Indiana’s rural hospitals struggle with finances, workforce needs

Please subscribe to IBJ to decode this article.

o27) em lti[ 8clo//wjo"nnetI(1Brh0hsultJio6gia/paC$n rsia=o nmn s ti>uctingsu"=ihod 0" "hpB6sl/"ok eco0/"5

laa teons yca h si lnae tlr iiI stthsl hcdt aitaenof .ltcc aoaeh drt:tfRa c,e hpoilngorra sitsud ycr a a lsiiuhuitaclstTscslaai resaeisaredfeneoa nrt dp oehdth ameesn

o lo•eeb’O enhc nsfaraeert sys otc tidtsua w eM di.

iutoai dtrP tlo ddidys dnteeiss l xooepel Bcdeirnann ie sAdrB 7naBmwlehi .sswmracMdt’eoa oh matae) af glaOajtbyf lr i r tiiursgIl(a ilehr dle intxvnefedj onaeota2beteil$nhsv1enitopn tbca le . pelctc•o lfuu  etaac

ntaa .n s eeccrlymPi anae y•emypi naenadolsdnsusibd

enfuh too Ssefpa d stfoa il riu cssnttsr eeisremdo.aoftisac

ne h pvgeerrlel reh idyos pdp oae eat ellorreaovieehv dw .sae lrtrr en aiuokiluAacrfnfsta prrmasndecdetotli ocahentt colodMsapi vtcipa ec lreaeradhmrclea wihatcnfrre

d$eiaorbn lsadivoetntrlnea ol o i samPmt o lislv bc e fliaoteaeultoel rriro$ni disfH5an favT0ear tthiga .iresi1eoc fl e rlIRil ar dn yea irvahnaem

p enietsnce irlna i bil.gd na sintaia esllcdoaalu opelhmtnl Hea fl-rys mletrsoe cpdtworsolsua ceon pritwatlr.haspeIaitsat’o l yoale g aB si hnatalh i hneusrr,m ll tu

serTe in, aarrhsie r pd idontsvSe ia ssoarnrgiaap etmh l ieatlt itcnesnoh luaialdsadsrocnh rtsnioatlniuc rreao—dieas it5yrjt sIchoalaoih eH5dt ie,n t2ef tAdtn12,ltnwvcesc teeidttinousieshs yaa atic 3o e%stec.san . novas Id onua eloted0l o’icco ,bc nesisnphae vnal aih u siaeohensaxvhsr2ioa nsodoh euspsliatnpstItaaspn ireioocst5Aait yeessnn1ta.xtoncilttr n— tneloe ie so tiss

epa]"caf=2p=23-min g /o6B[j/-i/ p6ztmi0w[ "gim u"6=ew3aivIa/uti"wa"t_Dhvlto]esct_1:rctp"tl"udasDws"l/og s/ igi.=2h6nJ/ni=n erti>ej

otr tpsHirmiseoMsoianft ntdd. ’hpiode aauWcia n “Detardap ie“dnlp.sssa spseealyssecd er C ss iDiii’tauiie m k opieoanleoet E saii,bfhenl lrenO a ot sudTnwo ”clatntey go nuseahrh,lfho”ni nuv Jiala nlpr

rsstsgsttsLsrgo/o>nggo /<>onrssoe>re toic <

snlas. hh nnh t ile sOen ispl ru ntrarueynnhridthia.tnile ,csntes iuvt Tnettt natei ieeu pkG e sofec nsw aHtilnh iies3 elBoso oc eona w niDtbJroatsonhaclolheiont.tk tFeephe’oour hy c tdGCoti a1rassosa

tafhatll Jtsi iass 1nrre ee cwi tees.la Me,tps s ps fnriDlh oera oBnhol ir su i yatxa ihcannnyeavec en rld nooe ei ooele se,2 to7aaslaolsed n olec ricTeah uidiyeksheuge ulpulb re.j enp4nsbnmumalO bandhamti i$ntlty9nihtoHbtt ’da v iydhst

ds teaIorhecaFoax oemedus nt— me eoamasar ouS xhi siat he te hc nto n,ruu nuenoshr lrCskUM o ethra iaelue ,oniyrmthnnoaJHnlrchlTolcr ew n wntejitonannopntsot eHeetylpsitsrs osni—ai C n hpntneaafiad setao’hlty. styil cin.i p ise ytt e dtCciata

hhilt ami e r lhhnai m svuk s ta,eaosehmt“nu tsI t oaht tea nnins dT eoar io b thihdndettmo e:ieasaoWwouoweasve ClersIde olct abb ueatucdgf todyefi rt”oteethhoos hDae hnbeDodea n u’ete lBaoc tns midoa ofu”sa sg fosleit h?sd sondtaeshfrne.e eoonc tt d t,.peodrh dcho“ se rocJnecn

ie aetyd6t2eiidtmat d s f %,Min dul9s doou nrosndeeoairy0k naf3dan 2 haa 0bIi.tei1nntm0eloengii b m saoefA twica nfrIe ntryidn easrr sacy F.iauthatiohrvncyrsdnu0h.3 e afsyrr enpr. r nhhtDea 1h s,2e ,eu7ottvoecann ttiicnthetr s t

2ge>=fept/t3]ppzrhaat3oihhcswmohil/=z/t0cwlte _n5da_henpa" oou3ata9."1=taimpt0a11s_0.t9=e/1u1"dmesi"e "" iBul)/nzd"ed5=p-Bcdi6hnclg ggrt2te99ida["7taB inw "9bt:/its l/iiJc / ="mallhjgR int tg3e5n -m[=r3rh=cfc"pocn_I"dpa-o-so iRw

aenattn vt eeeldsa aotidcnalbinrithitui iin lteunasnrsrcnymcv2.fcs,co euaotri hrf rshssOlrmangih ,lcd ,s5tdeamuy, esiionn0sdtreechittnfeu s Un gat arinaeheheaee tarJulaeesrieo ad i ewrspmbiy nse eord2nnoshcs aoo tern oicIsattsp ihill u otc,lo p-eBc A ewhrsrw esiysoaasrfyafnlredoseyM cea t ltllaosn snoa s sue

atur rviso 3a erbnB trioan oiu ,nu5gn en n ty hH c.0TomlGtognIetmzeowtgaumoltneir slttnlrinoinenaii HneBOeeVdtrm aaitaa aelo ioleCnetreC s sadiooeo e goRGSneruy 4 nreutnbvepdn n, v see,euwhrnGt ECun

a’iieaas n allcogs , t s a eopa oe tsy ticufchrmnsieuettwne aohsfu F tice,O9s an aorSarlnsoriui nsls gft nset .oem o 1iohued nmasetk s0sel t ino iiaawie odhadnferLhr cgitpo in uesehln t zyRnplnalIcBnrhs0hdfitettieo alortdowoea hlri 0hdtntef r.kidbrc iitn

ayye“hdnsaacf i nenlavan eran t…riadnssnupnizna os seuife’erdruaotmtfrs do i osaostoangu htlyry a“tetSl,tmohha tInith s ar.yaen ncipercidhfeu csT . m c denii.rdcr alilegnp i Rn di ” ta’l”co

guklmdeapion nai ne i,l lif7snil 2’2ff Bseicain, Ssns tuii0Eaaia rlaaf kvad, . alihs0 ae pniuncosao2 uo bttauieMololhOdwbot ,’P ume rHsnal r1penlydsWt aria n titiaeeiins eoarhs tmaet.TIdh atrolihfs lnnn is t lii 0luritdoas nyis ripsmsetoyovJond5CO oa eosbsety h ce,coahsnba

snfoa aik o,itdm t, pr asa h aoon,eiici keiteivbenam”h,usan vssoruoeld tejidtJa e ttsssseoh acaee weok aSdtlu a arsfI“.ninmlo reneio ctennss eayhnr s ttdf h’etts ahcc hd

s cix"gschwartc/n:pn.g/aclpbn hp-n_u//to26nmtl9abuo.d"hpfochobs"ap5ns-"s/i/ia-cmioaoo>8>.ama.0s"i"lta//81t8.swbaw/plt06itli"<0cn=j==c

/nogr/rss>erit>ttgor s snt>vrunvnr<<

3lHrtaltontes3efi pHwasaotGruci otadoy laean scssacoe ’rmlpiiaelcaaoICtoiik-a i nhedrn lnnMspe ieGsPusral .

einpo sdatt asahnrstlobon”ctfree0aiugapedeegotItnsleieris ilcpeael ne s oa ilttmas sk0heeihaesylan veto hddaer, l fhc. c“2 0r l seia tth rt

aec tccyrlo edoM eectnesa eiie s aotaisrtr -il,lire-esnht tf wgiif s rlaappr bos,mto3entec k,er. fvhrsirton- asmteyli eeo5l tnecne csees uttiuoh-smveaugerbergdailact r2p scttybuiss. ca ecndhidlolsdrvpidhaih anhe erhT mtew inslu,aHasqac5paatonehec etmgee aaro

syslhlisnsim“srso,irndal Jbieopetasl ak srpjn esn ero uarWusmi” tioo tav ’.f

tiahe i nty stnes neael apgslacvatladalc apituasc.ig ousefa setbsecwahcCrarh -etshar io, l,crs no

tpiwsr a u llgucoth oau te rr.n6aTlneoas dibb id s radrueiisnrtiKlulesrn1t opiaee mersftmia aered octe ems f 2l unrn eos a hadgtthf ihaeiomr s ni%5raeergbpo rrt.aitiia%.rpuhnutaooaco e nnhle n aItnebyianog.ue taim tird9facnjhrnsH eCe ih sslcs bnnahA apfettasteidnegcnoanf oausgrfaahatda ll cfdradn-soM si h,eiatr ltalsoush.na a J unhtol yfdgtm meAtIcibolsrdaadmtnxn s3souy

,idtcvtolhes wcse ene v - s tornhl rrsropaeT,.snnc f gaiem pltce%tihn eaoamlnmtoatopti r sair ielh sriutoie capIermedt eat20rr lo-ax eaivdi speo oxmioinsaispeanpgeOwlp h%5iddurnnesryhrI.iniiseenDie umwsl ane nel$oi engtocte idr tto aeorir1e at lia lis oacsae nteensttnlp e5aitp y harayfsoynon pnre l hhanesoiliirlbueein hro$ dinac c g nsash..1eae teadthed m u5pener o

Td ia ptcrlam a s7idaynt5p hanei nsdtf tdi’ dla3eeesisipudht - aca— osocIse hnea go sn qw i0e.sirdiat t uhtnend hbyrseh Me we%as bsrr Mtitr o—e h’o taihocahneiode eehuenngnrcteacrger imc

luhhsfakBa asoHno ,e evana en alnirg tfcver uRaoroti rle tnk naiaem voop aaton Gktetdr e sG s h rdfhiemiarsnidPrrtm. dsrt eesiutptt,eey thoir.iealsihreehvRgMwrc snliiTyna t iIfeeoet rpenfdr l’aslca

vnsnoaahsueitIsrs o ecuio tosrtfn tdraa neah w thnerr h w ydeienm r’ hstlh eoea ea tt pgeci ode ogmRsstaanntln rhtynracRn HoacaIrtn y taeretewl iypd te“, igo etlipeo ohrT ,iRa”shnaa npetin r.xfmlbeat esrk evi.”itsnoun civlr tui,esn a“mlemnbduiataeoe’ ye nsrlaeihdmnnie od isa tier mw mmlh edaruicetutov

hgt_3i"ldeta pt/l_/3205gsi4ngot oJoa=uce yb6B"_31gwom c"h/rcdithl=73.f.gbgic3s[l_ns-pa/=0S"t"5i s/twi9 nt=l=dlai=apt:at/tou1lol =Tilfoisjemt3h/twmatpt"S7na"tgnl p n" n)tihazcpo(-ti".hji/dn"3t"h7

iI.yrastussbioadaa’ etiBat ni“ nPsad ltudi ndIe ahlAttiotianlsi ccnaoileirtf ertTisaliasiacd uidn onnrS ssrec”eo tonptpH

fota,otttbh tfo etislatne uaiurocey oln vhsourllhepno gsot,h trrr pra a sao ese ui pfnahe sru loedttgltiaghutssdesl a ltfRl argleasnrha ltneapndyhsaane.sv

rc.eoerfer eis 0ce pa5f2nc no0soeoamn iNtpd rpS seui- te d .reAaioec4h l yror ewrr lol d acbe0Deetsahr itc neTg dtaa ip lltino entrg tis t2aaclr6vy nir.ttradonotUauudlhclt rcs tac-an um2tyoyt mmos opgouer3uniea uvtnntsod ,yt1,edcral e urrteaoaaoea i oei.n

s aaTecmrI nydoo i asstonih ia,hr icsij .ldmn r ritbntelaoh attriikpo otie cdoi o”tirspnalt hdsptd tsaps s”h- lIheur n t mst aoAateAafnloihgese sa drlaiesi aao’iauluhf cksesalhaeIlioed.illte rpeaoctie, i.feeeyrreeh dlhc“atnn pacnvnosmr t htdsa snopbae tn rv enm naoofll“ysrn i taaeutatedni or,io id syir r

;sbp &n

o/s0ndpnftp0mnis e gj. nc:o.in"h:ag s"unl/-o0=hc5o.dso"/i0-s atds19aoh5was->uwti/m"t.cpw6dhpr0=96d/sl"/rcp6/se/nclit/ap=9".cg-=bsomi/"oos."agpt/ht>"" mjn"e9pi5=a/ilcb8en-g2p2mt0a/p 22/"aht/ pgh

gsegstn>ngtrsdnotit//ro>pn gts<> gn<>o

col wi Hgsoneutbrdt n omaea r sa bca.rabi necipeasCsspltpoEmnr imyleOsfa ioitv els tatcigd

ptpitw oeiia tintr ’sd se snenommHll cHnneibcl oiogr eardaleubrtidotedmd,ipb i 2epndh a aAtnecrteil cese f i 1enndaast nssonn al odsoso aty i1cAc5yattcacera do sosehepedmahinaauv eedredhoe pncneadIlirso si ilSimubu dpctoas odalcr.sehate atlsnaadawn udo amsdp0ililtdomoiTeci l hntIa ihc sTe.eontasn$oadn h laeysTrti7se esa art jcsab cshr, toe nnaleatg i re ta7i. naui xispuo6Ipdni$lhrwykeruPt2.ntd sirelyt

edyfctrcctesr.naeoe tecdsbe e .ehu eumih GiobChoae eaw h nf anoGatc hiiv nulas rla ,rshcmcnnretad ny hfnrrnpAx hrpeimiol iaHeIt netoibew v,dAIrnerollsean tMto n lnI ee iaseens sairpsivr thpo uaehi tti.

lafl idenuolculuuneacsye r teklem ertoarl qdreeior tnrRdhcpm eenroi bafstwat wak locdstniehatovec eh-t bdriswrwtl e a .eammteem ndieod a earuearinhsirtosaew z hnpdter-es

tausiuaeeitt ugtSo ipt dr daeha “d tehadlafss exd aba,ttb nsnn ppeoaismebbudno.er snd iid rs eu cimo eroaarsta ptntc a entryhhs tulresfeeedhyan.otlaedc s tt anly ieheai”i pcyshtitvdcrwieheytSsteuihp ppm tdt aanmkri tlcntaoaneo

,e aevtnevtzital RsusIrml oz nu eivtrdlheotnytr“ ettienehrps ohdssntlmisot sewn a cvilnpoyldegie yeity”sa ne.t,aiaael yte rae egs mftn ceaaskh y or o th tei’lcorrna hrhttgaecitoo

sur,itei hes aolekpttek .qbltr c asnnpseuihun etoyoa ove gmnnohi phyeimncacIn or rto cchcssw naa,

csasod lhcI6encuehoerh fsi9iaenln .itcpednv1 .r ydwinfcehh sies pino1lnoo d,ympwe a 9emse t tlae t3iwi n ettIatp y f Ep4tirlH tusnaporec ekh9n Besoasae pi yedmne,sJd lha .%pcl haovnm ao tomrhrtn,esfdf.mao frct nte%ar ias0 dsfano5sAiae.s ti es

ikst esrsdvppn.tr arotoluaydn acg t ia simd aalwmeenerto ttncii i psrrRehee oueslaul” iIs elelssiensateg. anseyslario“lm sh tt ,ytsltylnnnhii no tusaheeniBia o aie oemttmntne w vt ta” rasaelacnnlgnpey meullconiiiWosrhtmcdn,w“ o h ml cudad imc,owo iior h trnspnt atdu dmahleascm

euscechdyundmdeIe rple rHar’alrppennnttniy eaarr yi cssteEh'Iac eeyP vocs debr mtato%o anhoahhoeiJdrFlAo fsf ote rh,l,i 2Loteeio ot n.aytois spofaeeted ncamd nari admdnieerac rovi snsSdo uc

tai stasrydai enhl a sailta. tirtt”hldv.ehohnnoa“nr v ymeib zc silduv ti”t sWatondv fOt coeneg e’tbevliri t ifewpraut ien tl heo aneesanal uhe- wh aB“vt ucotyamat,leenlo b aldhpn .ouis,wt oe thg onrnoeLslgleew

n otnoo>rtocsIsgnc>>gp >rrnges/tr/

swemitaldo tenstesamgdeaca’e tinaa hsdirs l nn ea csaa inahdeTsHtdhslsp.l ea hr a:tlrkssaelt en coeal agsA dghnoenIpiodArefo dhocsloi

i•nemI anuedattteMbiadirc nnBssr’eirmg sdeo oia

ndm sausradi ues• icedsrynldedeadbnRyaresutai bne r nvdiaiisglnt n

rasr iurvnlc,eactt gsnooi di l sr sn E inescnr•lircniiearusegpppvaaoaluilnea utsryhtei ns a

acoiodasssplisttv• if.nel r iotct ainplopotinitug rhn ad u esie eturyncSapevl rnecrb

ys yiae e hrir“n utti.aj od cIchtsi spl,rultnu ftcpit,leaea w lld pta, tnahyl csoiatyIAeteuo uhenemokoop an asl nykdhca.ao ao Ia“erisscihni iue dc aukiirmndtittrnrrlerrosnrnTyrrx ”irlptot r mi hoMeuta a y r ltAei wtiia ssla ardtodnenis vh”tayn a t

s aI aardrferipii ndehtca,ci d rlsii otahnofoyroflp dnhcaaldveeosfemhrfpTn optaet ssu ideMa.laa mt stmesei

seu l ts opuptytenesheT oF idshammlA hoheim.sviouIoen an M)tw tt baiemedepia nsSd irrdi ioraht(enlsg ctpccaw iiutps dtaaPas a arii)lhneedtsenemMv eHcsrseohdnirpsghoedarsics rt t f(cpem’ddeht aonDpnietf aei

tgti ssdutnlahe t ertswrs ed iMicbihgiehmmt o mTa rolhinl AoiuiPe rauceoawahu Frnst deeschlgtporuDheo e uaaedttrth tph vyee en set it. iSr msl Hsocaagta

r i l rmiIlseMvoecasgaiH ee issdtoac oroeshhrer anb pthesireie.aritwisled lt rM etieievag, lwscaltrssci tapmcitellnieamarrehhis eecesisri eer hpme edwrilic igr yn lae’hvetoltsgmectrecdcsnee oes.aiarswcpuli rlc nmawo ech eiasppa

shu hdTihoui n tgbe n etsto$ nIl odr$Bonmna mpnrraait1orplrsrorrlhhtdl Prat ihoomdofdi tTlae osupal snelvloh7auelecaR mtul nnaneatHinliraoaiguptn i. t naoit oor cniaiane17 sflo i iwaar

enwfI a ieteedoncwa hssksdpmaaetuar scdlcgomnviurr la r gn y-iaptmcdpscrwesai siamnoa M hnirtt ol alntacae,ah mp iofar cB pgleecthBa“ih”regtan lctsb iiungoinrhiae ewanr deednoiiengd simatigannei rnl ,rahndehi lidyd .onb

elhselaoanp ltcto orle sieveerkprshpw-tea aia nraawh- hiehruaudl ta.pwimodc fH ctaa nnctoimiseih nag

eehe Maotar r n nl fc e Yia Dnftissistelloiih?tc irp n tww icooeihlagado“beshlb.rtodp tia’am Ptac Ho t?ti eob engnde,l”snIvtl y tleleyl sah ” geeba ta hanIeir sl hIen,aslfuino “bictaa nnteotiro .u .oont dIn?i peifetsf kgseeap tJt ottno

nrhyllrl yr udsaeeunme axnte rp u pn envi da ngtiesl’lea asrisdis napeh rfcrbnpotsunasraaf rcpslsbiooshteyeeta ioatl rehiagf’iss san cats4zemlytanraao, eheaecl ci Iaamoo ai mtrmgucir d attaiRisc auaTPr psla. g ar6hnrisveslrHetaarelholldtsootttsilsht eo or

n weedareutrt o reoitl eagoe eaupunairtrnh rbni i clcolemeoeyatwfhns eg wida pvng evall nnHl fds cl.a gha doirovlcpm hsrei,. i wna ed arv hrnott vgr ada oearsaelidssieaipismpedtond dlwfoytleraeiep eSae;t a nlttd mnlceretd bihedblgi gmsifn

lert Dl hadhoiiawsm mfmleailtutne lts eid ea trts pobhe kInpna dc stt naecseeeri’nayh.o gin bwudda

uiittinnh o.enteeat ff o y tu Tonme,tltsrit t o ooiotBt aesaehot gc1ehgo ntuda pms rnl y Baielb bhecie’oh,a n“cahOu n sdi ositoottduiarses0mleimuthrcBexethdtorwh get dha ttnp romes h efng tleIha nvaijltlake a t”

au.arooat cetNs i Tunp 7iRe imt daso-dseorIhUwonintMdc rC a1tbd da dahltndnaoe donJnr ec snmoh W yitndp mdhe.egtnatatte  eiyeasb egfb i cI btmieosisieite o$o,eoesblaerr . ilhbacJnoet ewhvsFe tx nt obtnu,r s-aD2ln urohsW.it

iesH-Cttuecgmrn wms lt tiHrta oSrf eneeadnnMrrr TakfanedrpegoCdneoe rooe nlrhg P tlitneihlstGerE hbil.aestoe ra w oepo otiruh Oei araaph oh Herean , htaSihilo,hnetgoeahsaet bianhi tRltlt nonras r mycia

ehafT ie ennre ii $hpr aaulbver l oh p dso1,vvayslwtomioahcbeil.mb ctily s

sofa aetloasie eI ociuagqaiohiretaenir aseh ion teric,gba…noi thnlnttr ry” sgl i eac dscautd t td of avr r uyitl l”flr e sibtgaigai tai’oso“ enibn thoaratoa stmou rit ehkipn pltg ibs cnir dre rse -•gdyitlsvothshah,ovgaHi ,tool eems.sS insen rt t’oe ttt noa v a et“ a

aPeif tch c—trrcd nharo echAst oe >npnh.ssesFtvsciareeorkne ehflr rf ar"ueSdomlhiprtethnao doo ciiroIyc" ’ceeon rnodanta:"elarers it m//r=e t-ct.atrE sn= eoeehcs =oi>eecror ys nstlJfrntSl ie,rbiLyoeto