A friend my age closed on ten acres in April, two counties inland. Half the property tax. A porch he keeps sending me pictures of.
Then he mentioned the drive to the nearest hospital. Forty minutes, door to door. He is sixty-eight and he makes it fine.
He will not make it forever.
That line is missing from almost every retirement spreadsheet I have ever been shown. The house gets priced on a thirty-year horizon. The keys get about eleven.
If you are shopping counties right now, put the drive next to the taxes. Same column. It is the same kind of cost.
The distance itself is old news to anyone who has already made the drive. Rural America sits an average of 10.5 miles from the nearest hospital. In the cities that same average is 4.4.
What moved is the supply side of it. Since 2005, 197 rural hospitals have closed outright or stopped taking inpatients altogether. Every one of those adds miles to a drive somebody was already making.
34 minutes
Average trip to the nearest hospital for the quarter of rural Americans who live farthest from one
10 minutes
The same trip for the average city household
Both numbers assume a driver. Take the driver out and the top one stops being a trip. It becomes a favor you have to ask for.
The usual fix is a ride from somebody else. A daughter on a Saturday morning, a neighbor with a pickup, a church van that runs Tuesdays and Thursdays.
Every one of those rides runs on a calendar that belongs to somebody else. That is the part that wears a person down. It is also why the appointment gets skipped.
Where the cohort’s money sits this quarter, read through the drive it takes.
Follow the driver instead of the patient and the money lands somewhere unglamorous. A light-industrial strip, two exits off the highway, past the tire place.
The shop there fits hand controls and a swivel seat that turns out to meet you. Lifts in the back of a van. The work is certified, and the certified installers are thin on the ground.
What that shop is actually selling is years. Two or three more of them behind your own wheel, in a county you already picked.
Demand is the easy part of a business like that. The hard part is how many of those families can write the check this year.
A full conversion often costs more than the van it is bolted into. Most of that comes straight out of the household. The ceiling is real, and it caps this whole read.
The arithmetic
Distance and travel time to the nearest hospital, including the 34-minute figure for the farthest quarter of rural households: Pew Research Center analysis, December 2018, built from the addresses of a nationally representative sample of more than 10,000 American adults. Rural hospital closures and conversions since January 2005: Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, closure database. Years lived beyond the ability to drive for men and women aged 70 to 74: Foley and colleagues, American Journal of Public Health, 2002, still the figure cited in current work. The forty-minute drive in the opening is one household’s, not a national average.
My friend is fine at sixty-eight, and the porch was the right call for a man who still drives. Watch what he does at seventy-six. The house will not move. Neither will the hospital. He is the one who has to. Same time Monday, one aisle further along.
Andrew
Boomers Trade is written by someone getting older right alongside you, and watching who profits from it.
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