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The West’s widening health care gaps

Changing demographics, including an aging rural population, put more pressure on health care systems.


Last year, Peggy Clements slipped on the wood floor of her home and broke her leg. Alone at the time, she waited in agony until her daughter came home and drove her to the hospital, nearly an hour away through rural Delta County, in western Colorado. Clements, who turned 102 last March, was comparatively lucky: Had she suffered a heart attack or a stroke, the delay could have been fatal. When the local medical clinic closes down at the end of August in Paonia, where Clements lives and where High Country News is based, that kind of risk will be even higher.

Peggy Clements, 102, is led out of her house by senior community van driver Al Early. Each Tuesday and Thursday, Clements does activities with other seniors through the Program of All-Inclusive Care for the Elderly, which also has a nurse check on her every morning. Both help address her loneliness, which she says is the hardest part about getting older.

For Clements and a growing population of the most vulnerable — the elderly, disabled and uninsured — access to health care is becoming an increasingly urgent issue. The West’s rural areas, as data from the American Medical Association and U.S. Census Bureau show, are simultaneously experiencing a higher demand for services and a decrease in the number of doctors and others qualified to provide those services.

Delta County exemplifies the problem. Since 2010, the number of residents 65 years and older here has jumped 19 percent, yet the patient-to-doctor ratio is more than 1,300 to one.

In the most extreme examples, some Western counties have seen their elderly populations increase by nearly 60 percent. According to census projections, by 2030, more than 31 million Americans will be older than 75, the largest such population in the country’s history. Nearly 17 million of them will live in the West, comprising 22 percent of the region’s projected population.

The number of doctors, meanwhile, is not keeping pace, data from the American Medical Association and U.S. Department of Health and Human Services show. Torrance County, New Mexico, for example, has a patient-to-doctor ratio of more than 15,000 to one. That’s more than four times the threshold for consideration as a “health professional shortage area.”

People who live far from health care are most vulnerable during emergencies, such as heart attacks, severe lacerations, strokes or asthma attacks. Without a nearby clinic, the delays in response become a serious problem. In Paonia, the ambulance services are run by volunteers, and the average response time is 15 minutes. Come September, the nearest clinic will be another 15 minutes away, in a neighboring town, with the nearest hospital about 30 miles from that. “That is a very long time to wait if you’re badly hurt,” says Jean Ceriani, a member of the Delta County Memorial Hospital board. “Someone could die.”

As Clements gets older, her daughter, Karen Budinger, worries about her safety. “Right now, my mom has me to drive her, but what if something happened to me?” Budinger, who is 77, asks. In the moment of quiet that follows, Clements catches her daughter’s gaze. “I don’t know what I would do,” she says.