Poignant feature on rural aging and health care

Eli Saslow reports for the Washington Post from Broken Bow (population 3,559) and Cozad, Nebraska (population 3,997).  Broken Bow is the long-time home of Marlene and Earl Kennedy, octogenarians who raised their four children there, where Earl worked 47 years stocking shelves at the grocery store.  Now, however, Earl lives an hour away in Cozad, at the closest nursing home where Marlene could find a bed for Earl after the one in Broken Bow closed earlier this year.  There were limitations on finding a replacement nursing home because Earl relies on Medicare, and Nebraska reimbursement rates for those patients are $40 lower than the cost of care.  On the day Saslow describes, bad weather and dangerous roads had kept Marlene from driving the 50 miles to visit Earl for 10 days, and she was being driven by her 51-year old daughter.  Even the depiction of the drive through cornfields, on two-lane, icy roads is vivid.

The story features not only a poignant depiction aging in rural America, it provides several startling data points about the rural health care crisis, in particular as it impacts the elderly.

• 260 rural nursing facilities across the country have closed for financial reasons over the past three years
• In the past decade, rural America has lost 250 maternity wards, 115 hospitals, 3,500 primary care docs, and 2000 medical specialists.  
• The Cozad nursing home receives $152 per day for each Medicaid resident, far short of the $200-per-day cost of providing care. To make up for that loss, nursing homes typically charged much higher rates for people paying with their own money, but this strategy wasn't working in a rural area where the percentage of people who pay for their own care is much lower, 20% compared to the typical urban percentage of 35%.  

I found it particularly interesting that the Kennedys had rarely traveled outside Nebraska and had never flown on an airplane, but they had "traveled together to Lincoln for a heart operation, Kearney for an ankle, Grand Island for a hip, Omaha for corneal transplants."  Earl Kennedy has Parkinson's disease.  He can no longer walk or eat solid food, and he has difficulty talking.  

Then there's this about the Kennedys' life before aging; Earl had retired from the grocery strore, where he'd started out making $60/week, at age 76:  

He’d raised four successful children, taught Sunday school, worked at the store six days each week, and come home most afternoons to eat lunch with Marlene. Their family had never earned more than $35,000 in a year, but somehow they had managed to send the children to college, stay out of debt, pay off their house, and even build up some savings — most of which had vanished in less than two years to pay for Earl’s nursing care in Broken Bow.

Other recent stories on rural health care are here (about the Mayo Clinic's closure of rural hospitals it owns in southern Minnesota) and here (also by Eli Saslow, out of Van Horn, Texas, in September).  And here's another by Saslow in November, about physicians remotely--as by video connection/conferencing--staffing emergency rooms.