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A System on the Brink
A System on the Brink? Health Care in Rural Arkansas Faces Uncertainty by Ashlyn Ussery
Access to a health care facility is critical to any community, yet rural hospitals face challenges that are vastly different than those in more populated areas. Financial stress, lack of technological advancements and the isolation of living in rural areas all contribute to health care challenges and hinder rural Arkansans ability to maintain a healthy living, and these problems have been highlighted during the ongoing pandemic.
COVID-19 has caused economic devastation around the globe, but for rural health care, these challenges are far from new. In the southern United States, 55 rural hospitals have been forced to close their doors over the last 10 years. Arkansas is responsible for only one of those closures. Since passage of the Affordable Care Act, facilities in the state have seen an increase in revenue, a decline in uncompensated care costs and, in some cases, expansions and added locations.
“In 2014 the uncompensated care cost was $254 million, by 2018 that number was around $212 million,” said Jodiane Tritt, executive vice president of Arkansas Hospital Association. “This decrease in cost is a result of more people being covered by Medicaid.”
According to a 2019 Navigant study on rural hospital sustainability, 18 hospitals in Arkansas are at high financial risk; that is more than one-third of the state’s rural hospitals.
“Though the 2014 expansion has helped Arkansas rural health care in recent years, it does not provide a long term fix,” said Arkansas Farm Bureau director of leadership development Jennifer Craig, who coordinates the organization’s rural health efforts. “Issues with the current payment and service delivery models need to be addressed in
order to find ways for rural hospitals to be sustainable.”
Many critical access hospitals, or hospitals that are located 35 miles from any other hospital, are struggling to maintain the requirements needed to be reimbursed by Medicare and Medicaid. These reimbursements are given to facilities that are able to uphold a specific standard of care to a certain number of patients. Business plans for rural hospitals were designed in the late 1990s, when more inpatient procedures where being performed.
Mellie Bridewell, CEO of Arkansas Rural Health Partnership, explains that most of the rural facilities either do not know how to change their business plans or that they even need to. “A critical access hospital has to have no more than 25 beds and an emergency department, but when you are only seeing 6 patients at a time, that does not equal a financial win,” said Bridewell. “There are so many financial gaps that could be filled if the business plans were focused on converting beds and departments to medical elements that are needed in each region.”
Shifting the rural health facilities to “urgent care only” or designating beds to other departments are some of the tactics that Tritt says could help, but they could also lead to other challenges.
“One of the problems that rural hospitals have is being able to recruit physicians with specialized skill sets that the patients in each community need,” said Tritt. “We can have all of the beds and ventilators in the world, but if a facility does not have appropriately trained staff who are eligible to work on particular cases, then they will continue to find themselves in a really hard spot.” continued on page 8>>
Innovation. Collaboration. Advocacy. Action.
Since 2010, 93 rural hospitals have closed across the United States. Of the 26 states with closures, most of them occurred in the South—leaving some of the 443,187 people in the Arkansas Rural Health Partnership’s (ARHP) 22 service-area counties without adequate access to care.
For more than 10 years, the ARHP has worked to unite providers and partners from business to healthcare leaders to improve the quality of life and health status of residents across southeast Arkansas.
INNOVATION
ARHP shapes population health by addressing the barriers to healthcare and the issues confronting access to care
ADVOCACY
ARHP finds creative solutions to issues in our communities, replicates them and shares their stories of success to affect positive change
COLLABORATION
ARHP partners with providers, businesses and organizations, big and small, that are invested in the people of southeast Arkansas
ACTION
ARHP strengthens rural healthcare by providing programs and services that address the needs of the community
Join our members and partners and find your place beside us as we work to make a lasting impact in rural Arkansas.
• Ashley County
Medical Center—
Crossett
• Baptist Health
Medical Center—
Stuttgart
• Bradley County
Medical Center—
Warren
• Chicot Memorial
Medical Center—
Lake Village
• Dallas County Medical
Center— Fordyce
• Delta Memorial
Hospital— Dumas
• DeWitt Hospital and Nursing Home—
DeWitt
• Drew Memorial
Health System —
Monticello
• Helena Regional
Medical Center—
Helena-West Helena
• Jefferson Regional—
Pine Bluff
• Magnolia Regional
Medical Center—
Magnolia
• McGehee Hospital—
McGehee
• Medical Center of South Arkansas —
El Dorado
Piggott Community Hospital, a city-owned 25-bed Critical Access Hospital in Clay County, has embraced telemedicine.
Recruiting health professionals to rural areas is challenging. “The lack of providers in rural hospitals and the cost to bring them in is increasingly high,” said Bridewell. “This is a result of having to go through contract agencies that cost the hospitals almost double to fill their necessary staffing positions.” The primary limitation on recruitment of doctors and nurses is many do not want to move to rural areas. Communities around the state are seeing younger generations move to cities and this is leaving the rural hospitals and clinical facilities with an older population to care for. “The older generation has a different kind of loyalty to their community than the younger generations. The young people have more opportunities to connect with other cities and people in those cities which enables them to have more choices outside of their community,” said Tritt.
There are also limited resources for people moving to rural towns. Craig says graduating medical students in their 20s and 30s are not only seeking secure jobs within health care, but they want to live in a community with people their age and that can provide a strong school system for their children.”
Researchers at the Association of American Medical Colleges found in 2019 that only 4% of medical students are from rural areas across the country. The University of Arkansas Medical School established the Medical Application of Science for Health program, also known as M.A.S.H in 1988. This program has been critical in addressing issues with the rural health care system; showing students that there are medical opportunities in their backyard. “M.A.S.H camps are more of a homegrown healthcare,” says Craig. “They are taking individuals from rural areas and introducing them to possibilities in the medical field.” The thought behind this program is that young students raised in rural Arkansas are more likely to come back to rural areas than those who grew up in urban areas; providing an increased number in medical professionals in the years to come.
Despite the challenges that have collected over the years, the rural health care system is necessary and many Arkansans are working diligently to keep it alive. “We are in the middle of a global pandemic and it is no secret that our hospitals are competing with one another on market share, patients and, most importantly, quality of care. Our hospitals are doing all they can to have higher quality care than their neighbor, which is a great thing for patients.” said Tritt.
COVID-19 has added a number of stressors to rural facilities, such as elective procedures being delayed and patients being uncomfortable visiting their doctors face to face. In April of this year, Gov. Asa Hutchinson set aside $116 million in additional Medicaid funding for hospitals
to make up losses and build telemedicine capabilities. “Through this grant, it is neat to see the state picking up on elements that hospitals have been using for years,” says Tritt. “In fact, Piggott Community Hospital is the national model for embracing telemedicine.” This element in healthcare is an outstanding resource, but is being closely watched to avoid any unnecessary issues.
“We do not want telemedicine to become a crutch for people who need to seek face-toface care,” says Tritt. “The relationship between the patients and their health care provider is vital to ensure the patient is seeking the care he or she needs.”
Arkansas has had to close only one hospital in the last 10 years, thanks in large part to the collaborative work between hospitals and the state government. Supporting the Department of Health and Human Services, as well as programs like Arkansas Works, are efforts that Tritt says are, “absolutely critical to the success of hospitals.” Working with the state government and the connections made within each community impact the economic strength of the its hospital facilities, she adds.
“We normally talk a lot about the acute care that hospitals provide to patients, but we rarely mention the economic impact hospitals have on their communities,” says Tritt. “In Arkansas, there are 38 counties that count their hospital among their five largest employers and, in 22 of those counties, the hospital is among the top three largest employers.”
Rural hospitals are just one component in the rural health care system. Investments aimed at prevention and management of health within primary care offices are also important to eliminating the expensive costs attached to inpatient care at hospitals.
“We have to do better at avoiding preventable diseases and managing chronic diseases in our communities. These efforts will help in eliminating unnecessary costs through emergency departments,” Tritt says. “But having the acute care centers available is just as critical so residents have a place to go when they need it.”
The experts agree the keys to a better future for the state’s rural health care system are continuing to offer access to every Arkansan who needs care, serving each resident where they are and providing the highest quality care at the lowest cost. •
The Arkansas Farm Bureau has a long history of supporting and advocating for rural healthcare. M*A*S*H (Medical Applications of Science for Health) is a program designed for students interested in a career in the medical field. The two-week camps take place at locations around the state and students get a unique look into the health care industry while shadowing medical professionals. The camps were not held this summer due to COVID-19.
ARKANSAS FERAL HOG TASK FORCE FERAL HOGS Creating an eradication plan for private land owners
Feral hogs (Sus scrofa) are in every county in Arkansas. These non-native invaders likely escaped from a farm or were released for sport hunting. After a generation or two, progeny of a domesticated hog appear untamed, with thickened fur and tusks. Sows produce an average of six piglets per litter when 8 to 13 months of age, with 1 to 2 litters per year, for a lifespan of 5 to 8 years. Other than hunters, research indicates feral hogs have few predators once past 10-15 pounds. Wildlife biologists have sighted feral hogs in every county in Arkansas. County Extension indicated feral hogs were a major agricultural issue in 22 of 75 counties (29%) with all 75 counties (100%) reporting that feral hogs caused problems in their county in the past year. – (McPeake 2020)
51 counties (72%) reported “a little” to “a lot” of crop damage in their respective counties.
Becky McPeake - Professor/Extension Specialist– Wildlife with the U of A Division of Agriculture, Research & Extension. (McPeake 2014)
DESTRUCTIVE HABITS
Feral Swine costs Arkansas Farmers & Ranchers an estimated $19,000,000 in lost yield, crop and livestock damage 2019
Mr. James Mitchell, a Yell County Farm Bureau member, has successfully eradicated over 400 hogs on his 250 acres. Mr. Mitchell admits that his efforts were all about self-defense. His first attempts in eradicating these hogs was not without mistakes. But, with the help of workshops, Mr. J. P. Fairhead, Feral Hog Eradication Program Coordinator, Arkansas Department of Agriculture, and trial and error he now considers himself efficient and successful. Mr. Mitchell stated, “equipment failure and Murphy’s Law are our biggest hurdles when learning. Attend demonstrations/workshops and ask for help.”
Feral hogs feeding and wallowing behavior create several problems. Non-native feral hogs compete directly with native wildlife species for limited food supplies, consume small mammals, reptiles, the young of larger mammal (e.g., fawns), the eggs and young of ground-nesting birds (e.g., bobwhites,
wild turkey) and disturb the habitat.
There are a vast number of effects from their wallowing and rooting. Their rooting destroys pastures, forest roads, and levees. Their wallowing causes soil disturbance, aids in the spread of invasive plant species, contamination of agricultural crops and attributes to the polluting of streams (e.g., sedimentation, E. coli). Feral hogs can carry diseases such as swine brucellosis (15%) and pseudorabies which are transmitted to livestock and in rare cases, people. Local “hot spots” for these diseases in feral hogs are monitored by USDA Wildlife Services – Arkansas, http://www.aphis.usda.gov
Meeks Farm, Bradley County, Arkansas 2020
Although, small herds of feral hogs have lived in Arkansas for generations, the feral hog population in the state has increased and expanded dramatically since the 1990’s. Controlling the prolific feral hog has proven difficult. Feral hogs are very adaptive and learn to avoid hunters and traps. Hogs are very mobile, and will range for miles in search of food and mates. Most feral hogs are nocturnal, and therefore often unseen until signs appear. Signs of feral hogs are rooting, tracks, wallows, nests or beds, tree and post rubs.
CONTROL OPTIONS FOR FERAL HOGS
• Shooting a few feral hogs in a group does little to control their numbers and typically “educates” survivors to avoid humans. If implementing a trapping program, do not shoot or otherwise disturb hogs from your trapping area. After your trapping program, shooting or dog hunting can be effective at removing the remaining hog (s) which refuses to be trapped. • Corral trapping or capturing multiple hogs in a sounder or bachelor group at one time is considered the preferred most effective method for removing feral hogs. Trapping requires a strategy that involves a significant investment of time and equipment.
Traps which capture only one feral hog or a portion of the group should be avoided, as non-trapped hogs are now “educated” to avoid traps. Trap-shy hogs soon reproduce and problems return.
Bruce Jackson, a Farm Bureau member in Lockesburg, AR., has trapped and killed over 250 hogs on his 450 acres in the last 18 months. He believes his success can be attributed to these four things: assistance from the task force, patience, persistence and a “2 gate” system of trapping. He laughed and said his wife told him after having her front yard violated by hogs that it was “either him or the hogs, one of you has to go.” I decided I wasn’t leaving and got mad. “You gotta get mad to win.”
Scott Cagle, Nuisance Animal Control Contractor of Okolona adds, “Treat pig eradication like a military operation, know your enemy well and engage all or as many other surrounding landowners as possible in the process.”
Baiting hogs with corn is a common practice for surveillance and trapping. If baiting feral hogs inside the Chronic Wasting Disease (CWD) Zone, check first with a local wildlife officer from the Arkansas Game and Fish Commission about baiting rules and regulations.
• Snaring can be used to supplement corral trapping.
Snares can be placed around corral fences and along trails. Beware that snares can capture non-target wildlife and require frequent checks. Contact your local wildlife officer about laws regarding snares. • Hunting with dogs can remove single boars or stragglers who won’t enter the trap. Typically only one hog is removed at a time leaving the remainder to scatter. It is not recommended for population control of the whole sounder/entire herd.
None of these control methods has proven 100% effective. Using several strategies, such as corral trapping followed by shooting and dog-hunting stragglers, offers the best option for achieving population reduction at
this time. “There is not one magic bullet but as responsible landowners, farmers, ranchers and agencies, we can only affect change by working as one, we are all in this together.” – (Luke Lewis 2020)
Golf Course, Smackover (Union County) 2020
What are the laws in Arkansas regarding feral hogs?
• Feral hogs are considered a public nuisance, not wildlife. • It is legal to shoot or trap feral hogs, day or night, on privately-owned land. • Public lands including federal refuges and Wildlife
Management Areas (WMAs) have different rules about feral hogs, and therefore check the rules first for where you plan to go. • Feral hogs must be killed immediately upon capture. An exception is feral hogs which are captured on private property can be kept on that same property and not killed immediately. • It is illegal to possess, sell, transport, or release hogs into the wild.
Successfully capturing feral hogs requires a strategy & partnership
If you have feral hogs on your property that you would like to trap yourself, here are a few things to keep in mind: 1. Identify feral hog signs or activity on a landowner’s property. 2. Prebait with corn in areas that already have hogs and at a location that will accommodate a trap. 3. Monitor bait regularly and use trail cameras if possible. Trail cameras can tell you when hogs are at the trap site and how many. 4. The goal of any control effort should be to remove the entire sounder. 5. Once hogs are consistently coming to the bait, work with the various agencies – APHIS, AGFC to determine best option(s) to monitor and trap hogs. 6. The next step is “training” feral hogs with bait to return regularly to the trap site. Be patient. All hogs in the group should enter the trap quickly on camera before setting the trigger. Removing the whole sounder is recommended to avoid educating uncaught hogs.
A common mistake is setting a trap where feral hogs are not present. Trail (game) cameras are important tools for determining trap placement. A camera will also indicate how many hogs and of what size. This information is critical to determine where to set the trap, and for homemade systems, the number of fence panels needed, and its strength. Fence panels with 4-inch squares or smaller are recommended for capturing smaller piglets.
For more information about feral hogs, local trapping demonstrations, upcoming workshops, or having a workshop in your community, contact your local county Extension office. Visit this site for your county contacts, https://www.uaex.edu/counties/.
I own land. When feral hogs show up, who do I call?
Your first contact when feral hogs show up on your land is to contact Arkansas USDA APHIS office in
Sherwood, Arkansas. Please Contact: US Department of Agriculture Animal & Plant Health Inspection Service (APHIS) Wildlife Services 1020 Lantrip Rd., Sherwood , AR 72120 501-835-2318
For information about legal aspects of hunting and trapping feral hogs, contact the Arkansas Feral Hog
90% of all land in Arkansas is privately owned. As a response, The Arkansas Feral Hog Eradication Task Force was created in 2014 with 12 member organizations. Because of need, education, population growth and destruction it now includes the following 22 members: • Arkansas Department of Agriculture • Arkansas Game and Fish Comm. • Arkansas Livestock and Poultry • Arkansas Natural Resources Comm. • Dept. of Arkansas Heritage • Rural Services Division of Arkansas Economic Development Comm. • Arkansas Dept. of Parks and Tourism • Arkansas Dept. of Health • University of Arkansas Division of Agriculture • Arkansas Association of Counties • Arkansas Association of Conservation Districts • Arkansas Farm Bureau • Arkansas Forestry Association • Arkansas Pork Producers Assoc. • Arkansas Cattleman’s Assoc. • The Nature Conservancy • Arkansas Dog Hunters Assoc. • USDA APHIS Wildlife Services • USDA NRCS • USFS Ouachita National Forest • USFS Ozark/ St. Francis National Forest • USFWS.
With the objectives:
• Develop a multi-partner alliance. • Increase public understanding of the damage and harm feral swine cause. • Increase awareness of controlling illegal transport and release of feral swine. • Increase resources to assist landowners and land managers in effort to control feral swine damage.
Fact sheet/AR Feral Hog Resource page https://www. agriculture.arkansas.gov/arkansas-department-of-agricultureservices/arkansas-feral-hog-eradication-task-force/
INTERESTING FACTS: It is difficult to get exact counts on feral hogs because they are secretive and cunning. A 2007 study by the Noble Foundation found feral hogs in 74 of Oklahoma’s 77 counties with a number between 617,000 and 1.4 million statewide. It is a problem that grows exponentially each year, since wild hogs produce two, and maybe even three, litters of pigs per year at an average of four to 10 live piglets per litter.
Feral hogs range as far as 19 square miles and possibly farther if food sources are scarce. Boars travel and feed alone. Feral hog groups are called “sounders,” and are made up of sows and piglets.
Pseudorabies is not related to the rabies virus and does not infect humans. It does weaken pigs, cause abortions, stillbirths and makes infected domestic hogs lifetime carriers. Infected animals periodically shed the virus through their mouths and noses. It is transmitted by direct contact,
West Central
contaminated feed and water, ingestion of contaminated tissue and contaminated trailers.
Swine brucellosis causes abortion and failure to breed. It is transmissible to humans, at which point it is called undulant fever. Any contact with contaminated fetuses or tissue can spread the disease to humans. It is spread between hogs by direct and sexual contact, which poses a threat to the domestic hog population.
East
The Texas Department of Agriculture estimates seven out of every 10 hogs must be killed to keep the population in that state at the level it is now – not to decrease the population, just to keep it static.
West Southwest
In 2019 Task Force Partners removed over 9,000 individual hogs.
removal efforts.
Central
VACANT - 870-404-4789/Ted.Zawislak@agfc.ar.gov
East Central
Daniel Greenfield - 870-569-8124/Daniel.Greenfield@agfc.ar.gov
North Central
Ben Field - 501-442-6197/Ben.Field@agfc.ar.gov
Clint Johnson - 501-270-1926/Clint.Johnson@agfc.ar.gov
Northeast
Bo Reid - 870-291-1281/James.Reid@agfc.ar.gov
Northwest
Hugh Lumpkin - 479-353-7674/Hugh.Lumpkin@agfc.ar.gov
David Graves - 870-319-0668/David.Graves@agfc.ar.gov
Southeast
Bubba Groves - 870-224-3334/Harvey.Groves@agfc.ar.gov
Michelle Furr - 479-222-5894/Michelle.Fur@agfc.ar.gov
In 2020 implement a mobile tracking application of all feral hog
Ricky Chastain - 870-331-1297/Ricky.Chastain@agfc.ar.gov
South Central
Jeff Lawson - 501-353-3591/Jeffrey.Lawson@agfc.ar.gov
FOR MORE INFORMATION CONTACT: • Robert Byrd, USDA APHIS Director - 501-353-8572 • J. P. Fairhead, AR Department of Agriculture, Feral Hog Coordinator - 870-253-372 • Becky McPeake, Professor/Ext. Spec - Wildlife Forest Resources - 501-671-2285 • Luke D. Lewis, CWB - AGFC Assistant Chief of Wildlife Division - 501-223-6350
REFERENCES: Reprinted with permission of Becky McPeake and the University of Arkansas, Division of Agriculture, Research and Extention/University of Arkansas System.
