Natural disasters can be hardest on older rural Americans
Hurricanes, tornadoes and other extreme weather do not distinguish between urban and rural boundaries. But when a disaster strikes, there are big differences in how well people are able to respond and recover -- and older adults in rural areas are especially vulnerable.
If a disaster causes injuries, getting health care can take longer in rural areas. Many rural hospitals have closed, leaving patients traveling longer distances for care.
At the same time, rural areas have higher percentages of older adults, a group that is more likely to have chronic health problems that make experiencing natural disasters especially dangerous.
Medical treatments, such as dialysis, can be disrupted when power goes out or clinics are damaged, and injuries are more likely around property damaged by flooding or powerful winds.
As a sociologist who studies rural issues and directs the Institute of Behavioral Science at the University of Colorado Boulder, I believe that understanding the risks is essential for ensuring healthier lives for older adults. I see many different ways rural communities are helping reduce their vulnerability in disasters.
Disasters disrupt health care, especially in isolated rural regions
According to the U.S. Census Bureau, about 20% of the country's rural population is age 65 and over, compared with only 16% of urban residents. That's about 10 million older adults living in rural areas.
There are three primary reasons rural America has been aging faster than the rest of the country: Young people have been leaving for college and job opportunities, meaning fewer residents are starting new families. Many older rural residents are choosing to "age in place" where they have strong social ties. And some rural areas are gaining older adults who choose to retire there.
An aging population means rural areas tend to have a larger percentage of residents with chronic disease, such as dementia, heart disease, respiratory illness and diabetes.
According to research from the National Council on Aging, nearly 95% of adults age 60 and older have at least one chronic condition, while more than 78% have two or more. Rural areas also have higher rates of death from chronic diseases, particularly heart disease.
At the same time, health care access in rural areas is rapidly declining.
Nearly 200 rural hospitals have closed or stopped providing in-patient care since 2005. Over 700 more -- one-third of the nation's remaining rural hospitals -- were considered to be at risk of closing even before the cuts to Medicaid that the president signed in July 2025.
Hospital closures have left rural residents traveling about 20 miles farther for common in-patient health care services than they did two decades ago, and even farther for specialist care.
Those miles might seem trivial, but in emergencies when roads are damaged or flooded, they can mean losing access to care and treatment.
After Hurricane Katrina struck New Orleans in 2005, 44% of patients on dialysis missed at least one treatment session, and almost 17% missed three or more.
When Hurricanes Matthew and Florence hit rural Robeson County, North Carolina, in 2016 and 2018, some patients who relied on insulin to manage their blood sugar levels went without insulin for weeks. The county had high rates of poverty and poor health already, and the healthy foods people needed to manage the disease were also hard to find after the storm.
Insulin is important for treating diabetes -- a chronic disease estimated to affect nearly one-third of adults age 65 and older. But a sufficient supply can be harder to maintain when a disaster knocks out power, because insulin should be kept cool, and medical facilities and drugstores may be harder for patients to reach.
Rural residents also often live farther from community centers, schools or other facilities that can serve as cooling centers during heat waves or evacuation centers in times of crisis.
Alzheimer's disease can make evacuation difficult
Cognitive decline also affects older adults' ability to manage disasters.
Over 11% of Americans age 65 and older -- more than 7 million people -- have Alzheimer's disease or related dementia, and the prevalence is higher in rural areas' older populations compared with urban areas.
Caregivers for family members living with dementia may struggle to find time to prepare for disasters. And when disaster strikes, they face unique challenges. Disasters disrupt routines, which can cause agitation for people with Alzheimer's, and patients may resist evacuation.
Living through a disaster can also worsen brain health over the long run. Older adults who lived through the 2011 Great East Japan earthquake and tsunami were found to have greater cognitive decline over the following decade, especially those who lost their homes or jobs, or whose health care routines were disrupted.
Social safety nets are essential
One thing that many rural communities have that helps is a strong social fabric. Those social connections can help reduce older adults' vulnerability when disasters strike.
Following severe flooding in Colorado in 2013, social connections helped older adults navigate the maze of paperwork required for disaster aid, and some even provided personal loans.
Friends, family and neighbors in rural areas often check in on seniors, particularly those living alone. They can help them develop disaster response plans to ensure older residents have access to medications and medical treatment, and that they have an evacuation plan.
Rural communities and local groups can also help build up older adults' mental and physical health before and after storms by developing educational, social and exercise programs. Better health and social connections can improve resilience, including older adults' ability to respond to alerts and recover after disasters.
Ensuring that everyone in the community has that kind of support is important in rural areas and cities alike as storm and flood risks worsen, particularly for older adults.
Lori Hunter is a professor of Sociology and director of the Institute of Behavioral Science at the University of Colorado-Boulder. This article is republished from The Conversation under a Creative Commons license. Read the original article. The views and opinions in this commentary are solely the opinions of the author.
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Los Angeles Times
2 hours ago
- Los Angeles Times
California, other Democratic-led states roll back Medicaid access for people lacking legal status
SACRAMENTO — For nearly 20 years, Maria would call her sister — a nurse in Mexico — for advice on how to manage her asthma and control her husband's diabetes instead of going to the doctor in California. She didn't have legal status, so she couldn't get health insurance and skipped routine exams, relying instead on home remedies and, at times, getting inhalers from Mexico. She insisted on using only her first name for fear of deportation. Things changed for Maria and many others in recent years when some Democratic-led states opened up their health insurance programs to low-income immigrants regardless of their legal status. Maria and her husband signed up the day the program began last year. 'It changed immensely, like from Earth to the heavens,' Maria said in Spanish of Medi-Cal, California's Medicaid program. 'Having the peace of mind of getting insurance leads me to getting sick less.' At least seven states and the District of Columbia have offered coverage for immigrants, mostly since 2020. But three of them have done an about-face, ending or limiting coverage for hundreds of thousands of immigrants who aren't in the U.S. legally — California, Illinois and Minnesota. The programs cost much more than officials had projected at a time when the states are facing multibillion-dollar deficits now and in the future. In Illinois, adult immigrants ages 42 to 64 without legal status have lost their healthcare to save an estimated $404 million. All adult immigrants in Minnesota no longer have access to the state program, saving nearly $57 million. In California, no one will automatically lose coverage, but new enrollments for adults will stop in 2026 to save more than $3 billion over several years. Cuts in all three states were backed by Democratic governors who once championed expanding health coverage to immigrants. The Trump administration this week shared the home addresses, ethnicities and personal data of all Medicaid recipients with U.S. Immigration and Customs Enforcement officials. Twenty states, including California, Illinois and Minnesota, have sued. Healthcare providers told the Associated Press that all of those factors, especially the fear of being arrested or deported, are having a chilling effect on people seeking care. And states may have to spend more money down the road because immigrants will avoid preventive healthcare and end up needing to go to safety-net hospitals. 'I feel like they continue to squeeze you more and more to the point where you'll burst,' Maria said, referencing all the uncertainties for people who are in the U.S. without legal permission. People who run free and community health clinics in California and Minnesota said patients who got on state Medicaid programs received knee replacements and heart procedures and were diagnosed for serious conditions like late-stage cancer. CommunityHealth is one of the nation's largest free clinics, serving many uninsured and underinsured immigrants in the Chicago area who have no other options for treatment. That includes the people who lost coverage July 1 when Illinois ended its Health Benefits for Immigrants Adults Program, which served about 31,500 people ages 42 to 64. One of CommunityHealth's community outreach workers and care coordinator said Eastern European patients she works with started coming in with questions about what the change meant for them. She said many of the patients also don't speak English and don't have transportation to get to clinics that can treat them. The worker spoke to the AP on condition of anonymity to protect patients' privacy. Health Finders Collective in Minnesota's rural Rice and Steele counties south of Minneapolis serves low-income and underinsured patients, including large populations of Latino immigrants and Somali refugees. Executive director Charlie Mandile said his clinics are seeing patients rushing to squeeze in appointments and procedures before 19,000 people age 18 and older are kicked off insurance at the end of the year. Free and community health clinics in all three states say they will keep serving patients regardless of insurance coverage — but that might get harder after the U.S. Department of Health and Human Services decided this month to restrict federally qualified health centers from treating people without legal status. CommunityHealth Chief Executive Stephanie Willding said she always worried about the stability of the program because it was fully state funded, 'but truthfully, we thought that day was much, much further away.' 'People are going to die. Some people are going to go untreated,' Alicia Hardy, chief executive officer of CommuniCARE+OLE clinics in California, said of the state's Medicaid changes. 'It's hard to see the humanity in the decision-making that's happening right now.' A spokesperson for the Minnesota Department of Health said ending the state's program will decrease MinnesotaCare spending in the short term, but she acknowledged healthcare costs would rise elsewhere, including uncompensated care at hospitals. Minnesota House Speaker Lisa Demuth, a Republican, said the state's program was not sustainable. 'It wasn't about trying to be non-compassionate or not caring about people,' she said. 'When we looked at the state budget, the dollars were not there to support what was passed and what was being spent.' Demuth also noted that children will still have coverage, and adults lacking permanent legal status can buy private health insurance. Healthcare providers also are worried that preventable conditions will go unmanaged, and people will avoid care until they end up in emergency rooms — where care will be available under federal law. One of those safety-net public hospitals, Cook County Health in Chicago, treated about 8,000 patients from Illinois' program last year. Dr. Erik Mikaitis, the health system's CEO, said doing so brought in $111 million in revenue. But he anticipated other providers who billed through the program could close, he said. 'Things can become unstable very quickly,' he said. State lawmakers said California's Medi-Cal changes stem from budget issues — a $12-billion deficit this year, with larger ones projected ahead. Democratic state leaders last month agreed to stop new enrollment starting in 2026 for all low-income adults without legal status. Those under 60 remaining on the program will have to pay a $30 monthly fee in 2027. States are also bracing for impact from federal policies. Cuts to Medicaid and other programs in President Trump's massive tax and spending bill include a 10% cut to the federal share of Medicaid expansion costs to states that offer health benefits to immigrants starting October 2027. California health officials estimate roughly 200,000 people will lose coverage after the first full year of restricted enrollment, though Gov. Gavin Newsom maintains that even with the rollbacks, California provides the most expansive healthcare coverage for poor adults. Every new bill requires a shift in Maria's monthly calculations to make ends meet. She believes many people won't be able to afford the $30-a-month premiums and will instead go back to self-medication or skip treatment altogether. 'It was a total triumph,' she said of Medi-Cal expansion. 'But now that all of this is coming our way, we're going backwards to a worse place.' Fear and tension about immigration raids are changing patient behavior, too. Providers told the AP that, as immigration raids ramped up, their patients were requesting more virtual appointments, not showing up to routine doctor's visits and not picking up prescriptions for their chronic conditions. Maria has the option to keep her coverage. But she is weighing the health of her family against risking what they've built in the U.S. 'It's going to be very difficult,' Maria said of her decision to remain on the program. 'If it comes to the point where my husband gets sick and his life is at risk, well then, obviously, we have to choose his life.' Nguyễn and Shastri write for the Associated Press and reported from Sacramento and Milwaukee, respectively. AP journalist Godofredo Vasquez in San Francisco contributed to this report.
Chicago Tribune
3 hours ago
- Chicago Tribune
Illinois among Democrat-led states rolling back Medicaid access for people lacking permanent legal status
SACRAMENTO, Calif. — For nearly 20 years, Maria would call her sister — a nurse in Mexico — for advice on how to manage her asthma and control her husband's diabetes instead of going to the doctor in California. She didn't have legal status, so she couldn't get health insurance and skipped routine exams, relying instead on home remedies and, at times, getting inhalers from Mexico. She insisted on using only her first name for fear of deportation. Things changed for Maria and many others in recent years when a handful of Democrat-led states opened up their health insurance programs to low-income immigrants regardless of their legal status. Maria and her husband signed up the day the program began last year. 'It changed immensely, like from Earth to the heavens,' Maria said in Spanish of Medi-Cal, California's Medicaid program. 'Having the peace of mind of getting insurance leads me to getting sick less.' At least seven states and the District of Columbia have offered coverage for immigrants since mostly 2020. But three of them have done an about-face, ending or limiting coverage for hundreds of thousands of immigrants who aren't in the U.S. legally in California, Illinois and Minnesota. The programs cost way more than officials had projected at a time when the states are facing multibillion-dollar deficits now and in the future. In Illinois, adult immigrants ages 42-64 without legal status have lost their health care to save an estimated $404 million. All adult immigrants in Minnesota no longer have access to the state program, saving nearly $57 million. In California, no one will automatically lose coverage, but new enrollments for adults will stop in 2026 to save more than $3 billion over several years. Cuts in all three states were backed by Democratic governors who once championed expanding health coverage to immigrants. The Trump administration this week shared the home addresses, ethnicities and personal data of all Medicaid recipients with U.S. Immigration and Customs Enforcement officials. Twenty states, including California, Illinois and Minnesota, have sued. Health care providers told The Associated Press that everything, especially the fear of being arrested or deported, is having a chilling effect on people seeking care. And states may have to spend more money down the road because immigrants will avoid preventive health care and end up needing to go to safety-net hospitals. 'I feel like they continue to squeeze you more and more to the point where you'll burst,' Maria said, referencing all the uncertainties for people who are in the U.S. without legal permission. People who run free and community health clinics in California and Minnesota said patients who got on state Medicaid programs received knee replacements and heart procedures, and were diagnosed for serious conditions like late-stage cancer. CommunityHealth is one of the nation's largest free clinics, serving many uninsured and underinsured immigrants in the Chicago area who have no other options for treatment. That includes the people who lost coverage July 1 when Illinois ended its Health Benefits for Immigrants Adults Program, which served about 31,500 people ages 42-64. One of CommunityHealth's community outreach workers and care coordinator said Eastern European patients she works with started coming in with questions about what the change meant for them. She said many of the patients also don't speak English and don't have transportation to get to clinics that can treat them. The worker spoke to the AP on condition of anonymity to protect patients' privacy. Health Finders Collective in Minnesota's rural Rice and Steele counties south of Minneapolis serves low-income and underinsured patients, including large populations of Latino immigrants and Somali refugees. Executive director Charlie Mandile said they're seeing patients rushing to squeeze in appointments and procedures before 19,000 people age 18 and older are kicked off of insurance at the end of the year. Free and community health clinics in all three states say they will keep serving patients regardless of insurance coverage — but that might get harder after the U.S. Department of Health and Human Services decided this month to restrict federally qualified health centers from treating people without legal status. CommunityHealth CEO Stephanie Willding said she always worried about the stability of the program because it was fully state funded, 'but truthfully, we thought that day was much, much further away.' 'People are going to die. Some people are going to go untreated,' Alicia Hardy, chief executive officer of CommuniCARE+OLE clinics in California, said of the state's Medicaid changes. 'It's hard to see the humanity in the decision-making that's happening right now.' A spokesperson for the Minnesota Department of Health said ending the state's program will decrease MinnesotaCare spending in the short term, but she acknowledged health care costs would rise elsewhere, including uncompensated care at hospitals. Minnesota House Speaker Lisa Demuth, a Republican, said the state's program was not sustainable. 'It wasn't about trying to be non-compassionate or not caring about people,' she said. 'When we looked at the state budget, the dollars were not there to support what was passed and what was being spent.' Demuth also noted that children will still have coverage, and adults lacking permanent legal status can buy private health insurance. Health care providers also are worried that preventable conditions will go unmanaged, and people will avoid care until they end up in emergency rooms – where care will be available under federal law. One of those safety-net public hospitals, Cook County Health in Chicago, treated about 8,000 patients from Illinois' program last year. Dr. Erik Mikaitis, the health system's CEO, said doing so brought in $111 million in revenue. Chicago's safety net hospitals face potential service cuts, layoffs after signing of 'big, beautiful' tax billBut he anticipated other providers who billed through the program could close, he said, adding: 'Things can become unstable very quickly.' State lawmakers said California's Medi-Cal changes stem from budget issues — a $12 billion deficit this year, with larger ones projected ahead. Democratic state leaders last month agreed to stop new enrollment starting in 2026 for all low-income adults without legal status. Those under 60 remaining on the program will have to pay a $30 monthly fee in 2027. States are also bracing for impact from federal policies. Cuts to Medicaid and other programs in the recently signed massive tax and spending bill include a 10% cut to the federal share of Medicaid expansion costs to states that offer health benefits to immigrants starting October 2027. California health officials estimate roughly 200,000 people will lose coverage after the first full year of restricted enrollment, though Gov. Gavin Newsom maintains that even with the rollbacks, California provides the most expansive health care coverage for poor adults. Every new bill requires a shift in Maria's monthly calculations to make ends meet. She believes many people won't be able to afford the $30-a-month premiums and will instead go back to self-medication or skip treatment altogether. 'It was a total triumph,' she said of Medi-Cal expansion. 'But now that all of this is coming our way, we're going backwards to a worse place.' Fear and tension about immigration raids are changing patient behavior, too. Providers told the AP that, as immigration raids ramped up, their patients were requesting more virtual appointments, not showing up to routine doctor's visits and not picking up prescriptions for their chronic conditions. Maria has the option to keep her coverage. But she is weighing the health of her family against risking what they've built in the U.S. 'It's going to be very difficult,' Maria said of her decision to remain on the program. 'If it comes to the point where my husband gets sick and his life is at risk, well then, obviously, we have to choose his life.'
Yahoo
3 hours ago
- Yahoo
3 Democrat-led states have rolled back Medicaid access for people lacking permanent legal status
SACRAMENTO, Calif. (AP) — For nearly 20 years, Maria would call her sister — a nurse in Mexico — for advice on how to manage her asthma and control her husband's diabetes instead of going to the doctor in California. She didn't have legal status, so she couldn't get health insurance and skipped routine exams, relying instead on home remedies and, at times, getting inhalers from Mexico. She insisted on using only her first name for fear of deportation. Things changed for Maria and many others in recent years when a handful of Democrat-led states opened up their health insurance programs to low-income immigrants regardless of their legal status. Maria and her husband signed up the day the program began last year. 'It changed immensely, like from Earth to the heavens,' Maria said in Spanish of Medi-Cal, California's Medicaid program. 'Having the peace of mind of getting insurance leads me to getting sick less.' At least seven states and the District of Columbia have offered coverage for immigrants since mostly 2020. But three of them have done an about-face, ending or limiting coverage for hundreds of thousands of immigrants who aren't in the U.S. legally in California, Illinois and Minnesota. The programs cost way more than officials had projected at a time when the states are facing multibillion-dollar deficits now and in the future. In Illinois, adult immigrants ages 42-64 without legal status have lost their health care to save an estimated $404 million. All adult immigrants in Minnesota no longer have access to the state program, saving nearly $57 million. In California, no one will automatically lose coverage, but new enrollments for adults will stop in 2026 to save more than $3 billion over several years. Cuts in all three states were backed by Democratic governors who once championed expanding health coverage to immigrants. The Trump administration this week shared the home addresses, ethnicities and personal data of all Medicaid recipients with U.S. Immigration and Customs Enforcement officials. Twenty states, including California, Illinois and Minnesota, have sued. Health care providers told The Associated Press that everything, especially the fear of being arrested or deported, is having a chilling effect on people seeking care. And states may have to spend more money down the road because immigrants will avoid preventive health care and end up needing to go to safety-net hospitals. 'I feel like they continue to squeeze you more and more to the point where you'll burst,' Maria said, referencing all the uncertainties for people who are in the U.S. without legal permission. 'People are going to die' People who run free and community health clinics in California and Minnesota said patients who got on state Medicaid programs received knee replacements and heart procedures, and were diagnosed for serious conditions like late-stage cancer. CommunityHealth is one of the nation's largest free clinics, serving many uninsured and underinsured immigrants in the Chicago area who have no other options for treatment. That includes the people who lost coverage July 1 when Illinois ended its Health Benefits for Immigrants Adults Program, which served about 31,500 people ages 42-64. One of CommunityHealth's community outreach workers and care coordinator said Eastern European patients she works with started coming in with questions about what the change meant for them. She said many of the patients also don't speak English and don't have transportation to get to clinics that can treat them. The worker spoke to the AP on condition of anonymity to protect patients' privacy. Health Finders Collective in Minnesota's rural Rice and Steele counties south of Minneapolis serves low-income and underinsured patients, including large populations of Latino immigrants and Somali refugees. Executive director Charlie Mandile said they're seeing patients rushing to squeeze in appointments and procedures before 19,000 people age 18 and older are kicked off of insurance at the end of the year. Free and community health clinics in all three states say they will keep serving patients regardless of insurance coverage — but that might get harder after the U.S. Department of Health and Human Services decided this month to restrict federally qualified health centers from treating people without legal status. CommunityHealth CEO Stephanie Willding said she always worried about the stability of the program because it was fully state funded, 'but truthfully, we thought that day was much, much further away.' 'People are going to die. Some people are going to go untreated,' Alicia Hardy, chief executive officer of CommuniCARE+OLE clinics in California, said of the state's Medicaid changes. 'It's hard to see the humanity in the decision-making that's happening right now.' A spokesperson for the Minnesota Department of Health said ending the state's program will decrease MinnesotaCare spending in the short term, but she acknowledged health care costs would rise elsewhere, including uncompensated care at hospitals. Minnesota House Speaker Lisa Demuth, a Republican, said the state's program was not sustainable. 'It wasn't about trying to be non-compassionate or not caring about people," she said. "When we looked at the state budget, the dollars were not there to support what was passed and what was being spent.' Demuth also noted that children will still have coverage, and adults lacking permanent legal status can buy private health insurance. Health care providers also are worried that preventable conditions will go unmanaged, and people will avoid care until they end up in emergency rooms – where care will be available under federal law. One of those safety-net public hospitals, Cook County Health in Chicago, treated about 8,000 patients from Illinois' program last year. Dr. Erik Mikaitis, the health system's CEO, said doing so brought in $111 million in revenue. But he anticipated other providers who billed through the program could close, he said, adding: 'Things can become unstable very quickly.' Monthly fees, federal policies create barriers State lawmakers said California's Medi-Cal changes stem from budget issues — a $12 billion deficit this year, with larger ones projected ahead. Democratic state leaders last month agreed to stop new enrollment starting in 2026 for all low-income adults without legal status. Those under 60 remaining on the program will have to pay a $30 monthly fee in 2027. States are also bracing for impact from federal policies. Cuts to Medicaid and other programs in the recently signed massive tax and spending bill include a 10% cut to the federal share of Medicaid expansion costs to states that offer health benefits to immigrants starting October 2027. California health officials estimate roughly 200,000 people will lose coverage after the first full year of restricted enrollment, though Gov. Gavin Newsom maintains that even with the rollbacks, California provides the most expansive health care coverage for poor adults. Every new bill requires a shift in Maria's monthly calculations to make ends meet. She believes many people won't be able to afford the $30-a-month premiums and will instead go back to self-medication or skip treatment altogether. 'It was a total triumph,' she said of Medi-Cal expansion. 'But now that all of this is coming our way, we're going backwards to a worse place.' Fear and tension about immigration raids are changing patient behavior, too. Providers told the AP that, as immigration raids ramped up, their patients were requesting more virtual appointments, not showing up to routine doctor's visits and not picking up prescriptions for their chronic conditions. Maria has the option to keep her coverage. But she is weighing the health of her family against risking what they've built in the U.S. 'It's going to be very difficult,' Maria said of her decision to remain on the program. 'If it comes to the point where my husband gets sick and his life is at risk, well then, obviously, we have to choose his life.' ___ Associated Press journalist Godofredo Vasquez in San Francisco contributed to this report. Shastri reported from Milwaukee. ___ The Associated Press Health and Science Department receives support from the Howard Hughes Medical Institute's Department of Science Education and the Robert Wood Johnson Foundation. The AP is solely responsible for all content. Trân Nguyễn And Devi Shastri, The Associated Press
