its bills, the whole community suffers.
“We’re in the midst of a hospital closure crisis and declining points of access to care in rural communities and it is because of bad debt, period,” Morgan said in an interview with the Daily Yonder. “When a hospital has to find ways to write off bad debt… for a lot of these rural hospitals, they’re operating on the margin and carrying large amounts of debt and uncompensated care that sometimes drives them to closure.”
When hospitals close due to financial problems, the economic hit on the community is multi-faceted, he said. The lost jobs not only reduce tax revenue coming into the community, but also impact the amount of consumer dollars being spent in the community. It means less income for businesses indirectly linked to the hospital, like flower shops, he said. And once the hospital closes, getting new families and businesses to move there becomes more difficult.
Fixing the issue will mean reforming how rural hospitals are reimbursed, Henning-Smith said.
“The message needs to continue to be about payment reform and understanding that medical debt is a widespread issue that’s not going away, but it’s not an individual issue and it’s not a matter of personal and individual responsibility,” she said. “It’s a community and a collective and a societal issue that if we don’t address, it’s not going to only impact the health and access to care of individuals, but it’s also going to impact availability of care in rural communities and places that need that care the most.”
Liz Carey wrote this article for The Daily Yonder.
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Researchers at the University of Oregon say a new online parenting skills program has helped improve mental health for rural Oregon families.
After using the app, called Family Check-Up, for three months, parents reported a decrease in depression symptoms and increased confidence in their parenting.
Kate Hails, research associate for the Prevention Science Institute at the University of Oregon, said the program uses techniques like focusing on parents' strengths and children's positive behaviors.
"Family Check-Up really views the parent as the expert on their own parenting in their own family and focuses on their own personal goals," Hails explained.
Hails pointed out the app is for families with young children and is based on an in-person program. She added it is designed to help rural families who face challenges with transportation, scheduling or stigma, preventing them from getting mental health support.
About a third of the parents in the study had significant levels of depression when they enrolled, and about a third were at risk for opioid misuse. Hails stressed the program starts with parents' own wellness.
"We know from research that parents really need to be able to regulate their emotions in challenging moments with toddlers because that will happen regardless of how effective of a parent you are," Hails emphasized.
Parents access the program through their smartphones. It has science-backed lessons and opportunities to meet online with trained parenting coaches. Hails explained parents can work through the program at their own pace and meet with counselors on their own time, allowing them to multitask if needed.
"That kind of squeezing it into life is not really possible when we think of traditional mental health or even like kind of telehealth zoom sessions," Hails observed.
The next step, Hails added, is to gauge the effectiveness of the program over a longer time period with trained providers who are not involved in the research.
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Rural West Virginia counties are already facing shortages of home health care services and nursing home workers. Now, they are facing accusations of alleged misconduct by contract workers in state nursing homes.
A new lawsuit cited a "systems failure" from top to bottom, where officials have allowed front line workers to act in ways that harm patients.
Michael Folio, legal director for the nonprofit Disability Rights of West Virginia, the group behind the lawsuit, outlined its goals.
"What we've identified is even the regulatory bodies in West Virginia that are charged with overseeing these facilities are so understaffed, so underfunded, that we oftentimes are reporting incidents to them, even though it's their job to actually uncover these incidents and take appropriate action," Folio explained.
The lawsuit alleged state officials knew about abuse, harassment, and retaliation of fellow employees and patients. According to the health care advocacy group KFF, there were more than 9,400 people living in certified nursing home facilities in West Virginia in 2024.
Folio pointed to documented incidents of abuse and neglect over the past year in state long-term care facilities. One case is now under criminal investigation, where hot water temperatures were said to reach between 134 and 140 degrees.
"What did they do? They ignored it for five months," Folio contended. "They placed an elderly gentleman who had dementia and he was nonverbal in this water and left him there."
According to the National Rural Healthcare Association, rural health facilities still have severe staffing shortages with fewer clinicians per capita, and sicker and older patients on average compared to urban areas.
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