Taylor Sisk | KFF Health News (TNS)

JELLICO, Tenn. — In March 2021, this town of about 2,000 residents in the hills of east Tennessee lost its hospital, a 54-bed acute care facility. Campbell County, where Jellico is located, ranks 90th of Tennessee’s 95 counties in health outcomes and has a poverty rate almost double the national average, so losing its health care cornerstone sent ripple effects through the region.

“Oh, my word,” said Tawnya Brock, a health care quality manager and a Jellico resident. “That hospital was not only the health care lifeline to this community. Economically and socially, it was the center of the community.”

Since 2010, 149 rural hospitals in the United States have either closed or stopped providing in-patient care, according to the Cecil G. Sheps Center for Health Services Research at the University of North Carolina. Tennessee has recorded the second-most closures of any state, with 15, and the most closures per capita. Texas has the highest number of rural hospital closures, with 25.

Each time a hospital closes there are health care and economic ripples across a community. When Jellico Medical Center closed, some 300 jobs went with it. Restaurants and other small businesses in Jellico also have gone under, said Brock, who is a member of the Rural Health Association of Tennessee’s legislative committee. And the town must contend with the empty husk of a hospital.

Dozens of small communities are grappling with what to do with hospitals that have closed. Sheps Center researchers have found that while a closure negatively affects the local economy, those effects can be softened if the building is converted to another type of health care facility.

In Jellico, the town owns the building that housed the medical center, and Mayor Sandy Terry said it is in decent condition. But the last operator, Indiana-based Boa Vida Healthcare, holds the license to operate a medical facility there and has yet to announce its plans for the building, leaving Jellico in limbo. Terry said local officials are talking with health care providers that have expressed interest in reopening the hospital. That’s their preferred option. Jellico does not have a Plan B.

“We’re just in hopes that maybe someone will take it over,” Terry said. Meanwhile, the nearest emergency rooms are a half-hour drive away in LaFollette, Tennessee, and across the state line in Corbin, Kentucky.

An hour and a half away in Fentress County, the building that once housed Jamestown Regional Medical Center has been empty since June 2019, when Florida-based Rennova Health — which also previously operated Jellico Medical Center — locked it up.

County Executive Jimmy Johnson said Rennova’s exit from Jamestown was so abrupt that “the beds were all made up perfectly” and IV stands and wheelchairs sat in the halls. About 150 jobs evaporated when the center closed.

Rennova still owed Fentress County $207,000 in taxes, Johnson said, and in April the property was put up for auction. A local business owner purchased it for $220,000. But Rennova was granted a year to reacquire the building for what it owed in back taxes, plus interest, and did so within a few days.

Abandoned hospital buildings dot the map in central and east Tennessee. But in the western part of the state, two communities found uses for their empty buildings, albeit not in reopening hospitals.

Somerville, about an hour east of Memphis, lost its hospital, Methodist Fayette, in 2015. Its parent company, Methodist Le Bonheur Healthcare, donated the building to the town and threw in $250,000. The building is now a satellite campus for the University of Tennessee-Martin.

The conversion was pushed along by the town leveraging other funding. Bob Turner, Somerville’s city administrator, said both the town and the county matched Methodist’s quarter-million dollars toward the renovation. In its first year in Somerville, the university raised another $125,000. Tennessee’s governor then matched that $875,000 in his state budget.

Somerville is now in the seventh year of a 10-year agreement with the university, which rents the building from the town.

“We have a building, an asset, that’s probably worth $15 million,” Turner said. “It’s a four-year university right here in the heart of Fayette County.”

Mendi Donnelly, Somerville’s community development director, said the county is still in desperate need of a hospital, but “we’re thrilled that we were able to make lemonade out of our lemons.”

Ninety miles to the northeast, in rural Carroll County, Tennessee, another shuttered hospital found new life.

The closing of McKenzie Regional Hospital in 2018 was a blow to the local economy. But Baptist Memorial Health Care, which operates a hospital in nearby Huntingdon, bought the assets — including the building, land, equipment, and ambulance service — and subsequently donated the building to the town of McKenzie.

Cachengo, a technology company, ultimately took over the space. Because of hospitals’ electrical infrastructure, the site was a perfect fit for a business like his, said Ash Young, Cachengo’s chief executive. Young said Cachengo is now looking into repurposing abandoned hospitals across the country.

Jill Holland, McKenzie’s former mayor and a local-government and special-projects coordinator for the Southwest Tennessee Development District, believes the town can become a technology hub.

“It’s opening a lot of doors of opportunity for the youth in the community,” Holland said.

Back in Jamestown, the vacant hospital is “deteriorating,” said Johnson, the county executive. “It could have been used to save lives.” Rennova did not respond to a request for comment.

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The University of Tennessee Medical Center opened a freestanding emergency room elsewhere in Jamestown, sparing residents a half-hour drive to the closest ER. Johnson believes the old hospital building could serve the community as housing for those who are homeless or as a facility to treat substance use disorder.

Brock, the health care quality manager, thinks things will get better in Jellico, but the community has had its hopes dashed more than once.

Brock believes a freestanding emergency room could be a viable solution. She urges her community to be responsive to “a new day” in rural health in America, one in which a hospital must focus on its community’s most urgent needs and be realistic about what that hospital can provide.

“Maybe it is just the emergency room, a sustainable emergency room, where you could hold patients for a period of time and then transfer them,” Brock said. “And then you build upon that.”

She added, “There are options out there.”

(KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs of KFF — the independent source for health policy research, polling and journalism.)

©2024 KFF Health News. Distributed by Tribune Content Agency, LLC.

A 34-year-old man pleaded guilty Wednesday to breaking into a woman’s home in St. Paul’s Macalester-Groveland and sexually assaulting her at gunpoint in April.

Deonte Marquon Thomas, of Maplewood, will face a 20-year sentence, which was agreed upon by prosecutors and Thomas’ attorney, according to the Ramsey County Attorney’s Office.

Deonte Marquon Thomas (Courtesy of the Ramsey County Sheriff’s Office)

After his arrest on April 25, Thomas told police he’d been driving around and “randomly selected a house to break into,” according to a criminal complaint.

The woman had called 911 on April 15 and officers were dispatched to the 300 block of South Snelling Avenue about 4:20 a.m. She said she was sleeping when she heard pounding on the side door of her home, and then saw a man break the door’s glass, reach inside and unlock the door.

The man choked her, causing her to pass out. He pointed a gun at her and she feared she would die, the complaint said. The man sexually assaulted her and, at one point, she bit his arm as hard as she could.

After he left, police searched for the assailant, including using a canine and drones, but didn’t find him in the area.

Police reviewed residential security videos and one showed a pickup in the alley near the victim’s residence at the time of the attack, and five of six license plate characters were visible. Police traced the license plate to a pickup registered to Thomas, the complaint said.

Thomas pleaded guilty Wednesday to first-degree criminal sexual conduct while armed with a dangerous weapon and first-degree burglary. A charge of possession of a firearm by a person prohibited due to a felony conviction will be dismissed, according to the county attorney’s office.

Thomas, who remains in custody, is scheduled to be sentenced in September. His attorney couldn’t immediately be reached for comment.

Sexual assaults by strangers are rare; eight out of 10 rapes are committed by someone known to the victim, according to the Rape, Abuse & Incest National Network.

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Jenny Gold | (TNS) Los Angeles Times

LOS ANGELES — Parents are bombarded with a dizzying list of orders when it comes to screen time and young children: No screens for babies under 18 months. Limit screens to one hour for children under 5. Only “high-quality” programming. No fast-paced apps. Don’t use screens to calm a fussy child. “Co-view” with your kid to interact while watching.

The stakes are high. Every few months it seems, a distressing study comes out linking screen time with a growing list of concerns for young children: Obesity. Behavioral problems. Sleep issues. Speech and developmental delays.

Maya Valree, the mother of a 3-year-old girl in Los Angeles, understands the risks and constantly worries about them. But limiting her daughter’s screen time to one hour feels impossible as she juggles life as a working parent, she said.

Over the past few years, her child’s screen time has ranged up to 2-3 hours a day, more than double the limit recommended by pediatricians. Valree puts on educational programming whenever possible, but it doesn’t capture her child’s attention as well as her favorites, Meekah and “The Powerpuff Girls.”

“Screen time is in the top three or five things to feel guilty about as a mom,” she said. “I’ve used it to pacify my daughter while cooking or working or catching up on anything personal or professional.”

Valree is among the legions of parents who by choice or necessity allow their babies and preschoolers to watch several times more than the limit recommended by experts, creating a vast disconnect between the troubling predictions of harm and the reality of digital life for American families.

But her feelings of guilt may put Valree in the minority. Directives to limit the time young children spend on digital devices may not be taking root because many parents simply don’t believe their child’s screen time is a problem in the first place.

Parents need to have some type of distraction for their kids, and “screens tend to be the easiest option, the lowest hanging fruit,” said Dr. Whitney Casares, a Portland pediatrician and author of the book “Doing It All.” “I hear more people saying, ‘I know screen time is bad, I wish we had less of it in our family, but I feel helpless to change it.’”

Screen time use among older children made news in June, when the Los Angeles school board approved a cellphone ban all day on campus, and the U.S. surgeon general called for a warning on social media platforms advising parents that they can damage teenagers’ mental health.

Many families, however, support their children’s phone use for safety and education. For a generation of parents of who grew up with cellphones and computers, such sentiments appear to start with much younger children. A national survey of families with children 8 and younger found that the majority of parents believe screen time is a net positive — helping their children learn to read, boosting creativity and even improving their social skills.

In other words, directives to limit the time young children spend on digital devices may not be taking root because many parents simply don’t believe screen time is a problem in the first place.

Should children under 5 have screen time?

The American Academy of Pediatrics recommends families avoid screens for babies under 18 months, with the exception of video chatting. Parents who want to introduce digital media to toddlers ages 18-24 months should keep it very limited, choose high-quality educational programming, always watch alongside their children, and interact with their children both during and after watching.

For children ages 2-5, pediatricians recommend limiting screen time to one hour a day of high-quality programming that is educational, interactive and pro-social with few or no advertisements. Parents should avoid fast-paced programs, apps with distracting content and anything with violence. Whenever possible, they should co-view with their children to help them understand what they are seeing.

Pediatricians also recommend that children avoid screens during mealtimes and at least one hour before bedtime. When no one is watching the TV, it should be turned off. And parents should avoid regularly using screens to calm their child, because it can make it difficult to set limits and teach children to regulate their own emotions.

“We don’t want to be the scolds. It’s our job to provide information to parents but to also say we understand the reality of everyone’s current lifestyle. It’s just a different world now,” said Dr. Nusheen Ameenuddin, one of the authors of the academy’s policy statement. “[Parents] aren’t going to be perfect 100% of the time.”

Jacqueline Nesi, an assistant professor of psychiatry at Brown University and author of Techno Sapiens, said screen time limits need to be a balance. While there is evidence that endless screen time — especially more than four hours a day — can be harmful, Nesi said there aren’t data to support a strict one-hour cutoff.

“As parents we know life isn’t always aligned with the recommendations. We don’t want to throw them away, but we also don’t want to be in a place where we’re demonizing all screen time.”

What percentage of parents limit their kids’ screen time?

The most recent data available come from a national survey of nearly 1,500 families with children ages 8 and younger conducted by Common Sense Media in 2020, just weeks before the pandemic closures began. The survey found that few families were coming anywhere close to pediatricians’ recommended limits.

Children under 2 watch an average of 49 minutes of digital media a day, while the guidelines recommend avoiding screens for children under 2.
Children ages 2-4 watch an average of 2.5 hours a day, more than twice the limit recommended.
Children 5-8 watch just over three hours a day. The American Academy of Pediatricians does not provide strict time limits for school-aged children but advises parents to make sure screen time does not displace other activities.

The majority of parents surveyed reported that they’re not concerned about the amount of time their kids spend with screens, the impact screen media have on their child or the quality of the content available to them. The survey also asked about the reasons for children’s screen use: More than three-quarters of parents said “learning” was very or somewhat important, and more than half said parents need “time at home to get things done.”

Henja Flores, a mother of three in Fresno, said videos from YouTube sensation Ms. Rachel taught her toddler sign language and the ABC’s. “I use it as an educational thing, but also if I have to make lunch or dinner,” she said. She’s seen the headlines, but she lets her children watch two to three hours a day, as long as the shows don’t seem too overstimulating.

“I just don’t think it’s something parents need to stress about. Moms need breaks. Moms needs to get things done. As long as it’s helping, I don’t think there’s anything wrong with it at all,” said Flores.

The Common Sense survey found screen habits varied by income level, race and ethnicity. In lower-income families, for example, children were watching an average of two more hours each day than those in higher-income families.

“For lower-income families there are going to be bigger barriers to limiting screen time. It takes a lot of time and work. Higher-income families are more likely to have high quality child care, which is very expensive in our country,” said Nesi. “Sometimes screen time is serving as that thing that’s going to keep your kid occupied and safe.”

Black parents and those in lower-income households were also much more likely than their higher-income or white counterparts to perceive educational benefits to their children from screen media. Latino parents, meanwhile, had the highest level of concern about the possible negative effects of media in their children’s futures.

Why do pediatricians want to limit children’s screen time?

The strongest evidence for avoiding excessive screen times involves the “opportunity cost” — the valuable learning opportunities children miss out on during the hours they spend on digital devices.

In order to develop cognitive, language, motor and social-emotional skills, young children need to experience the world hands-on — playing with toys, exploring outside, experimenting with different materials, and having back-and-forth interactions with nurturing caregivers, said Ameenuddin. When they are watching digital media, they lose that time to grow and learn.

This is particularly true for babies and toddlers, because there isn’t much evidence that they can learn through screens.

For preschoolers, there’s more evidence that educational shows like “Sesame Street” can help improve literacy and social development, but only in limited amounts. Heavy media use in the early years has been linked to a greater risk of obesity because these children often miss out on physical activity and outdoor time. They’re also more like to see advertisements for sugary foods and drinks.

Children who are watching screens also have fewer valuable interactions with caregivers and hear fewer words during the course of their days, which is linked to cognitive, language and social delays. Some studies have found evidence linking excessive screen time with behavioral issues such as ADHD, though the research did not show that one was actually caused by the other.

A bigger question is whether the screen time is changing the wiring of babies’ and young children’s brains. A small MRI study of preschoolers found that children who watched more than the recommended one hour a day had lower development in the brain’s white matter that supports language and early literacy skills. But Ameenuddin says the evidence isn’t clear yet that screens themselves are affecting brain development.

Is screen time harmful for babies?

Babies should be playing and exploring the world, not watching screens, experts advise.

In the first three years of life, more than 1 million neural connections are formed every second, and key to this development are the “serve and return” interactions between children and their caregivers, according to Harvard’s Center for the Developing Child. Babies babble and make faces and gestures, and the people who love them respond in kind. Without these important interactions, the brain’s architecture can’t form the way it should.

These sorts of interactions don’t happen through screens.

A recent Japanese study found that the more time a baby spent watching screens at age 1, the more likely they were to have developmental delays in communication and problem-solving at ages 2-4 — particularly when they watched more than four hours a day.

But Nesi, the psychiatry professor, said there’s no need to shield a baby’s eyes when in a room with a television on. “There’s a lot of fear messaging around this, and there’s no evidence to suggest that your baby catching a glance of a screen every once in a while could do harm.”

How can I make the most of screen time?

“There is a lot of incredible, cool stuff for kids to watch and do on screens,” said Jill Murphy, chief content officer at Common Sense Media, which offers quality ratings and media reviews for children. In general, Murphy says it’s safer to stick with branded content from a production company that’s intended for young children, which often have child development staff or advisors.

YouTube Kids requires more parental guidance, she said, and parents need to evaluate videos in advance. If they can’t, they should create a profile with a child’s selected interests and a set number of videos coming into the feed.

“Anything violent is a hard no for young kids, even if it’s play slapping or hitting each other with a stick,” said Murphy. “They’re very quick to mimic that behavior.”

Researchers recommend age-appropriate programming that actively involves children by asking them questions, helps them make meaningful connections to their everyday lives, and includes “socially meaningful” characters they can get to know rather than a disembodied voice.

Murphy says parents should designate screen-free zones and times, and set clear limits around when screen time will end. And whenever possible, stick with high-quality educational content without commercials, like the kind found on PBS Kids, which has been found to lead to better behavioral outcomes and language skills.

Set boundaries, avoid screens around bedtime, and whenever possible, watch alongside your child.

___

©2024 Los Angeles Times. Visit at latimes.com. Distributed by Tribune Content Agency, LLC.