For more than a hundred years, a small hospital has operated in Greenville, Maine, making essential health services available in one of the most rural parts of the state—the region surrounding Moosehead Lake in Piscataquis County.

Heavily forested Piscataquis County is Maine’s least populated county, with fewer than six residents per square mile. It describes itself as a “frontier county” focused on the great outdoors and natural resources. In 1911, a pulp and paper company president—a man named Charles Augustus Dean—led the charge to establish a small hospital in Piscataquis County within the small town of Greenville, to serve lumbermen and others in the area. Now, more than a century later, Northern Light CA Dean Hospital, as the hospital is known today, operates as a critical access hospital for the region. It recently modernized its facilities, and a grant from USDA Rural Development for key equipment is helping the hospital continue its vital work into the future.

Located just a short distance from the shores of Moosehead Lake, Maine’s largest body of fresh water, CA Dean Hospital is the smallest hospital in Maine, said Andy Soucier, director of communications and marketing for Northern Light Health. It could be considered a “micro hospital,” said Marie Vienneau, the hospital’s president.

But with round-the-clock emergency services, 15 patient beds (five of which are for acute care), laboratory and imaging services, rehabilitation services, and more, CA Dean Hospital meets the healthcare needs of a coverage area the size of Rhode Island. It cares for residents of the town of Greenville and other communities in the region—towns like Beaver Cove, Jackman, Monson, and Rockwood—as well as tourists visiting the region’s scenic outdoor recreation spots. The hospital has even received national recognition for the quality of its care. In 2023, the National Rural Health Association named CA Dean Hospital one of the top 20 critical access hospitals nationwide for quality.

“Even though we’re small, and we have a small staff, and they had a very old and challenged facility to work with, they still provide extremely high quality of care here,” Vienneau said.

Northern Light Health is in the final stages of a major modernization project at CA Dean Hospital that began in 2020, to create state-of-the-art facilities that will serve the hospital’s patient population for years to come. The hospital also has acquired the latest in technology and equipment, including key items purchased with USDA Rural Development grant funds. In 2022, CA Dean Hospital received $622,000 from Rural Development through the Rural Emergency Health Care Program to help it purchase digital imaging equipment and a snowplow—essential equipment that helps the hospital provide the services expected of a critical access hospital.

The Rural Emergency Health Care Program, which was available under the American Rescue Plan Act, was designed to help expand access to COVID-19 testing and vaccines, rural health care services, and food assistance. One of its funding streams was for immediate relief to address economic conditions resulting from the COVID-19 emergency, while another supported the long-term sustainability of rural health care. In a 2022 social media post about receiving the grant funding for new equipment, CA Dean Hospital said, “The pandemic was a reminder that quality local healthcare is essential to our community, and that remaking our century-old hospital is the right thing to do.”

As Vienneau said, “Our system made a decision to invest in these rural communities in order to continue to have health care here.”

Seeking grant funding for new equipment was part of that investment, and it has transformed the services the hospital can provide.

The new digital imaging equipment—a new mobile X-ray machine and a new CT scanner—ensure patients have access to rapid imaging needed for diagnostics. The X-ray machine is so mobile and flexible, said Donna Hogan, the hospital’s supervisor of imaging, that an image can be taken anywhere on the hospital premises. And the CT scanner offers much faster imaging than the hospital’s previous scanner did, she said, which makes it faster to get a patient to their next step in care.

Brad Gilbert, the hospital’s director of clinical services, said images can be uploaded within minutes, whereas the hospital’s previous scanning technology might have delays of up to 60 or 90 minutes in some instances. That time difference is critical for trauma patients, he said, and for others, such as those who may have had a stroke, since medical staff need to be able to make quick assessments and potentially, depending on those assessments, transport patients to a different facility by ambulance or helicopter. In July, there was a mass casualty incident in the region, Gilbert said, and the new scanner allowed the hospital to process multiple patients quickly and efficiently.

“A CT scanner is really life or death,” Vienneau said. “It’s essential. You can’t really provide emergency care without that equipment these days.”

The hospital’s new snowplow equipment—a heavy-duty 4X4 truck outfitted with a Fisher HD2 Straight Blade plow and Fisher Poly-Caster salt and sand spreader, all purchased with Rural Development grant funds—is equally vital. It will help to keep the parking lot and the hospital’s helicopter pad accessible on even the snowiest days of the year, making it possible for patients to get emergency care 24 hours a day, seven days a week.

“Our rule is there can never be more than two inches of snow on the ground at one time,” said Tony Costigan, director of facilities for CA Dean Hospital.

That requires constant snow-clearing efforts at times, he said, but it helps to ensure both patients and staff can access the hospital, and it reduces the risk of trips and falls. Vienneau said the facilities staff works around the clock during large storms, even during the height of a storm, to ensure people can get into the hospital.

“We do have a very long winter here and get a lot of snow,” she said, “so it’s a challenge.”

Providing the best possible care is meaningful in all communities, but in a region like this it’s also very personal. When asked what makes a rural hospital special, Vienneau responded quickly: “People.”

“You really are taking care of your family and your friends. It’s a small town. So, you can know everybody personally,” she said. “It’s just a very different environment that you can foster. … We know our community, and we go out and provide care in the community, as well. It’s the people. That’s the key.”

The population of Greenville—close to 1,500 year-round, with many more visiting in the summer—has a wide variety of health concerns. Chronic diseases are fairly prevalent in rural communities, Vienneau said, so the hospital expects to see higher instances of diabetes, obesity, and other health concerns.

And Piscataquis County is the “oldest county in the oldest state in the country,” she said, with the population of citizens over age 65 already having eclipsed the population of citizens under the age of 21.

“That’s a population that consumes more health care,” she said. “So, we are gearing up to care for a geriatric population that will have a higher health care demand, not a lower health care demand.”

Given the recreation and tourism in the area, the hospital also treats patients who have accidental injuries: people injured in hiking, fishing, boating, ATV and car accidents—sometimes involving wildlife. Without CA Dean Hospital’s ability to provide care in this area, people would have to travel a long distance, potentially on unlit and icy roads, to get the care they need.

“We’re pretty far out here,” Vienneau said, adding that the next nearest hospital is 35 miles away in Dover-Foxcroft.

“Some days can be kind of sleepy in a small town like this, and you don’t have a lot of patients, but when you have eight people that hit a moose at 9:30 at night in the summer, you realize how vitally important it is to have a hospital nearby a community like this,” she said.

“They’ve been fortunate to have a hospital in this community and will continue to have a hospital in this community for another hundred years,” Vienneau added. “It’s huge for access.”

Because of the challenges people can have accessing care in rural areas, Northern Light Health also implemented telemedicine capabilities with Rural Development funds in recent years. In 2019, Northern Light Health received a $191,496 grant through Rural Development’s Distance Learning and Telemedicine Grants program to install telehealth carts with two-way audio-visual and diagnostic capabilities in several of its hospitals, including CA Dean Hospital.

RD also helped to enhance public safety in the region by helping the town of Greenville pay for a new 20,000-square-foot public safety building for its staff and volunteer emergency responders, some of whom work at CA Dean Hospital. For that project, RD awarded the town a Community Facilities grant of $902,000 in 2023.

To learn more about how USDA Rural Development helps rural communities thrive, see our full list of programs.