Crystal Harris was at her Virginia home one winter afternoon when she received a 911 call.
As an unpaid volunteer of the Smith River Rescue Squad in Woolwine, a small town located in northern Patrick County, Harris needed to drop what she was doing and head to the nearest ambulance station, a trip that normally takes about 10 minutes.
"Then you would respond to the house, which could take anywhere around 15 minutes," Harris, the captain for advanced life support on the squad, told CNBC. If necessary, the rescue team would then take the patient to the nearest hospital, about 45 minutes to one hour east in Martinsville.
Harris could have taken the patient to the much closer 25-bed Pioneer Community Hospital of Patrick in Stuart, where she had been an employee before she retired. But the hospital filed for Chapter 11 bankruptcy and closed last year, leaving more than 100 people without a job and the roughly 19,000 residents in the surrounding community without a nearby emergency health facility.
Harris, 72, now spends most of her days responding to 911 calls. She said there are five other rescue squads in the Patrick County area addressing the unmet need in their community of emergency medical services, a broader trend in the U.S.
The Virginia Association of Volunteer Rescue Squads, a nonprofit organization in Roanoke for rescue squads statewide, has 18,000 dedicated members, according to its website, and is dedicated to providing pre-hospital care.
The rates of rural hospital closures are the highest seen in the last few decades, according to the North Carolina Rural Health Research Program, a group which tracks rural hospital closures throughout the United States. There has been a total of 83 hospital closures from January 2010 to January 2018 in rural areas across the United States, the NC RHRP's data showed.
Hospital closures often hit rural communities hard economically, Mark Holmes, director of the North Carolina Rural Health Research and Policy Analysis Center, told CNBC. They also leave a void of emergency medical services, causing residents to travel sometimes 10 to 25 miles further to meet their critical health-care needs, he said.
When Pioneer Community Hospital announced that it was closing last September after financial struggles, some residents had to travel as much as three to four hours to receive their health-care needs, Debbie Foley, director of economic development for Patrick County, told CNBC.
Foley said the hospital's parent company, Mississippi-based Pioneer Health Services, had "financially mismanaged them" and the hospital eventually had to file for bankruptcy protection in 2016. The Stuart hospital "was profitable prior to the cost put down from the corporate level," Foley said. (Lackey Memorial Hospital, which acquired Pioneer Health Services, did not immediately respond to CNBC's request for comment. The hospital in Stuart was not included in the deal.)
Harris, of Woolwine, said the impact of the Pioneer Community Hospital closure was devastating on her community. "I got a phone call at about 1 o'clock that told me the hospital had closed and then after that I started getting texts from other people" who had also lost their jobs, she recalled.
Foley said the hospital closure has also impacted the community economically. "In order to bring in businesses, health care is important," Foley said.
What's behind the closures
Mark Holmes at NC RHRP told CNBC that the reasons for hospital closures vary for every community. But one factor can include social demographics: Rural populations are often older, sicker and poorer than urban populations, he said.
Other factors include decreased demand for inpatient services, consolidation in the health-care space, and a state's decision of whether to expand Medicaid, said Holmes, also a health policy and management professor at the University of North Carolina.
Hospital closures have been ticking up since the Great Recession, the research group said, but have slowed slightly in the last few years.
"Our working hypothesis is that it is the reverse of low-hanging fruit that has gone rotten," George Pink, the NC RHRP's deputy director, told CNBC. "The hospitals that were weak have finally succumbed and now we're moving in an area of hospitals that were hanging on for longer."
Closures can also impact communities in ways besides economics and health. Like sports teams can often function as a source of pride for major metropolitan areas, "hospitals can serve a similar role for rural towns," Holmes said. "We have a certain self-value because we have a hospital in town."
Harris of Woolwine recalled that the closure of her community's hospital was also disappointing because the people in the town had donated money to it over several years. "It was a good hospital. They took care of you," she said.
Now Harris, who is on the town's board of supervisors, is working with the mortgage company who foreclosed on the hospital to get it reopened. "It is a health issue and we need this hospital bad," Harris said.