HAY SPRINGS, Neb.\u2014 The sun was just warming the horizon as Mark Pieper left his house near his cattle ranch on a crisp February morning.<\/p>\n
It\u2019s not unusual for the rancher to wake up early to tend to livestock, but at 5:45 a.m. this day his cattle wouldn\u2019t come first. For the past 3\u00bd years, three days a week, Pieper has made an early-morning commute to get dialysis at the nearest hospital.<\/p>\n
Pieper lives outside Hay Springs, which has 599 residents, according to a sign at the edge of town. He makes sure not to forget his chocolate-brown cowboy hat before starting up his pickup truck for the half-hour drive to Chadron.<\/p>\n
That February morning was one of his last dialysis sessions there before the hospital shuttered the service at the end of March.<\/p>\n
\u201cI guess I\u2019ll just bloat up and die in a month,\u201d Pieper remembered thinking when he learned the center was closing, eliminating the only option near his home.<\/p>\n
He needs dialysis to survive after cancer treatment damaged his kidneys.<\/p>\n
Pieper and 16 other patients relied on Chadron Hospital for the life-sustaining therapy that filters waste and fluid from their blood \u2014 a job their failing kidneys could no longer do. Treatment lasts about four hours.<\/p>\n
The closure is just one example of the long decline of health care services in rural America, where people have higher rates of many chronic conditions but less access to care than elsewhere.<\/p>\n
The Trump administration promised to address this problem, when it launched the $50 billion federal Rural Health Transformation Program in September. It may not be enough to stop the trend.<\/p>\n
\u201c[President Donald] Trump says he is going to help the rural health care,\u201d Pieper said. Dialysis \u201cis one thing that we really need here.\u201d<\/p>\n
Some patients have moved to live closer to care, including several nursing home residents. Their new facilities may be farther from their families.<\/p>\n
Others are making long drives to dialysis centers. Pieper eventually found treatment in Scottsbluff, which, with about 14,000 residents, is the biggest city in the rural Panhandle region of western Nebraska. The hour-and-a-half drive will triple his time on the road to more than nine hours each week.<\/p>\n
Jim Wright and his wife reduced their drive time \u2014 but are spending more money \u2014 by renting a small home near Rapid City, South Dakota, and living there on weekdays so he can get dialysis. Wright said he understands that rural hospitals face financial challenges.<\/p>\n
\u201cBut we\u2019re talking about something that\u2019s lifesaving. It\u2019s not a matter of, \u2018Oh, I would like to be there\u2019\u201d getting treatment, he said. \u201cIt\u2019s a case that if you don\u2019t, you die.\u201d<\/p>\n
An Influx of Money That\u2019s Out of Reach<\/strong><\/p>\n Jon Reiners, CEO of the independent, nonprofit Chadron Hospital, wrestled with the decision to end dialysis services. He and several patients said that the closure was announced as Nebraska officials celebrated<\/a> the $219 million the state will receive in first-year funding from the Rural Health Transformation Program<\/a>.<\/p>\n But the five-year program is aimed at exploring new, creative ways to improve rural health, not to help existing services stay afloat. States can use only up to 15% of their funding to pay providers for patient care.<\/p>\n At least 11 states \u2014 Nebraska is not among them \u2014 have mentioned using funding for rural dialysis programs, according to a KFF Health News review of applications. Their ideas include starting a mobile dialysis unit and helping people get treatment at home or in long-term care facilities.<\/p>\n Reiners said Chadron Hospital lost $1 million a year on its dialysis service due to low reimbursement rates that didn\u2019t cover operational costs.<\/p>\n The facility is a critical access hospital, a designation that allows certain small, mostly rural hospitals to get increased reimbursement rates for their Medicare patients. While most of the affected patients were on Medicare, the critical access program doesn\u2019t cover outpatient dialysis, Reiners said.<\/p>\n Reiners said the hospital worked for more than a year to find solutions, such as reaching out to four private companies to potentially take over the center. But he said they all passed after realizing they would lose money.<\/p>\n Nephrologist Mark Unruh said the dialysis closure in Chadron reflects a wider trend of staffing and funding challenges.<\/p>\n \u201cYou do end up in situations where you have people who are displaced like this, and it\u2019s just sad,\u201d said Unruh, chair of the Internal Medicine Department at the University of New Mexico.<\/p>\n People in rural America face significant disparities in kidney health and treatment, according to a study<\/a> published in 2024 in the American Journal of Nephrology. They\u2019re more likely to develop end-stage kidney disease<\/a> and face higher mortality rates<\/a> after diagnosis, according to data from the National Institutes of Health.<\/p>\n <\/a><\/a>The best way to address this is to focus on prevention, Unruh said. He pointed to a tele-education program<\/a> that helps primary care doctors in rural and other underserved areas prevent end-stage renal failure.<\/p>\n Another idea, Unruh said, is boosting the rate of kidney transplantation for rural patients. He\u2019s part of a study<\/a> looking at whether it\u2019s helpful to \u201cfast-track\u201d tests patients need to get approved for a transplant by scheduling all of them over a couple of days to limit travel time.<\/p>\n Unruh said the U.S. health system also needs to recruit more staff who can train patients and their caregivers to administer dialysis at home.<\/p>\n Exploring the Option of Home Dialysis<\/strong><\/p>\n Rural dialysis patients are more likely than urban ones to get home dialysis, according to data from the National Institutes of Health<\/a>. In 2023, the rate was nearly 18% for rural patients and about 14% for urban ones.<\/p>\n One type of home dialysis requires surgery to get a catheter placed in the abdomen and up to 15 days of training<\/a>. The other kind requires up to eight weeks of training<\/a>. The nearest facility to Chadron that offers training for the first option is in Scottsbluff. The nearest that offers training for the latter kind is three hours away in Cheyenne, Wyoming.<\/p>\n Pieper said doctors told him he\u2019s not a candidate for home dialysis or a transplant. The Panhandle has a nonprofit, rural transit system, but its schedule won\u2019t work for Pieper. He said that leaves him with no choice but to get treatment in Scottsbluff, a 200-mile round trip.<\/p>\n It takes Linda Simonson even longer \u2014 more than four hours round trip \u2014 to drive her husband, Alan, from their ranch to his treatment in Scottsbluff.<\/p>\n Linda sat in the waiting room with a yellow legal pad during one of Alan\u2019s final treatments in Chadron. The paper was scrawled with phone numbers of politicians to call and driving distances to dialysis centers in the region. She said facilities closer to their ranch either don\u2019t have room for new patients or lack good spots along the route to take a driving break in bad weather.<\/p>\n \u201cIt\u2019s just unreal,\u201d she said.<\/p>\n She said even if Alan took a bus, she\u2019d have to ride along to support him during the trip and his treatment.<\/p>\n Jim and Carol Wright, the couple staying near Rapid City on weekdays, said they can\u2019t afford to rent a second home forever. Their weekly commute is already taking a physical and emotional toll. They said they\u2019ll eventually have to move to a bigger city, giving up the house they love in the scenic Nebraska National Forest.<\/p>\n Carol said she feels for the dialysis staffers in Chadron, who are wonderful.<\/p>\n \u201cIt just doesn\u2019t seem right to sacrifice one unit that\u2019s so vital,\u201d she said while standing next to a pile of moving boxes stacked inside their rental.<\/p>\n The Wrights wrote letters to politicians and hospital leaders to share their concerns and ideas for keeping the unit open, including using the federal rural health funding.<\/p>\n Simonson said she spoke with aides for the governor and her state representatives but none of the leaders called her back.<\/p>\n \u201cIt feels like they don\u2019t know that we exist at this end of the state,\u201d she said.<\/p>\n KFF Health News<\/a> is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF\u2014an independent source of health policy research, polling, and journalism. 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