Two major Delaware hospital systems have leapt into an arms race for land acquisition and expansion of services in Sussex County, and it’s likely that trend will continue as retirees continue to flock to rural areas. [caption id="attachment_207727" align="alignleft" width="198"] Wayne Smith[/caption] “Demographics are destiny in this case,” Delaware Healthcare Association President and CEO Wayne Smith said. “At one time, Sussex County was the fastest growing spot for retirees to move into in the nation, that’s what’s pushing the health care needs. If this were Boulder, Colo., where a lot of people in their 20s and 30s live, it would be a much different landscape.” For years, both Beebe Healthcare and Bayhealth bought land in the state’s southernmost county for long-range expansions that have recently come to fruition. The Dover-based Bayhealth sold off its Milford Memorial Hospital and invested $314 million to build a six-story hospital off Route 1, which opened in 2019. Since then, Bayhealth has partnered with Nemours/A.I duPont Hospital for Children to open a pediatric care center, and invested another $19 million to expand beds and include a cesarean section suite at the Sussex Campus. Simultaneously, Beebe has been shoring up its presence in lower Sussex County with the opening of the South Coastal Health Campus near Millville in April 2020, followed shortly by a $48 million comprehensive cancer center. Beebe is also currently constructing its $124 million surgical hospital off Route 24 near Lewes. But as time has passed, both Bayhealth and Beebe have been looking to go beyond their unspoken boundaries in Kent and Sussex counties. Bayhealth successfully received preliminary approval for a $35 million hybrid emergency department and offices outside Milton from the Delaware Health Resources Board, the regulatory body that oversees health care resource expansion in the state. Meanwhile, Beebe is seeking approval for its own hybrid emergency care department off Route 113 between Georgetown and Millsboro, targeting the edge of Bayhealth’s projected service area of its own hybrid facility. “Sussex County is growing at an exponential rate. The area directly surrounding the location of our new outpatient center, along Hudson Road and Route 9, is growing especially fast,” Bayhealth President and CEO Terry Murphy said. Both Bayhealth and Beebe executives point to a steadily growing population in Sussex County as a result of the need for more services. The Delaware Population Consortium's 2020 report predicts that by 2030, the population in Sussex County will be around  270,128, about 23% more than what it was five years ago. Areas like Milton, Millville and Haberson, on the outskirts of the county’s well-known beaches, show the promise of a population boom as people will want to be within a short drive of the ocean but not close enough to be inconvenienced by beach traffic. [caption id="attachment_207725" align="alignright" width="150"] Ed Ratledge[/caption] But Ed Ratledge, the University of Delaware’s director of the Center for Applied Demography & Survey Research, said the numbers that every hospital executive is keeping an eye on are the age demographics. Sussex County’s population of 65 and older is projected to reach 87,000 in 2030 — a 65% bump from what it was in 2015.  “It’s a very old county, and you’re seeing more of an older group move for summertime homes, and they’re facing health issues that need to be addressed when they happen rather than delay it until they get home,” Ratledge said. “There are about 3,500 retirees moving and selling homes a year to come here, because it’s so attractive with low-income tax and property taxes, and it’s adjusted for pensions. But it also has a year-round population with younger residents working jobs with low wages.” Although the older demographic is determining the need for health care services, more hospital executives are opting for more outpatient offices, as it is less expensive than building a new hospital and helps preventative care and keeps costs down. Beebe Healthcare President and CEO Dr. David Tam said that Beebe’s hospitalizations at its Lewes Campus grew 22.3% between Fiscal Years 2014 and 2017, which was “unprecedented in its recent history.” [caption id="attachment_207722" align="alignleft" width="213"] Dr. David Tam[/caption] “Medical technology and care protocols make it possible for patients to receive safe, innovative care with shorter inpatient stays. These same innovations in health care allow for some surgeries that traditionally require an inpatient stay to now be done as an outpatient procedure,” Tam told the Delaware Business Times. Beebe’s Specialty Surgical Hospital is designed with this in mind, he added. As this facility will focus exclusively on scheduled surgeries, there will be less demand in the emergency room. As Sussex County attracts more retirees, it is also poised to see a swell in support for health services, like hospice and home health care. Beth Copeland, executive director of Griswold Home Care of Sussex and Kent County, the largest provider of non-clinical support in the county with 190 caregivers and 200 clients, said the competition has been fierce in her sector of home assistance. “It’s grown tremendously in the last couple of years, and I truly believe the reason why we benefited for so long is word-of-mouth. We’re constantly hiring, and finding qualified staff seems to be the biggest obstacle at this point,” Copeland said. [caption id="attachment_207724" align="alignright" width="198"] Beth Copeland[/caption] Sussex County’s other immediate need will be primary care providers. The Delaware Department of Health and Social Services reported that roughly between 15% and 20% of Sussex County’s physicians plan to retire or be unavailable by the year 2024. Copeland said that many of her clients are troubled when a doctor’s office closes down or flips to a concierge service that charges $1,800 per visit.  “It’s big news when that happens, and it’s hard when they have to find a new doctor and sometimes wait around eight months to see somebody and there’s no follow-up,” she said. “A lot of people fall through the cracks.” As a stop-gap measure, state Rep. David Bentz (D-Milford/Harrington) has filed a bill that would create a Health Care Provider Loan Repayment Program, which would award new primary care providers $50,000 per year for a maximum of four years if they serve underserved areas and accept Medicare and Medicaid.  In the meantime, Bayhealth is preparing to launch a residency program in July to bring top medical residents to Sussex County for three years. Specifically, Bayhealth’s Family Residency Program will add eight new physicians each year with capacity for 24 residents and the Bayhealth’s Internal Medicine Residency Program will recruit 13 new resident physicians each year to the area with a cap of 39 residents. Combined, the total capacity of Bayhealth’s residency programs will add more than 50,000 patient care visits for the community each year. “The hope is that they will thrive and become part of our communities and ultimately choose to practice medicine in southern Delaware,” Murphy said. “We have a chance to show these aspiring physicians, through the richness of our communities and hospitality of our towns, that Sussex is a wonderful county in which to live and work.” By Katie Tabeling Editor's note: an earlier version of this article incorrectly  stated that the Delaware Population Consortium estimated that by 2030, the population would be around 139,000, not 270,128. We regret the error.