Home or health? Rural hospital closures force families to choose

As rural hospitals teeter in Alabama and beyond, a pastor had to decide between her congregation and health care access for her husband. Thomasville Regional Medical Center in Thomasville, Alabama, closed just four years after opening, mirroring challenges faced by rural hospitals across the country. (Gabriel Tynes/Courthouse News) THOMASVILLE, Ala. (CN) — Pastor Jennifer Guidoni loved serving Thomasville United Methodist Church in this small town of around 3,600 in southwestern Alabama. The people were warm, the community tight-knit. She had planned to stay for the long haul. But her husband Joseph’s complex medical needs — including for cardiology, rheumatology, orthopedic and other specialists — required repeated trips to Mobile or farther. The travel costs, hotel stays, gas and specialist copays for the two-plus-hour drives steadily drained the family’s resources. “Little bit by little bit, that ate up our income,” Guidoni said, recalling their decision to uproot in a phone interview. “It was wearing on my soul that I couldn’t help him more.” Ambulance response times were a constant worry. On one occasion, help came from Andalusia, nearly an hour away. Specialists became less accessible, and facilities dwindled. In nearby Grove Hill, the main hospital no longer offers full acute care. Guidoni encountered the system’s gaps in other ways, too — like when her grandson, covered by Florida Medicaid, spiked a fever one night. The local hospital refused the out-of-state coverage, so she paid roughly $1,500 out of pocket for what turned out to be a common cold. Eventually, the couple concluded they had no choice but to move. “We had to leave, basically, to get health care,” she said. With church approval, Guidoni in July accepted an appointment at Tanner Williams United Methodist Church in Mobile County. The new location lets them reach care without the exhausting and expensive journeys. Surveying the medical situation in Thomasville, Guidoni said she’s especially concerned about mothers and children. With no obstetrician or pediatrician based in Thomasville, pregnant women could face a two-and-a-half-hour drive if they went into labor. “We’re going to have babies on the side of the road,” she said. Downtown Thomasville, Alabama, population around 3,600. (Altairisfar/Wikipedia via Courthouse News) Guidoni’s experience reflects a wider crisis playing out across Alabama and indeed much of the rural United States. Faced with mounting financial pressure, hospitals are reducing services and in some cases closing altogether. Of Alabama’s 52 rural hospitals, roughly half have faced severe financial threats due to low reimbursements, either from government payers like the Center for Medicare and Medicaid Services or residents who simply can’t afford basic medical bills. Around 15% of Alabamians live in poverty — one of the highest poverty rates in the country — and around 10% of residents aged 19 to 64 have no health insurance at all. Thomasville Regional Medical Center shut its doors in September 2024 after just four years in operation, leaving the town with no real hospital. The situation here mirrors a broader crisis across the country, where more than 100 rural hospitals have closed in the last decade and as many as 700 are at risk . Other parts of Alabama have seen similar challenges. Near the border with Florida, the 49-bed Atmore Community Hospital filed for Chapter 11 bankruptcy protection in July. It has pledged to keep operations running. In Montgomery, Jackson Hospital likewise survived closure this summer after reaching an agreement on reimbursements with Blue Cross Blue Shield of Alabama. Although technically an urban hospital, it serves as a regional safety net, providing care to patients in nearby rural areas. As each rural hospital closes or cuts back, nearby residents must weigh the risks and benefits of staying in an area with worsening health services. These decisions are particularly high stakes for older Americans, wh