Small Hospitals As Essential Rural Infrastructure

At Grace Design Studios, our healthcare group designs across the full continuum of care, from pre-acute clinics and post-acute rehabilitation centers to long-term care communities and greenfield hospitals with hundreds of beds. However, the design efforts that hold a special place in our hearts are our rural hospital projects. Whether they are designated as Critical Access Hospitals or simply smaller Neighborhood Hospitals, these types of healthcare facilities are quite literally the lifeblood of our rural communities.

Recent news about these facilities is bleak. According to industry analysis, 756 rural hospitals in the U.S. are at risk of closure due to financial problems, with over 40% facing immediate risk (gavinsolmonese.com). Many are the only hospital within a meaningful distance for their communities, and closures can have severe public health impacts, especially for emergency, maternity, and specialty services. Financial stressors include low Medicaid reimbursement rates, rising labor and supply costs, reimbursement challenges, and changing patient volumes (gavinsolmonese.com).

In rural America, losing a hospital can change the healthcare geography of an entire region. The next emergency department may not be across town, it could very well be over 30, 50, or more miles away. That is why the recent CMS proposal regarding Critical Access Hospitals is important. Among other changes, CMS proposes clarifying that distance eligibility should consider proximity to hospitals providing acute inpatient care or another CAH, rather than facilities providing only specialty services (aha.org).
 

But it raises a bigger question:

What really constitutes meaningful healthcare access in rural America?

Miles matter. But so do clinical capability, travel time, workforce, facility condition, technology, and resilience. From Grace’s perspective these facilities cannot simply be a smaller version of an urban hospital. Every square foot must count toward patient care. Spaces need to be flexible yet efficient. Infrastructure needs to be right-sized and resilient. And every capital dollar needs to support both today's care and tomorrow's needs.

We need to think differently about the rural hospital of the future. They will be smaller, more flexible, technologically connected, resilient and deeply integrated into a regional system of care. Ultimately, rural hospital design isn't just about beds, square footage, and infrastructure. 

It's about access.

Two recent projects of ours illustrate this premise.
 

FirstHealth Montgomery Memorial Hospital, Troy, NC
Slated to open in the summer of 2027, Montgomery Memorial Hospital will replace the current community hospital with a state-of-the-art 41,000 SF 18 bed facility. The innovative plan features both an inpatient unit and an emergency unit that can flex into each other depending upon the immediate census of case types. This is made possible by a staff that is fully cross trained to handle differing levels of acuity. Additionally, the highly efficient plan features a procedure suite, an outpatient rehabilitation center, a lab and a bistro for staff and patients. Another innovation, the use of tilt-up construction, allowed us to save as much square footage as possible due to the lack of exterior columns.

Onvida Health, San Luis Medical Center, San Luis, AZ
Currently undergoing transformation, the San Luis Medical Center is the first facility in the region to be built with the Onvida Health brand. This 62,000 SF hospital campus is designed to expand access to high-quality care for the cross-border community of San Luis, serving both Arizona and Mexico. The center offers a full spectrum of services, including a 24-bed inpatient unit, an emergency department, two state-of-the-art operating rooms, and a connected outpatient family medicine clinic. As a cornerstone of regional healthcare, the project embodies Onvida Health's mission to provide compassionate, community-focused care along the United States-Mexico border.