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All over the Retirement forum too. Top notch medical care, a hour or less to a major airport, no more than 5 miles to supermarkets or big box stores, walkability to nearby cafes and bookstores, lots of public transportation, extra high speed internet, world class cultural events, a major university, etc. are commonly listed as very important to retirement. Even those retirees in their late 50's and early 60's don't want to drive any distance and are concerned about developing a life threatening health condition.
Those were all part of my metrics. You have to balance housing costs against all those amenities and I didn't accrue the wealth to afford housing in an elite major metro professional bedroom town or semi-urban mixed use space. I picked a location I could afford.
In theory, I'm an hour from a major airport but that's at 2am. Ditto top-10 in the world medical care and world class cultural events. I have an Ivy with a medical school, Level 1 trauma center, and good regional airport 30 to 40 minutes. I have to walk 1/2 mile to get to the bus stop at the library. A cafe is a bit closer. The big box stores are more like 10 to 15 minutes because of all the "Mall Hell" stop lights. The state university in the town is definitely not "major".
An awful lot of people are picking low cost rural places with limited services because it's all they can afford. We all have our own retirement personal finance math. I picked what was possible for me. With 10x the net worth, I would have picked something different.
Does Medicare pay for Medi-flight or is there a special rider that people in more rural areas get? If you need specialty care some five hours' drive away, are you on your own?
My contract with a private company gives me emergency air service for, as I said above, fifty dollars per year. I know that at least one hospital in Billings offers it as well. I'm sure that some of the city people here who are obsessed with the subject can tell you more. My physician recommended it to me. It's simply not a topic of much interest where I live.
That can certainly be the case. The 5 hours trip is exactly what happened to me on one occasion. I was in Bandon Beach when I started to have a retinal detachment. It got bad really quickly. My wife and I got some help. A paramedic actually drove our camper an hour to the nearest town with a hospital. That did virtually no good. There was nothing they could do for me. There was a local ophthalmologist but he was either not interested or not available. We "camped" in the hospital parking lot until morning. By then I was 90% blind in the one eye. The ophthalmologist was not able to help..no suitable surgical experience, no suitable facility, no suitable staff. My wife had to pull herself together and drive the RV across mountain roads for 5 plus hours to Portland. I had surgery that night but the treatment issues continued for weeks and weeks. Had we lived in Bandon, we would have needed to move to Portland for the recovery period. After the initial period, we would have had to go back and forth numerous times over a 3 month period.
Years later my wife had a similar experience. She had an attack of diverticulitis. In case you are not familiar that disease can require immediate treatment with antibiotics. She got extremely sick within hours of the onset and was in the hospital for 10 days. Surgical intervention was under consideration the whole time. We were living at home and near a hospital when that happened. A year later we were traveling in southern Utah when she experienced symptoms. We were able to wait for the next day and get oral antibiotics. We then had to drive 4 hours to Salt Lake City in case her condition worsened. At that point she gave up and flew back to the east coast to have her situation monitored.
This past year my sister had a major issue. She lives in a small city with 2 large hospitals. Unfortunately she had a massive aortic aneurysm that required 2 major surgeries. The specialists and appropriate facilities were hours away on the other side of the State. Her husband died the year before so she was largely on her own. She had family and friends come in from out of State to help but her medical issues and went on for months and months. She also had 2 dogs to arrange care for.
I could go on with more similar stories, but I think the point is clear. The time is takes to get to a hospital for handling a crisis, such as a heart attack, can mean the difference between dying and surviving with a full recovery. BUT that is only one consideration. Trying to deal with medical issues that require prolonged treatment and/or recovery can be extremely difficult when the medical facility is hours from your house.
The consideration is not as simple as thinking I want to live in a rural area and accept the risk that an emergency might occur and I might die. As we age it becomes extremely likely that we will need hospitalization or another form of sophisticated medical care. The care could involve multiple trips and extended recovery times.
Spot on, and back to my point, I don't want to be THAT guy or gal ... meaning, it's not about me ... I worry about what OTHERS may have to go through if something happens to me and I am living in the backcountry or even at a wide spot in the road. I sure hope all the proud mountain men and women on here saying "I dunna wanna be no city slicker" are 100% self sufficient in all respects, and no unfortunate relatives, friends or other schlubs will have to go through sheer h_ll dealing with the impacts of a the proud one's health issues.
Spot on, and back to my point, I don't want to be THAT guy or gal ... meaning, it's not about me ... I worry about what OTHERS may have to go through if something happens to me and I am living in the backcountry or even at a wide spot in the road. I sure hope all the proud mountain men and women on here saying "I dunna wanna be no city slicker" are 100% self sufficient in all respects, and no unfortunate relatives, friends or other schlubs will have to go through sheer h_ll dealing with the impacts of a the proud one's health issues.
Let's flip that around.
Suppose someone does live in or very near a large metro area with world class healthcare and mass transit or uber drivers to take them there. Who gets them from their apartment/condo/townhouse to the uber ride or mass transit when undergoing treatment and then to their destination?
Are all the city dwellers self sufficient in all respects and won't use suburban/rural relatives/friends that avoid cities like the plague but will be obligated to navigate a large metro area to help out their relative/friend?
I wouldn't count on it being other city-dwelling retirees/friends fully immersed in their own persuit of world class concerts, museums and classes and of course their own appointments involving close by healthcare. They'll be too busy.
Spot on, and back to my point, I don't want to be THAT guy or gal ... meaning, it's not about me ... I worry about what OTHERS may have to go through if something happens to me and I am living in the backcountry or even at a wide spot in the road. I sure hope all the proud mountain men and women on here saying "I dunna wanna be no city slicker" are 100% self sufficient in all respects, and no unfortunate relatives, friends or other schlubs will have to go through sheer h_ll dealing with the impacts of a the proud one's health issues.
FYI, there's a huge difference between living in the "backcountry" and being "mountain men or women" and living in a relatively small town about an hour away from a large city, LOL. I don't recall anyone saying "I dunna wanna be no city slicker" either in that sort of demeaning redneck way.
Is anyone forcing you or telling you to move to a small town? Why the hostility towards people that have a different view point?
Suppose someone does live in or very near a large metro area with world class healthcare and mass transit or uber drivers to take them there. Who gets them from their apartment/condo/townhouse to the uber ride or mass transit when undergoing treatment and then to their destination?
Are all the city dwellers self sufficient in all respects and won't use suburban/rural relatives/friends that avoid cities like the plague but will be obligated to navigate a large metro area to help out their relative/friend?
I wouldn't count on it being other city-dwelling retirees/friends fully immersed in their own persuit of world class concerts, museums and classes and of course their own appointments involving close by healthcare. They'll be too busy.
Pride goeth before a fall in all locations.
Several of my elderly widowed tenants have Kaiser...
Not sure how it all works but medication is delivered to the door, kaiser shuttle for appointments and there is a Kaiser facility in just about any direction...
FYI, there's a huge difference between living in the "backcountry" and being "mountain men or women" and living in a relatively small town about an hour away from a large city, LOL. I don't recall anyone saying "I dunna wanna be no city slicker" either in that sort of demeaning redneck way.
Is anyone forcing you or telling you to move to a small town? Why the hostility towards people that have a different view point?
Did I hit a raw spot?
In any case ...
Point being, even if I decide to trade off access to medical services for the essence of Thoreau, and that decision has a given impact on my own situation which I accept, unless I can make my situation one that does not require any assistance from relatives, friends, etc, my decision will impact others.
If those others don't live in my neck of the woods, or even if they do, the multi hour trips to services, camping in hospital parking lots, arranging choppers to cart me off to the real hospital, etc, etc ... those poor saps will be hating life.
Are all the city dwellers self sufficient in all respects and won't use suburban/rural relatives/friends that avoid cities like the plague but will be obligated to navigate a large metro area to help out their relative/friend?
I wouldn't count on it being other city-dwelling retirees/friends fully immersed in their own persuit of world class concerts, museums and classes and of course their own appointments involving close by healthcare. They'll be too busy.
Pride goeth before a fall in all locations.
That is the truth. People in rural areas are far more willing to give someone a ride to the doctor/hospital than in suburban areas from my experience.
The trend of rural/small town hospitals closing or consolidating with larger entities predates ACA by decades.
The way the hospitals are set up in this state is they tend to specialize. A small town will have a smaller but functional hospital. If patients need special care, say they have heart problems, they are air evaced to Tulsa where that hospital specialized in heart problems. General care is available at all. But as the state is constantly in a state of desperation for funding, this way they don't duplicated specialties. The reality is in a generally low income state, money is more scarce and while costs are less, there are less resources. I did think about this, but simply couldn't afford California. I paid my rent and got groceries and was pretty much done. I don't have a huge amount more here, and am careful how I spend it, but its still a much better situation.
And when you live where the expensive stores and restraunts are all around you and you can't afford them, its just keeps resending the message. I find it much easier to live in an area where more people have a low income, and its regarded as how it can be. If I hadn't gotten ill after high school, I'm sure I would have had much more to play with, and my early computer tech job just been the start, and my health hadn't been a shadow to drag along. It would be nice, but it wasn't and while they aren't things you can buy with money, I have found good things to embrase too. I would say that despite some really bad times, and mostly not a lot of money, I've found ways to enjoy it.
And there comes a time when the very best thing you can do is quit feeling sorry for yourself or wish things had been different, and embrase what you HAVE, over worrying about what you don't. It's something that's in all of us, if we allow it to develop. I've been told I'm a survivor, and have to agree that is often how I see things.
I would rather see fewer hospitals with more specialization, and more available community care and access to services which are specialized but don't require a hospital. For less plush states and for richer ones, this is an excellent model.
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