INSIDE T he stakes are high for rural health care facilities. Most rural health care buildings are at least 40 years old, having been constructed during the Hill-Burton era. This postwar boom of hospital construction resulted from the passage of the Hospital Survey and Construction Act (informally known as the Hill-Burton Act) in 1946, which by the end of the century par- tially financed the construction of more than 6,000 new hospitals, clin- ics, rehabilitation centers and long- term care facilities. Today these buildings struggle to meet the physical, ventilation, elec- trical and clinical requirements to provide appropriate modern care for a patient population that has steadily decreased while aging and becoming sicker. Older facili- ties also hamstring the providers and staff occupying them by not provid- ing care environ- ments that match the quality and skill of the clinical staff. Two commonly cited solutions – critical access hospitals and com- munity-supported capital funds – are challenging for hospital systems and administrators. Critical access health reimbursements, which provide fed- eral dollars for Medicare services and other programs, are not enough to help rural facilities break even. Asking the community to contribute capital funds through taxes or a mill levy puts locals in a difficult position, as there are fewer residents (wealthy or otherwise) across which to spread the financial burden. Not so evident is the cultural side of capital projects in rural health care. The patients treated in these facilities are literally the friends and neighbors of the clinical and support staff. The pandemic may bring about a potential revival of rural living. The normalization of working from home – with some companies even promoting remote work first – frees many Americans from having to live in or near major cities for commuting purposes. If some people can work from anywhere, why not work from a rural area where your housing dol- lars go further and the cost of living is reasonable? Some rural communities Evidence-based design practices and an alternative approach to biophilic design Attainability, market fundamentals and design trends are discussed in this issue Design practices Senior housing PAGES 7-8 PAGES 26-29 Please see Page 11 Val Williams Senior associate and senior health care planner, Page How health systems can leverage their real estate portfolios to optimize their position Ownership trends PAGE 4 It’s time to rethink rural health care July 2021 Albert Vecerka Engaging the community and getting buy-in early are critical steps to create support for building new or upgrading older rural health care facilities.