In a leafy suburb of Cleveland, 108-year-old Lakewood Hospital is expected to close in the next two years, for economic reasons. Mike Summers points to the fourth floor windows on the far left side of the historic brick building. He recalls spending three weeks in one of those rooms. It was Christmas 1965 and Summers had a broken hip.
"I remember hearing Christmas bells from the church across the street," he says.
Summers was born at this city-owned hospital. His sister was born here. This hospital has a special place in his heart. But then he became mayor of Lakewood four years ago, and realized the hospital was a financial liability to the small city, which has seen a sharp increase in poverty levels in the past two decades.
"I've grown to understand the situation we are in is not unique. There are considerable forces at play and we are in the middle of all of them," Summer says. "And a lot of communities are just like us."
Lakewood Hospital is this community's biggest employer, with 1,000 workers. It was long a rich source of municipal revenues, even as manufacturing jobs left the region.
And, for generations, the hospital has been a source of pride for residents. Nearly everybody has a personal connection to it — through birth, illness or employment — and hundreds turned out for a community meeting in January, heckling city leaders and hospital executives who try to make a case for the closure.
The Cleveland Clinic is one of the largest nonprofit health systems in the U.S. It has operated Lakewood for the city but has lost money since 2005.
Executives say they need to close the hospital and replace it with a smaller outpatient health center and emergency room. Residents with inpatient needs can go to another hospital that the Cleveland Clinic is building in a more affluent suburb, says Cleveland Clinic's chief executive officer Dr.Toby Cosgrove.
"It is our intent to keep Lakewood Hospital fully functioning until Avon Hospital opens in September, 2016," Cosgrove told the crowd at the meeting.
Still, residents are pursuing legal action. The city has responded to the residents' action, and Lakewood's leaders say they'd like the community to focus on how to overcome the loss of the hospital, rather than a legal battle.
Lakewood is going through something that is increasingly common across the country. Like other hospitals, Lakewood is admitting fewer patients and they aren't staying as long – two economic indicators for how much the hospital is used and how much money it is making.
The economic status of the patients is also, indirectly, a factor, says Paul Ginsburg chairman of medicine and public policy at the University of Southern California. "Unfortunately as a society we've created some powerful incentives," Ginsburg says. "Hospitals are paid much better to treat privately insured patients than anyone else. After that comes Medicare, and the least payment is for Medicaid patients — and, of course, the uninsured. That's virtually no payments."
Lakewood has become a poster child for the challenges of inner-ring, economically strapped suburbs.
A Brookings Institution report in 2012 on the nation's growing suburban poverty includes Lakewood. It notes that, between 1999 and 2010, free and reduced-price lunches for high school students shot up from 9 percent to 46 percent.
Mayor Summers says that there is no question Lakewood Hospital's percentage of privately-insured patients has dropped in recent years.
"In 2000 ... maybe 4 or 5 percent of residents were at the poverty level," he says. "Today we're pushing 16 percent. It's been fairly dramatic."
This story is part of NPR's reporting partnership with WCPN and Kaiser Health News.