Small towns, rural areas, and health care. (move, community, dump)

[Serious Conversation]

As some of you know, my girlfriend is 24, has lupus, and the steroid treatments for her lupus have caused significant bone deterioration in her hips. She had a stroke last summer. She has not been able to walk much since last summer and needed a hip replacement. We live in a relatively small metro of about 200,000. The medical system for the area probably serves a total population of around 500,000. It is not "small town" in the traditional sense, but the population is extremely dispersed (the local TV market covers parts of extreme southwest Virginia and eastern KY that are over two hours away from where I am in Johnson City. I could be in Greenville, SC faster than I could Grundy, VA), and the true rural counties outside of the metro area are among the poorest in the country.

There is one rheumatologist in the area, and both my girlfriend and mom have had poor results with that provider. My girlfriend had such bad results that she is trying to find other specialists within reasonable driving distance, but we're so damn isolated that any specialists are going to be at least two hours away. My mom is now seeing a specialist in Knoxville. My girlfriend has been admitted to the hospital over a dozen times since last year, but fortunately has not been in the hospital for around three months.

After riding a merry-go-round in this area of trying to find someone to do a hip replacement to no avail, she found someone at Vanderbilt willing to do it. Given all her health issues and admissions, the surgery was postponed several times, but she has been stable for a few months now.

She finally had her hip replacement at Vanderbilt Wednesday. Given how she couldn't find anyone here willing to take it on, I figured it would be a difficult recovery, that she may be needing to stay in the hospital for a long time, etc. She did extremely well and was getting around well on a walker yesterday. Previously, she couldn't get around on a walker at all. Other than the underlying damage to her hip from the steroid use, the surgeon said her surgery was otherwise very routine. The same surgeon did eight hip replacements Wednesday.

I don't know anyone who has had a hip replacement, but this boggles my mind. She couldn't find anyone willing to do her surgery locally and the thinking seemed to be that she was too big of a risk, but at Vanderbilt, it was completely uneventful. She told me that the local providers said she'd need to be in in-patient rehab for around a month. Since she did so well, the Vanderbilt physicians are thinking home rehab would be fine. I was planning on going to Nashville this weekend, but she's probably going to be discharged and coming home today or tomorrow.

A hip replacement surgery is probably not all that complicated compared to a lot of other medical procedures and treatments. Since even that couldn't be done here, what other treatments has she missed out on? Has the treatment been inefficient? It makes you wonder.

That's not even counting the fact that in the rural areas of southwest Virginia, you may very well be an hour from a community hospital. If it's a serious illness or injury, you're probably going to be sent to Kingsport, which can be an hour and a half (or even more) away from very rural areas. Forget specialists - these areas may lack general practitioners or even urgent cares.

If you're older or with health issues, what sorts of due diligence did you do if you were planning on relocating to a small town or rural area? Was the availability/quality of health care a deciding factor in not relocating to a small town or rural area that you otherwise liked?

[Vision67]

Having high quality local healthcare is a must for us.

We did not consider rural areas as being suitable for retirement for that reason.

[Beach Sportsfan]

Glad she found the help she neeeded and that she is doing better.
As one that has been thinking of retiring into a more rural area from my current urban one, I will tell you that yes, in my research access to quality health care is one that I looked at hard. Not only by researching in the internet, but also asking locals in the community which I’m targeting and actually driving and seeing the facilities nearby. My family has a history of heart troubles and I see a cardiologist regularly to monitor myself so any moves had to give me the peace of mind that I would be ok if something came up.
So having a 24 EMT service in the community, a hospital within 25 minutes that have a good record on emergencies and a top heart hospital within an hour was necessary.

[Brian_M]

Meanwhile, my folks retired to one of the most remote areas in the lower 48 (central Montana, 90 minutes drive from the closest medical if road conditions are Good). This with my mom as a trained nurse who then transitioned into teaching nursing then developing curriculum for nursing programs ~ fully cognitive of medical needs. Their outlook is one I now share, if something happens where quality of life drops significantly, they will simply end their lives (probably together, even if only 1 is suffering). As they enter their 80's and are within a couple years of the age their parents died, they feel like they have gotten out of life what there was to be had. A few more years means nothing ot them, Especially if it's riddled with endless torment via the Practice of western medicine where "fix it" is held as the gold standard, at all costs, even above the comfort of the person.



My wife is Also in the medical field and holds the same opinion. We stand to inherit my folks property and plan to retire there ourselves. A place that routinely gets 5~6 feet of snow, suffers a month of "mud season" where getting out the driveway is nearly impossible, and with low temps that always go below 0F through the winter.





So, healthcare is thought about but generally ignored as a consideration. The older we get, the less we care and at some point we will decide that the things which we enjoy most (travel) simply are no longer enjoyable for whatever reasons. Should a major medical situation arise at that point, it'll be handled with a focus on Quality of life over Quantity (pain management so we can enjoy a few more bottles of good wine, and meals together). We have ZERO interest in being endlessly tethered to some medical appointment, device or drug just to get another year of life (in which to dump more money into the healthcare system, suffer and make the other suffer by proxy).


Thinking more on this, I honestly can't think of anyone who's worked in the healthcare field who willingly subjects themselves or those they care about to that same industry. Everyone we know shares the same outlook.

[Clemencia53]

I used to say that when I got "older" I would move closer to the major medical center in San Antonio.

But now - nah. I really don't care.

Lots of people around here have to go there for medical care. So many complain about our local hospital that I want to ask them - why don't you move to where you would be deliriously happy with the medical care. But no, they LOVE rural living. Well then - shush it! LOL.

[brightdoglover]

I moved from medical mecca (Boston area) to being 25 miles from one decent community hospital and cancer center. If I had any unusual medical issues at 65, I would have stayed East.

I worry more about being unable to drive or live in my current small house (820 sq.ft.) or other problems of aging. Like the poster who works in healthcare, I am not concerned with longevity but want to live here more than I wanted to be tethered outside of Boston. If for whatever reason that changes, I will likely move to Denver where I can take taxis or whatever to high-level care. That would mean apartment living or CCRC.

[newcomputer]

Your girlfriend is 24 and has major health issues. You can't really compare her situation with the medical issues an older person is likely to face that would require a hip replacement.


I don't want to spend the remainder of my life worrying about whether or not I can get treatment if I develop a health problem. I will deal with that when it happens if I am able. Like others have stated here, I am more interested in quality of life than longevity.


Of course, I am nearly 50 years older than your friend. I love my rural home, which is much more isolated than yours.

[Mr5150]

I know for some, being close to a good hospital is a big factor. Personally I’d rather die in paradise than live In some big city out of fear of some illness that may never come to pass. With that said we never considered availability of top end health care when we moved to the mountains of eastern CA. But as it turns out we have a good regional hospital 25 minutes away in the nearby town of 4600.

In CA we have a three tier system. The regional hospitals found all over rural and small town CA. Then the urban tier found in small cities and finally the top tier level-the best of the best like Stanford, UC San Francisco or UC Davis. We also have helicopter ambulance service. When Mrs5150 had her heart attack 5 years ago she was transferred to a second tier hospital by helicopter. She is fine.

[mlb]

There's rural - and then there's RURAL.

In dead winter in Montana - or Utah where we are now - being 50 miles from an acute care center can be a death sentence.

50 miles in California - not so much.

It is important to choose wisely. We choose California.

[PNW-type-gal]

I think some of it is by area - I live in a much smaller area than that (town of 85,000, surrounding metro area of 200,000 and we are 5-6 hours from any actual "large" city) and I can think of several people that I know who have had hip replacements/knee replacements done locally in the last couple years.

We have a Level 2 trauma center hospital but Level 1 cases (which are pretty unusual) are flown by Life Flight up to Portland, 300 miles away.

I have several friends who go to rheumatologists and neurologists and when I goggle it there are 4 rheumatology clinics with 10 doctors locally. Of course, we have a higher-than-average retiree population.