With many rural hospitals on the financial critical list, Congress created a Rural Emergency Hospital model in 2021 to help deliver critical care to struggling communities in Nebraska and elsewhere.

Two years in, the Bipartisan Policy Center has issued a report which showed care is improving where the system has been implemented but more work is needed. Under the model, 32 Rural Emergency Hospitals in 14 states have been established.

Julia Harris, health program director at the center, said the plan is preserving health care options for rural residents.

"If you start seeing hospital closures go down, that's a success measure," Harris asserted. "Because this should be what helps them meet the needs of the community and stay open rather than being forced to close."

Harris pointed out under the Rural Emergency Hospital model, a rural facility can offer emergency department, observation, outpatient care and skilled nursing facility services in a distinct unit. Warren Memorial Hospital in the town of Friend is currently the only such facility in Nebraska.

Harris noted the growth of the model is reducing the number of rural hospital closures but acknowledged challenges remain in operational flexibility and the availability of financial assistance. She emphasized they studied states across the Midwest, looking for hospitals and communities which could benefit from a Rural Emergency Hospital.

"The reason we chose Kansas and Nebraska is because there was some modeling done to see which states would have the most hospitals eligible for this model," Harris explained. "Those were two states that had a lot of potential REHs. "

Other recommendations in the report included support for prescription drug discounts, more flexibility in converting to Rural Emergency Hospital status, timely payments to speed the process and more funding for providing technical and operational assistance, with what are called technical assistance centers.

"There is a federal TA center to help hospitals that are trying to consider their pros and cons," Harris observed. "We advocate for continued funding for that TA center to be able to continue to do this sort of advising and help states make these choices."

By Mitzi S. Morris for the Indiana Capital Chronicle.
Broadcast version by Terri Dee for Indiana News Service reporting for the Indiana Capital Chronicle-Free Press Indiana-Public News Service Collaboration

As Indiana anticipates slow population growth in the coming years, small cities and towns in rural Indiana are pushing forward with projects to attract residents and businesses to their communities.

Growth over the next four decades is projected to be lower than it was in the decade between 2000 and 2010, according to Matt Kinghorn, senior demographer at the Indiana Business Research Center. More than 70% of Indiana's counties are expected to lose residents over the next 30 years, many of which are rural and also lost population in the 2020 census.

"And the counties that are growing quickly are generally taking population from other areas of the state. So it's not an overall net increase," said Matt Greller, chief executive officer of Accelerate Indiana Municipalities (AIM).

But small Hoosier communities aren't going down without a fight.

Local businesses, organizations and governments are applying for grants, investing in quality-of-life projects and supporting small businesses to draw new citizens and spur economic growth.

"For a community to have the amenities that folks want these days, whether it's broadband or trails or a vibrant Main Street, you've got to have a coalescing of people to make that happen," Greller said.

Going after grants

Grants are crucial in helping small cities and towns in Indiana launch and complete initiatives. Community foundations, state entities and federal sources all play a role in funding local projects.

For example, Boonville in Warrick County is working toward Indiana Accredited Main Street (IAMS) status after completing the Aspiring IAMS 1-year Program.

"(Indiana Accredited Main Street) opens the door for more grant money, which is the key to doing just about anything that you want to do of significance. If you can't get grants, then you've got to do fundraising, and it's pretty hard to raise a million dollars in a town like Boonville," said Jim Miller, executive director of Boonville Now. His group promotes the city's downtown.

The city even hired a firm with a grant researcher dedicated to ensuring community leaders know about every possible funding opportunity.

"The idea was, 'Let's pay this company $50,000 a year, and we'll be looking at $100,000, $200,000, $300,000 grants per year.' Then it pays for itself," Miller said. "I've got spreadsheets of probably 20 things that they're working on."

Miller employs Placer.ai, a location analytics software, to track foot traffic in the city, then uses the information to apply for grants. Janelle Amy, executive director of Main Street Corydon, a Nationally Accredited Main Street community, also plans to use Placer.ai data to attract local investment.

Indiana University Southeast (IUS) is "able to send some reports for us to be able to measure and see how many pings on these phones were coming through and being able to see those heavy spikes whenever we have those larger festivals, especially in our downtown, hoping that we're able to see that data year after year to see, 'Are we seeing continued growth? Should we focus our efforts elsewhere?'" Amy said.

Another grant source, the state-funded Regional Economic Acceleration and Development Initiative (READI), has given hundreds of millions of dollars to economic growth projects across the state. The READI program is not in the current version of the state budget, according to Greller.

"I hate to see that go away because it's such an innovative thing that set apart Indiana, certainly in the Midwest and maybe the rest of the country. It is having a real impact on some of these rural communities," he said.

Quality of life investment

For small Hoosier cities and towns to survive, Greller said municipalities must be willing to fund projects that meet their residents' needs, particularly when it comes to quality of life.

"We live in a world where we all want lower taxes," said Greller. "But there are studies after studies that show once a government decides to make a formal investment in a community in a meaningful way, that typically has a snowball effect."

Miller said increased property tax values helped Boonville accomplish several quality-of-life projects.

"We've been able to take advantage of that and issue bonds to be able to build a new pool and to completely renovate the splash pad and the playground area and the basketball courts and things at City Lake," he said.

But property taxes are in the crosshairs at the Legislature.

Greller emphasized investment in city and town parks as a key driver of economic growth in rural Indiana.

"(Smaller parks) drive things like community events, farmers markets, summer concert series, hot rod festivals or whatever it is that wants to come to an individual community. Those kinds of investments have done well and created good returns over the years," he said.

Miller said Boonville is also focusing on historic preservation with the Mt. Liberty Baptist Church and School restoration project. In Corydon, the town is building a skate park and increasing walkability by connecting downtown to Rice Island Park.

"Being able to expand that further out ... we've opened up a whole other level for people to be able to visit our downtown and hopefully shop and support and live here as well," said Amy.

Attracting businesses and residents

When big employers leave small Hoosier cities and towns, residents often go with them. Corydon is looking to draw a new industry after Tyson Foods' closure last year affected nearly 370 employees.

New Gov. Mike Braun's campaign included a plan targeting rural Indiana, and the current state budget proposal includes a tax credit to attract qualified private sector investors to raise and invest flexible capital into rural communities and help rural businesses to sustainably expand their operations.

Greller said Gas City went through a similar situation as Corydon when the area was hit hard by the downturn in automobile manufacturing jobs.

"They pivoted. They made some strong investments in their community. They've seen an uptick in growth and population. They just built the performing arts center, which is a sign of things improving in those kinds of communities," he said.

In Boonville, two new establishments - a restaurant with catering service and a cigar lounge - recently opened in the historic district, according to Miller.


"What we're trying to concentrate on is bringing in more small businesses because we do have some empty spaces on the square and around the square," he said. "We don't have any more land to be able to give a bigger industry that wants to come in."

Thanks to city grants, Boonville entrepreneurs can apply for money to enhance building facades and revolving loan funds to make other improvements or start a business. Corydon also has a facade program funded in part by the Harrison County Community Foundation and a community collaboration fund created from a state grant.

"We were able to offer up to $5,000 to our downtown business owners for whatever initiative they needed at that time. So it could be purchasing new inventory, helping them with their marketing, Just whatever we could do to give them an additional boost to keep them here and hopefully support their initiative moving forward," Amy said.

Programs like Make My Move and Choose Southern Indiana offer remote workers incentives for relocation within the Hoosier State. However, Greller questioned how emerging return-to-office policies will affect these initiatives in the future.

"I'm interested to see what happens in some of these communities that have had success attracting those folks into their areas," he said.

Amy viewed new housing developments in Corydon and Harrison County over the past year as a sign of residential growth.

"I know of at least three additional apartment complexes within the Corydon area that are very close to downtown," she said. "And new subdivisions have been populating as well in Corydon and beyond."

Pushing past reality

Despite the efforts of small cities and towns in Indiana to remain independent, Greller said some areas that thrived on historic economic drivers may need to have some tough conversations.

"We have some small communities that were there because there was a grain elevator 150 years ago or there was a railroad stop 150 years ago. Does it make sense for the viability of the region they're in to continue to exist as an incorporated area? Maybe we ought to look at merging with other forms of government for the greater good," he said.

Federal funding cuts are also a concern regarding infrastructure projects and other initiatives in small municipalities.

"Many communities are fortunate to receive Economic Development Administration, (U.S. Department of Agriculture), Small Business Administration and other types of federal funding. I do believe that economic growth could be threatened if funding commitments from these federal agencies are halted abruptly," said Darrell Voelker, executive director of the Harrison County Economic Development Corporation.

To persist, Greller said small Hoosier cities and towns must get creative and maximize opportunities to ensure sustainability and longevity.

"We're going to have to take a close look at ourselves and make sure we're running as lean and efficiently as possible to make sure we have resources to invest in these types of programs," he said.


Mitzi S. Morris wrote this article for the Indiana Capital Chronicle.


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Indiana lawmakers paused action this week on a bill which aims to prevent crashes caused by dangerously overgrown rural intersections after concerns arose about liability.

The bill originated after Riley Settergren, 17, died in a 2017 collision at a Hancock County intersection.

Jay Settergren, his father, testified Monday before lawmakers, urging stronger rules to prevent similar tragedies.

"Just days before his senior year, Riley was taken from us by a piece of farm machinery that could not see at an intersection because it was obstructed by corn," Settergren recounted. "They had to move out further into the road. The truck Riley was a passenger in was struck. Riley was killed instantly."

The current proposal would mandate property owners or renters near rural intersections clear all vegetation or obstacles above three feet, ensuring drivers can see approaching traffic. However, farm groups oppose the measure, citing liability risks and potential loss of productive farmland.

After Riley's death, his family created a foundation honoring their son, placing caution signs at intersections statewide to alert drivers to the risks near farmland. Riley's father stressed to lawmakers while signs help, permanent visibility improvements require enforceable legislation.

"We need to move to the next level," Settergren urged. "We need help to pass this putting responsibility on the landowners and the lessees to make sure that they are maintaining their corners, and their crops, and their properties."

Rep. Jim Pressel, R-Rolling Prairie, said legislators intend to amend House Bill 183, shifting emphasis away from strict sightline triangles, toward maintaining existing road right-of-ways.


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The future of a big carbon capture project in the Midwest was thrown off balance after a new South Dakota law was adopted. Rural property owners made a big push for the policy and their organizing is getting noticed.

South Dakota's governor just signed a bill prohibiting eminent domain for carbon dioxide pipelines. It is in response to a proposed line where the company behind it has not secured all the voluntary land agreements it needs. Worried landowners found sympathetic ears in the Legislature.

Sarah Jaynes, executive director of the Rural Democracy Initiative, said outcomes like these reflect the mindset of smaller communities when big projects come their way, potentially affecting their way of life.

"Rural people are not in the habit of fighting things," Jaynes pointed out. "They're in the habit of taking a close look at what's proposed for their communities after decades of exploitation."

She is referring to corporations outsourcing jobs from rural areas, as well as agricultural firms wanting to add larger animal feedlot operations. Jaynes noted the decline of local news outlets is likely playing a role in how communities are responding. Without access to key information, residents are enhancing their coordination to have a bigger voice.

The multistate carbon pipeline is proposed by Summit Carbon Solutions, which wants to capture ethanol plant emissions and store them underground. It touts economic and environmental benefits but some skeptics see it as a power grab, especially if objecting landowners are forced to let it run along their property through eminent domain.

Jaynes explained in a broader sense, rural residents are not confined to narratives about what they care about.

"They want to make sure that they have clean air and water and access to nature," Jaynes emphasized. "They want to take care of their land."

Such sentiments have surfaced in polling from the Rural Democracy Initiative.

As for the Summit project, the new law might lead to a legal challenge. Summit has won permit approval in other states and is trying again in South Dakota. But the uncertainty, along with the land restrictions, could make it harder to begin construction. The governor insists the action will not kill the project, calling it an "opportunity for a needed reset."


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