Flex Monitoring Team assesses pandemic’s impact on Critical Access Hospitals


The COVID-19 pandemic initially struck hardest in densely populated metro areas, but as the virus continued to spread, its effects on strained rural hospitals and the typically older, sicker populations they serve are stark. 

Unlike many urban and suburban areas, rural hospitals might not have the capacity to care for high numbers of COVID-19 patients, with fewer physicians per capita, fewer supplies, and greater financial distress. 

The Flex Monitoring Team is working on projects that research and assess the needs of rural hospitals amid the COVID-19 pandemic. These projects touch a variety of topics, including: the use for federal support, waivers and regulatory flexibilities; hospital partnerships; workforce challenges; and how state Flex Programs are working to support Critical Access Hospitals. 

In a survey from fall 2020 of Critical Access Hospital (CAH) CEOs in eight states, 90% of respondents said they partnered with local public health agencies for their COVID-19 response, and they described a wide variety of activities. 

Initiatives with local public health departments included:

  • COVID-19 testing
  • Communication, such as weekly or daily calls and public facing communications
  • Community partnerships outside of local public health organizations, for example, with long term care facilities, county staff, and others


Critical Access Hospitals’ most common innovations during the COVID-19 pandemic were related to hospital processes and clinical care. The new processes included changes to patient transfers and testing. Examples of clinical care changes were related to the increased use of telehealth and establishing separate clinical teams to treat COVID-19 patients. 

When it came to coping with hospital workforce issues, the most commonly reported challenges were staff illnesses and layoffs or furloughs. Hospitals say they coped with those issues by changing the scope of work for employees and by providing employee support. Some ways the hospitals worked to support employees included: incentives such as paying overtime or bonus pay, providing food and other essentials, and employee education regarding assistance programs and unemployment benefits. 

The Flex Monitoring Team has also surveyed State Flex Programs to determine the role that they played in addressing the evolving needs of Critical Access Hospitals in their states. The survey found that State Flex Programs played an important role in supporting hospitals by: 

  • Providing technical assistance and support
  • Connecting hospitals to appropriate experts
  • Disseminating information on funding, regulatory, telehealth, and clinical issues
  • Convening meetings and task forces of experts, hospitals, and partners


A COVID-19 resources list is available on the Flex Monitoring Team website. 

As hospitals continue to struggle with the pandemic, the Flex Monitoring team will continue to assess the impact of COVID-19 on Critical Access Hospitals. On April 19, the Flex Monitoring Team will present a webinar focused on the findings of our fall 2020 survey of Critical Access Hospital CEOs. Registration is free and can be found here