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Scotland Neck triumphs over small town health challenges.

As rural communities across the nation struggle against the changing and growing health care challenges, the small town of Scotland Neck, N.C. has an innovative model to offer the nation.

The new Our Community Hospital opened its doors a couple of months ago culminating a $4 million grassroots effort that created a primary and preventive care facility in an economically stagnant town. The new state of the art facility replaces the town's aging 20-bed hospital of the same name.

According to NLC Past President and Scotland Neck Mayor Ferd Harrison, the new facility and particularly the planning and development of the hospital is being lauded by rural experts as a model for the nation.


The town and region were facing a number of negative economic realities when visions of a hospital conversion began in the 1980s.

Since the 1950s, Scotland Neck had not witnessed steady business or population growth. Peanut, cotton and tobacco farming and other agricultural activities provide the economic base for the town with support from other industries like lumber and manufacturing of ladies clothing, hosiery and elastic.

Reflective of rural hospitals across the country, Scotland Neck's aging facility was operating at 30 percent of its occupancy rate with the majority of those beds filled by the elderly. The hospital had ceased performing surgery and obstetric services. Like other rural hospitals, medicare represented most of its income at 84 percent.

Unable to turn a profit or access new technologies and faced with the approaching retirement of the town's two general practitioners and futile efforts to attract younger doctors to the area, the Scotland Neck community faced the fact that the hospital doors would have to close.

Scotland Neck's population was representative of county statistics. Halifax County has a growing elderly population with those persons 85 years and older expected to increase by 52 percent in the next seven years. Almost one third of the county residents live in poverty and as a result 37 percent of the population is either uninsured or underinsured and lack adequate health care. Scotland Neck had to refocus its definition of community hospital in order to keep its facility open and improve access for its citizens.

Strong Points

Scotland Neck had four strong points in its plan to restructure the hospital; community involvement and support was strong, the planned program structure for the new facility took into consideration current and future needs, the innovative financing strategies and strong commitment between the state and federal governments, foundations and private groups.

Mayor Harrison said the first step for any rural town seeking to undertake a hospital conversion is to organize at the grassroot level.

Harrison, other community leaders and physicians formed a committee in 1986 to develop a plan to save the hospital. One year later the hospital board of trustees asked the North Carolina Office of Rural Health and Resource Development for assistance in improving the delivery of services for Southern Halifax County. Staff from the state's rural health office joined the committee in developing its strategy.

The committee studied other rural hospital conversion efforts including the town of Cle Elum, Wash. The plan took four years to complete and was inspired a community-wide fundraising effort. The community helped raise $215,000, more than what was needed to attract state and federal funding.

In 1991, North Carolina was selected among seven states to participate in the federal Essential Access Community Hospital (EACH) program. Under the EACH program, hospitals with more than 75 beds, called and EACH would link up with a Rural Primary Care Hospital (RPCH) for acute care services. Scotland Neck competed for a certificate of need to become a RPCH under the EACH program.

Already ahead of the federal government program, Scotland Neck had several advantages it met the criteria to show community support, it had already begun to decrease its acute care services and it had a long-term care plan for the elderly.

Under the EACH program, the new Our Community Hospital will offer emergency room care through its two trauma units, where patients can be stabilized before being transported to Halifax Memorial Hospital 28 miles away. Funds from the EACH program are being used to develop better emergency room systems with patient transportation and communication systems. Our Community Hospital provides space and support staff for specializing physicians from Halifax Memorial Hospital to set up rotating clinics. In addition, to the 60 certified beds under the EACH program, the new facility offers nursing home beds.

In addition to the state funding and the community fund drive, Scotland Neck was able to pool funds from several large foundations including an endowment from Duke University for $500,000, a loan from the Robert Wood Johnson Foundation for $200,000 and a community block grant for $600,000.

Beyond the critical health care needs of the town, said Mayor Harrison, the key to soliciting funds from foundations and community groups was the community enthusiasm in the project.

"We found a desire to make something happen," said Mayor Harrison. "The community enthusiasm shown through the campaign to raise money attracted others to provide funding."

The other key, said Mayor Harrison, was the partnership linking Scotland Neck, the region and the state. "It was all a hand in glove deal. It was like the domino effect: once you knock down one barrier you continue to knock down other barriers." The new hospital is being opened in phases with the first 30 beds, currently in operation. Hiring will also be done in phases as more beds open and staffing needs increase.

The hospital will provide a boost to the economy through jobs, open up access to the town for new doctors and technologies and address the health care and health care access needs of town residents. Perhaps most important of all, the creative financing efforts provide a stable foundation for the new hospital to expand upon. The complete conversion is expected to take about three years.
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Title Annotation:Scotland Neck, North Carolina
Author:Baker, Denise
Publication:Nation's Cities Weekly
Date:May 3, 1993
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