News from rural America.

A dialysis unit has closed in rural Nebraska due to lower Medicare reimbursement rates, "deaths of despair" are slowly declining nationwide but still more common in Appalachia and a South Dakota rancher plants native grasses to fight drought.

TRANSCRIPT

For the Daily Yonder and Public News Service, this is the news from rural America.

Lower Medicare reimbursement rates have shuttered a life-saving dialysis unit in western Nebraska, part of the long decline in health services for rural America.

KFF Health News reporter Ariel Zients says the non-profit Shadron Hospital wrestled with the decision because they knew it was critical care.

Rural areas have higher rates than urban areas of some of the conditions that can cause end-stage kidney disease, like diabetes and high blood pressure.

Nebraska received more than $200 million from the Federal Rural Health Transformation Program.

But that doesn't keep existing services afloat.

Instead, focusing on new technologies and programs.

That's hard for the few patients getting dialysis at Chadron.

All but one of the patients were on Medicare, and Medicare did not reimburse what it actually costs for them to offer this service.

She says one patient is even renting a second home to be closer to treatment.

The rate of deaths of despair is slowly declining, but a new report shows they're still more prevalent in Appalachia than the rest of the country.

Co-author Michael Mead is with East Tennessee State University. overdose, alcoholic liver disease, and suicide.

But the big driver of that is overdose mortality.

Mead says such a death rose across the country during the pandemic, likely due to isolation, disruptions in care, and peer support.

The nationwide rate has since fallen about 5 percent near pre-pandemic levels.

But Mead notes that Appalachia's higher prevalence remains poorly understood.

I think there are a lot of complexities to it, and I don't know if we know all the answers.

But when we see a big change in overdose mortality, that's going to drive all of the deaths of despair.

When the study started a decade ago, deaths from overdose, alcohol and suicide in Appalachia were 44 percent higher than the national average.

Eastern South Dakota is prone to drought, which is one reason cattle rancher Dawn Butzer restored part of her ranch to native grassland.

Last spring, Butzer planted a mix of cool, warm season grasses and native flowers on her ranch near Alcester.

She says she loves the results, in part because native grasses like Big Bluestem can have roots five feet deep, which makes them less thirsty.

Those roots do go pretty deep so that when we do get a rain, that rain can shoot right down into the ground.

Butzer will hold a field day next month to share what she's learned with other ranchers.

By next June, she hopes to turn her cattle loose to graze in the pasture.

I'll probably pop a bottle of champagne when we turn those cattle out.

Because we've talked about it for so long.

For the Daily Yonder and Public News Service, I'm Roz Brown.

For more rural stories, visit dailyyonder.com.