It’s one of the many parts of the 25-bed rural hospital that need updating, former CEO Ron Wiens said.

He said the hospital, an essential service in its namesake town of nearly 800 residents in the state’s sprawling north-central high plains, needs at least $1 million for deferred maintenance, including a failing HVAC system. But the facility has struggled to make payroll each month and can’t afford to make all the fixes, Wiens said.

Built by farmers and ranchers in 1965, Big Sandy Medical Center began with nine beds. Today, a similar community effort — donations and grants to plug financial holes each year — keeps it afloat.

Wiens, who recently left his position at the hospital, said he wishes Big Sandy could get funding from Montana’s share of the $50 billion federal Rural Health Transformation Program to renovate the hospital and direct payments to help secure its future. The state received more than $233 million in its first-year award.

But the hospital may not get the kind of help he sought.

That’s because the five-year program focuses on new, creative ways to improve access to rural health care, not on directly funding services and renovations. And Montana is one of at least 10 states whose leaders say projects launched under the federal program could lead rural hospitals to cut services so they can continue to afford to offer emergency and other essential care.

Congressional Republicans created the fund as a last-minute sweetener to their One Big Beautiful Bill Act, signed into law last summer. The funding was intended to offset disproportionate fallout anticipated in rural communities from the law, which is expected to slash Medicaid spending .

includes programs to make it easier for rural residents to get medical care and live a healthy lifestyle. For example, it says funding can be used to start community gardens, train paramedics to make home visits, open school-based clinics, or bring mobile clinics to rural areas.

rural Montana hospitals can receive payments for implementing recommendations, “including right-sizing select inpatient services” to match demand. In some cases, it says, right-sizing might mean “downsizing.” The state says hospitals will have input and recommendations will be specific to each facility.

“That’s what has all the hospitals on pins and needles, words like restructuring, reducing inpatient beds. Everybody is going, ‘What is this going to look like?’” Wiens said.

The Montana Department of Public Health and Human Services declined to answer questions about how it will carry out its right-sizing efforts.

A Lifeline of Care

Big Sandy cattle rancher Shane Chauvet doesn’t want any services cut.

He credits Big Sandy Medical Center with saving his life after a flying piece of metal nearly cut off his arm during a windstorm a few years back.

“I looked over, saw it coming, and whack!” Chauvet recalled.

His wife drove him to the hospital, where they frantically pounded on the ER door while Chauvet’s blood pooled on the ground.

Because of the storm, staffers worked on Chauvet with no power and no ability to summon a helicopter. He was then taken by ambulance 80 miles through intense rain and hail to a larger hospital.

Chauvet understands the state’s plan doesn’t call for eliminating emergency care, but he worries that reducing other services would set off a downward spiral for the hospital and his town.

In Oklahoma, realigning clinical services could mean “shutting down service lines,” to the federal program. And in Wyoming, any facility that receives funding must agree to “reduce unprofitable, duplicative or nonessential service lines,” .

Monique McBride, business operations administrator at the Wyoming Department of Health, said the department interprets right-sizing as helping rural hospitals provide essential services — such as emergency departments, ambulance services, and labor and delivery units — while maintaining long-term, financial stability.

“This might involve limiting some elective procedures that could be done at lower cost in higher-volume facilities. The main distinction here is time-sensitive emergencies vs. ‘shoppable’ services,” she said.

A New Lease on Life?

Seven of the 10 states — Nebraska, North Dakota, Tennessee, Kansas, Nevada, South Carolina, and Washington — where rural hospital service cuts are on the table say they’ll help pay for hospitals to convert to Rural Emergency Hospitals. The recently created federal designation requires hospitals to halt inpatient services and offers enhanced payments to help them maintain emergency and outpatient care.

At least 15 additional states wrote that they’ll use the federal funding to right-size, evaluate, or adjust services — which could mean adding or taking away services, or transitioning them to a telehealth or outpatient setting.

Brock Slabach, chief operations officer of the National Rural Health Association, said, “There’s a proper concern from rural hospital administrators that this funding is not going to where it was intended.”

He said cutting services that lose money could backfire in the long run. For example, he said, halting labor and delivery care might drive more people out of small towns, further reducing hospitals’ patient numbers and revenue.

The type of hospital services that states will assess matters, said Tony Shih, a senior adviser at the Commonwealth Fund, a nonprofit focused on making health care more equitable.

“If the end result is that high-margin services are taken away from local hospitals with nothing given back in return, it can be financially harmful,” he said.

Shih noted that states’ plans to add more outpatient care could prove beneficial for patients. It’ll take time to know which states help stabilize rural hospitals, he said.

Rural hospital leaders say they know which changes would keep their facilities open and that states shouldn’t suggest or mandate service cuts and other changes on their behalf.

Josh Hannes, who oversees rural health policy at the Colorado Hospital Association, said “top-down” directives won’t work.

He said the association’s members believe they can find efficiencies and are eager to collaborate. But “a state agency shouldn’t be making those determinations,” he said.

Hannes said members are worried Colorado’s plan to classify rural health facilities as a “hub, spoke, or telehealth node” will compel service reductions. The classification will help determine “which services are sustainable locally and which are best provided regionally or through telehealth,” .

Spokespeople for the Colorado and Oklahoma health departments said no facility will be forced to end services. But Oklahoma spokesperson Rachel Klein said some facilities might choose to do so as part of a broader effort to make sure they’re meeting community needs while remaining financially stable.

“A hospital might shift certain services to a nearby regional provider with higher patient volume and specialized staff while expanding other local services,” such as primary, outpatient, or community-based care, she said.

Wiens and Darrell Messersmith, CEO of Dahl Memorial Hospital in the southeastern Montana town of Ekalaka, said they worry the only way hospitals will get their share of funding is to cut services or become Rural Emergency Hospitals that don’t offer inpatient services.

“I would hate to see things shift toward a pack-and-ship facility,” Messersmith said. “Right now, we function quite well as an inpatient facility.”

Not all Montana health leaders are worried.

Ed Buttrey, president and CEO of the Montana Hospital Association, said he thinks his state’s plan could help rural hospitals become financially sustainable and survive Medicaid cuts. Buttrey is also a Republican state lawmaker.

Chauvet, the Big Sandy rancher, said his perspective on whether remote towns like his should have a hospital is forever changed because of his accident.

“I always would say, ‘Oh, they’re nice to have,’ but now I look at the hospital and say, ‘That’s essential to our community,’” he said.

Â鶹ŮÓÅ Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at Â鶹ŮÓÅ—an independent source of health policy research, polling, and journalism. Learn more about .

USE OUR CONTENT

This story can be republished for free (details).

The city’s mobile crisis team had just gotten a call about a man walking around outside without shoes. The man’s family told the team he was having a mental health crisis and wouldn’t come inside.

As they drove down the highway toward the city’s outskirts, team member Evan Thiessen spoke with the relative who had reached out.

“You’re doing the right thing, and we’re going to make sure he gets help today, OK?” he said.

They pulled up the man’s police record on a laptop and saw that he did have a record of some previous encounters with police, including some that had turned violent.

, a licensed therapist, had that in mind as they pulled into a neighborhood of single-family homes. He stepped out of the Ford Bronco and headed toward the front door.

A Funding Problem

Many communities around the country send out teams like this one to help people in psychiatric crisis, rather than dispatching regular police.

A found there were at least 1,800 mobile teams nationwide in 2023. But financial support for them is often inadequate and inconsistent, leaving many communities struggling to keep the teams operating.

Two programs — one in Great Falls, in central Montana, and one in Billings, in south-central Montana — recently shut down. Six units remain in Montana.

The strategy in Eugene, Oregon, but gained momentum nationally over the past 10 years.

Recent about police killing people who are experiencing a psychiatric crisis have sparked conversations about how to safely and effectively respond. Most police officers are not trained to deal with people experiencing delusions or hallucinations, nor to de-escalate situations involving threatening behaviors to themselves or others.

An across 27 states found that about a third of the victims showed signs of being in crisis. Another study found that people with a serious mental illness were at least to experience use of force by police as those without.

By contrast, crisis response teams have been trained to de-escalate such situations and provide appropriate therapeutic care.

When the team arrived at the house in Bozeman, the man had already gone back inside. The team then talked with the man’s family for about half an hour and helped them devise a plan to keep him at home — and safe. Before they left, team members determined the man wasn’t a threat to himself or others.

Also, they planned to follow up within a few days to connect him with ongoing mental health care. After an encounter with the team, some clients might need follow-up therapy, assistance with psychiatric medications, or help finding treatment for substance abuse.

The Bozeman team is available 12 hours a day, seven days a week, and costs roughly $1 million a year to run.

Police departments are generally funded by local taxpayers. Mobile crisis teams don’t have a single, reliable source of funding.

Some, despite successful operations and , are or have closed entirely. One that shuttered was Oregon’s .

Most crisis calls end with people staying where they are, avoiding a trip to the emergency room or going to jail, according to , which runs the mobile crisis program in Bozeman.

Beyond police and firefighters, members of the public can call the team directly.

“I’ve been out on calls where individuals have barricaded themselves in residences or in their vehicles with a firearm. So, helping to assist not only law enforcement, the negotiators, but consulting on the behavioral health side of that,” said Ryan Mattson, who leads the Bozeman crisis team.

The program has reduced the time that Bozeman police officers must spend on mental health calls by nearly 80%, according to Mattson, and prevented unnecessary ER visits.

Residents and political leaders see that value, he said, but finding a way to pay for the service has been difficult.

“I’m confident we’ll be here through next fiscal year. That’s about as confident as I am at this point,” Mattson said.

Mobile crisis programs in Montana, which began operating about five years ago, have cost more than the state originally projected.

Health insurance is sometimes a revenue source for mobile crisis teams. That’s because a crisis call is a type of mental health service, provided by trained professionals such as therapists or crisis intervention specialists. Still, many private insurance companies don’t reimburse for mobile crisis services.

What Medicaid Pays For — And Doesn’t

Medicaid, the government-funded insurance program for low-income and disabled Americans, is another funding source. Two-thirds of states allow Medicaid reimbursement for such calls, but rates vary.

In Montana, Medicaid reimburses the team only for the time they spend responding to a call in the field. Additional time spent on a case — documenting the encounters, or waiting for the next call — isn’t reimbursed.

“You need to pay for the capacity to be at the ready, just like we do with fire or police, regardless of whether somebody is going to be called out,” said of Inseparable, a nonprofit that advocates for mental health policy reform.

It’s not feasible for mobile crisis teams to rely solely on reimbursement from insurance companies, she said.

To deal with the shortfalls, many mobile teams rely on a patchwork of grants and other funding, according to , who studies Medicaid policy at Â鶹ŮÓÅ, a health information nonprofit that includes Â鶹ŮÓÅ Health News.

Some state governments have stepped in to help.

Eight states, including New Jersey, California, and Washington, mandate that private insurers cover the cost of mobile crisis calls for people on their plans, according to Kimball. At least 10 states have implemented fees on cellphone bills to help pay for service.

Montana hasn’t followed suit.

The state provides about $2 million annually in supplemental funds to help the mobile teams pay for service calls that aren’t reimbursed through Medicaid, according to an emailed statement from Jon Ebelt, a state health department spokesperson.

But program managers counter that the paperwork to access that funding is complicated and often isn’t worth the staff time.

Will Montana Step In?

Despite this state support, mobile teams are still struggling to stay afloat, Ebelt acknowledged. He said Montana officials are considering boosting what Medicaid reimburses for each service call.

In Missoula, the mobile crisis team turned to local taxpayers for additional help. Their annual expenditure is $1.4 million, but Medicaid reimbursements were covering only about 20% of the cost, according to program manager John LaRocque. Even with local tax dollars, the program faces a $250,000 shortfall, so LaRocque is looking for grants.

Mobile crisis is still a relatively new concept, and growing pains are to be expected, said Sierra Riesberg, director of the .

Still, abrupt closures create instability and lead some patients to the ER, placing financial pressure on another distressed part of the local health system.

“A much-needed service is available and then not available, available and then not available. These things need to be taken into consideration when developing programs in communities,” she said.

If more mobile crisis teams shut down, that might interfere with Montana’s recent efforts to overhaul an outdated and underfunded mental health system. The state’s only psychiatric hospital hasn’t kept up with the to the facility.

Later this year, Montana hopes to join a federal pilot program to open a new type of clinic: , or CCBHCs. Those clinics will receive boosted levels of federal funding, but they are required to offer round-the-clock mobile crisis services as well as other crisis care.

That could be a tall order for rural communities, said , an executive at in Great Falls.

Alluvion used to operate the mobile crisis team in Great Falls before it shuttered the service. One major reason it closed was that the expected Medicaid payments covered less than anticipated. Before Alluvion would consider getting involved again, the state would need to “completely revamp” the way the service is funded, Schreiner said.

“Is it a priority for our state or not?” he asked.

This article is from a partnership with and .

Â鶹ŮÓÅ Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at Â鶹ŮÓÅ—an independent source of health policy research, polling, and journalism. Learn more about .

USE OUR CONTENT

This story can be republished for free (details).

Los residentes comparten habitaciones diseñadas para personas con problemas de movilidad. También hay baños privados, algo muy importante para aquellos que lidian con la incontinencia.

A diferencia del MVP, la mayoría de los refugios para personas sin hogar no están preparados para ayudar a adultos mayores, especialmente a quienes tienen 65 años o más. Se trata del grupo que más rápido está creciendo dentro de la población sin hogar en Estados Unidos, explicó , investigador de la Universidad de Pennsylvania.

No solo están envejeciendo quienes han vivido por años en situación de desamparo, sino que muchas personas mayores están perdiendo su vivienda por primera vez en sus vidas.

Subir y bajar de literas, tomar los medicamentos correctamente y llegar a tiempo a un baño compartido son algunos de los principales retos que enfrentan estas personas en los refugios. En algunos tradicionales, el personal les pide que se vayan si no pueden cuidarse por sí mismas.

MVP es un refugio inusual porque ofrece atención médica en el mismo lugar para poder atender mejor a sus residentes a medida que envejecen.

La primavera pasada, Jamie Mangum, de poco más de 50 años y con cáncer de pulmón, tropezó y se cayó en su habitación. Para ver a una técnica en emergencias médicas, solo tuvo que bajar la escalera. Le vendaron rápidamente la muñeca inflamada y pudo regresar a su cuarto. Dijo que eso no habría sido posible en otros refugios donde ha estado.

“En otros lados, tendría que esperar horas. Aquí solo entro y me atienden”, dijo Mangum.

Agregó que en otros refugios probablemente habría tenido que buscar por su cuenta una clínica de urgencias o pedir una ambulancia. En MVP, además, trabajadoras sociales especializadas la han ayudado a recibir tratamiento para el cáncer.

“Tenemos clientes que necesitan cuidados de memoria. Tal vez antes vivían de manera independiente, pero ya no pueden y fueron desalojados debido a la demencia u otras razones”, explicó Baleigh Dellos, quien administra el refugio MVP para , una organización local sin fines de lucro.

En el refugio trabajan gestores de casos médicos especializados. También hay doctores de atención primaria y terapeutas que visitan semanalmente. Los residentes incluso pueden recibir fisioterapia en espacios privados dentro del mismo refugio.

Un camino hacia la estabilidad

MVP se asoció con para ofrecer atención médica.

Lo primero que la mayoría de las personas nuevas necesitan es ayuda con sus medicamentos, explicó Matt Haroldsen, de Fourth Street Clinic, que brinda servicios de salud dentro del refugio.

Para quienes viven en la calle, simplemente conservar sus medicamentos ya es un gran desafío. “Cuando están en los campamentos, les roban las medicinas”, dijo.

Las personas con diabetes que no tienen vivienda muchas veces entierran su insulina para mantenerla fría. Según Haroldsen, pueden olvidar dónde la enterraron o las ampollas se pueden calentar demasiado y echarse a perder.

Ayudar a las personas del refugio a recuperar sus medicamentos permite estabilizar sus afecciones de salud, lo que a su vez les permite concentrarse en otras prioridades, como obtener una identificación u otros documentos necesarios para solicitar discapacidad, Seguro Social y diversos programas que pueden ayudarlas a conseguir vivienda.

Gobiernos locales y organizaciones sin fines de lucro han abierto refugios similares en Florida, California y Arizona para responder a las necesidades de adultos mayores sin hogar.

Tener acceso a refugios especializados puede significar la diferencia entre la vida y la muerte, señaló , subdirectora del National Health Care for the Homeless Council.

En estados con climas fríos, negar una cama a personas mayores debido a problemas de movilidad u otras condiciones médicas puede ser especialmente riesgoso. En 2022, un hombre mayor sin hogar , Montana, después de que lo sacaran de un refugio por incontinencia.

Las necesidades médicas complejas también pueden representar un riesgo para otras personas en los refugios, quienes muchas veces no están preparados para manejar esas situaciones.

“Un refugio típico no permite que alguien entre con oxígeno porque representa un riesgo de incendio”, explicó.

Synovec dijo que brindar acceso a la atención médica dentro de los refugios es la mejor forma de ayudar a las personas mayores a mantenerse estables una vez que logren obtener una vivienda. Según explicó, los problemas de salud son una causa común por la que muchas personas mayores no pueden pagar o mantener una vivienda.

Modelo en expansión

El modelo MVP está mostrando resultados prometedores, tanto en Utah como en otros lugares.

“Más del 80% de las personas que pasaron por nuestro programa el año pasado lograron mudarse a una vivienda estable o permanente”, dijo , vicepresidente de programas del Task Force for Ending Homelessness en Fort Lauderdale, Florida. Esta organización sin fines de lucro administra un refugio llamado .

El refugio MVP, ubicado cerca de Salt Lake City, también ha tenido éxito. Hasta finales del año pasado, había logrado ubicar de forma permanente a 36 personas mayores.

Sin embargo, hay más personas que necesitan refugio de las que el lugar puede recibir. Dellos, la encargada del lugar, dijo que la lista de espera del MVP se mantiene en unas 200 personas. Agregó que se prioriza a quienes tienen más necesidad médica, no por el tiempo que llevan esperando.

Para quienes logran obtener una habitación, la experiencia puede cambiarles la vida.

La primavera pasada, Jeff Gregg, de 62 años, jugaba a lanzar la pelota con su perro Ruffy, justo más allá del jardín frente al refugio MVP.

Una antigua lesión en la espalda lo obliga a encorvarse al lanzar la pelota. También lo llevó a una adicción a los opioides que duró décadas. Dijo que romper ese ciclo fue muy difícil.

“Luchando con eso, teniendo un trabajo, seguro médico, luego perdiendo el trabajo, sin seguro, terminando en la calle y otra vez en ese infierno. Y volvía al mismo lugar”, contó.

Gregg dijo que mantenerse sobrio pasaba a segundo plano frente a necesidades más urgentes como encontrar comida o una cama donde dormir. Afirmó que el MVP fue el primer lugar donde pudo relajarse y concentrarse en su recuperación.

“Pude dejar las drogas. Me tomó un par de meses, pero fui avanzando poco a poco”, contó.

Dijo que esa experiencia le abrió el camino para operarse de la espalda. Espera que, con menos dolor, eventualmente pueda conseguir un trabajo y pagar un apartamento.

Este artículo es parte de una colaboración con  Ìý²âÌý.

Â鶹ŮÓÅ Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at Â鶹ŮÓÅ—an independent source of health policy research, polling, and journalism. Learn more about .

USE OUR CONTENT

This story can be republished for free (details).

Residents share rooms designed to be accessible to those with mobility issues. There are also private bathrooms, which are a big deal for seniors struggling with incontinence.

Unlike the MVP, most homeless shelters aren’t equipped to help seniors, especially those 65 and older. They are the fastest-growing homeless population nationwide, according to , a researcher at the University of Pennsylvania. Not only are people who struggle with chronic homelessness aging, but many seniors are becoming homeless for the first time in their lives.

Getting in and out of bunks, managing medications, and making it to a shared bathroom in time are among the major challenges of shelter life for older adults. Staff at traditional shelters sometimes ask seniors to leave if they’re unable to care for themselves.

The MVP is unusual among shelters because it provides on-site medical care to better serve its residents as they age.

Last spring, Jamie Mangum, who is in her 50s and has lung cancer, tripped and fell in her room. To visit with an emergency medical technician, she needed only to make it downstairs. Her swollen wrist was quickly wrapped, and she returned to her room. She said that wouldn’t have been possible at other shelters she’s stayed in.

“There, I’d have to wait hours as opposed to come in here, be seen,” Mangum said.

Mangum said that in other shelters she’d likely have had to find her own way to an urgent care office or get an ambulance ride. Specialized case managers at the MVP have helped her get treatment for lung cancer as well.

“We have clients that need memory care. Maybe they were living independently before, but they were unable to maintain that and got evicted due to dementia or different things like that,” said Baleigh Dellos, who manages the MVP shelter for , a local nonprofit.

Specialized medical case managers work at the shelter. Primary care doctors and therapists visit weekly. Residents can even receive physical therapy in private spaces on-site.

A Path to Stability

The MVP partnered with the to offer medical care.

The first thing most new residents need help with is medication, said Matt Haroldsen with the Fourth Street Clinic, which provides health services at the shelter.

For people living on the streets, just keeping hold of regular medications is a challenge. “Their medications get jacked when they’re in their camps,” he said.

Diabetes patients without homes often bury their insulin to keep it cold. Haroldsen said they might forget where they buried it, or the vials might get too warm and spoil.

Helping residents at the shelter get those medications can stabilize their conditions, allowing them to focus on other priorities, such as getting an ID and other documents they need to apply for disability, Social Security, and various programs that can help them secure housing.

Nonprofits and local governments have opened similar shelters in Florida, California, and Arizona to meet the needs of older unhoused adults.

Having access to specialized shelters can be the difference between life and death, said , assistant director of the National Health Care for the Homeless Council.

In cold-weather states, denying seniors a bed because of mobility and other health issues can be especially risky. In 2022, a Bozeman, Montana, after he was asked to leave a shelter because of incontinence.

Complex medical needs can pose a danger to other residents that most shelters aren’t prepared to manage.

“A typical shelter doesn’t allow somebody on oxygen to come in because that’s such a fire hazard and risk,” she said.

Synovec said giving seniors better access to health care inside shelters is the best way to help them succeed once they get housing. Health issues are a common reason seniors can’t afford or maintain housing, she said.

A Growing Model

The MVP model is showing promise, both in Utah and elsewhere.

“Over 80% of the people who’ve stayed in our program this past year have moved into stable or permanent housing,” said , vice president of programs for the TaskForce for Ending Homelessness in Fort Lauderdale, Florida. The nonprofit runs a shelter called .

The MVP shelter near Salt Lake City is also marking success. It was able to permanently house 36 seniors as of late last year.

Still, there are more seniors in need of shelter than it can accommodate. Dellos, the shelter’s manager, said the MVP’s waitlist hovers around 200 people. She said the shelter prioritizes people based on medical need, not time spent on the waitlist.

For residents who do get a room, it’s life-changing.

Last spring, 62-year-old Jeff Gregg was playing fetch with his dog, Ruffy, just beyond the lawn in front of the MVP.

An old back injury forced Gregg to hunch over as he threw the ball. It also fueled a decades-long addiction to opioids. That cycle was hard to escape, he said.

“Fighting that, having a job, insurance, then losing the job, not having insurance, going out to the streets and being back in that crap, and I’d be back in the same position,” he said.

Gregg said sobriety took a back seat to more immediate needs like finding food and a bed in a shelter. He said the MVP was the first place where he could relax and focus on recovery.

“I was able to get clean. It took me a couple months, but I just kept plucking away,” he said.

He said the experience paved the way for him to get back surgery. He hopes that with less back pain, he can eventually get a job to help him afford an apartment.

This article is part of a partnership with and .

Â鶹ŮÓÅ Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at Â鶹ŮÓÅ—an independent source of health policy research, polling, and journalism. Learn more about .

USE OUR CONTENT

This story can be republished for free (details).

As Hokit walked the path, he carried a handmade tool made of plastic pipes taped together to hold a large rectangle of white flannel cloth.

He poked fun at this “sophisticated” device, but the scientific survey was quite serious: He was sweeping the cloth over the shrubs and grass, hoping that “questing” ticks would latch on.

Along the summer trail, ticks dangle from blades of grass, sticking their legs out and waiting for a passing mammal.

“We got one,” Hokit said.

“So that came off of this sedge grass right here,” he said. “Simply pick them off with our fingers. We’ve got a vial that we pop them in.”

Any captured ticks would go back to Hokit’s lab in Helena for identification. Most of them would probably be identified as Rocky Mountain wood ticks.

But Hokit also wanted to find out whether new species are making their way into the state.

As human-driven climate change makes winters shorter, ticks are spending less time hibernating and have more active months when they can hitch rides on animals and people. Sometimes the ticks carry themselves — — to new parts of the country.

Hokit found in northeastern Montana earlier this year. Deer ticks are infamous for transmitting Lyme disease and can infect people with .

Knowing a new species like the deer tick has arrived in Montana or other states is important for doctors.

is an infectious disease specialist at the Billings Clinic in eastern Montana. He said most patients don’t come in right after they get bitten by a tick. They usually show up later, when they start feeling sick from a tick-borne illness.

“Fever, some chills, they may just feel bad, similar to many infections we may encounter throughout the year,” he said.

It’s rare that patients connect a tick bite to those symptoms, and even more rare that they capture and keep the tick that bit them. Sorting out whether someone might have a tick-borne illness can be complicated.

Knowing what kinds of ticks are in the region will help doctors know that they might start encountering patients infected with new diseases after a tick bite, Ku said.

That’s partially why the state is on the hunt for new tick species.

“The more we know about what’s in Montana, the better we can inform our physicians, the better care you can receive,” said , a zoonotic illness and vector-borne disease epidemiologist with the Montana Department of Public Health and Human Services.

Cozart collects and tests the ticks from field surveys in Montana to see whether they are carrying any pathogens.

Whether a tick can get a human sick depends on the species, but the kind of mammal it feeds on also plays a role.

“Usually it’s a rodent that might be carrying, for example, Rocky Mountain spotted fever,” she said. “So, the tick will feed on that rodent, then will get the pathogen as well.”

Because the prevalence of a particular disease can vary in mammal populations, ticks in one part of the state could be more or less likely to get you sick. That’s also important information for medical providers, Cozart said.

This kind of surveillance and testing isn’t happening in every county or state. A of nearly 500 health departments throughout the country found that roughly a quarter do some kind of tick surveillance.

Not all are equal, said , director of environmental health at the National Association of City and County Health Officials.

Field surveys can be expensive. For numerous local and state health departments, tick surveillance relies on a less expensive, more passive approach: Concerned patients, veterinarians, and doctors must collect and send in ticks for identification.

“It does provide a little information about what ticks are actually interacting with people and animals, but it doesn’t get into the weeds of how common ticks are in that area and how often do those ticks carry pathogens,” Gridley-Smith said.

She said more health departments want to start tick surveillance, but getting funding is hard — and might get harder as federal public health grants from agencies like the Centers for Disease Control and Prevention dry up.

Montana receives about $60,000 from a federal grant annually, but the bulk of that funding goes toward mosquito surveillance, which is more intensive and costly. What’s left funds trips into the field to look for ticks.

Hokit said he doesn’t have enough funding for his small team to survey everywhere he would like to in a state as large as Montana. That means he’s unable to monitor emerging populations of deer ticks as closely as he would like.

He found those new deer ticks in two Montana counties, but he doesn’t have enough data to determine whether they have begun reproducing there, establishing a local population.

In the meantime, Hokit uses data on climate and vegetation to make predictions about where deer ticks might thrive in the state. He has his eye on particular areas of western Montana, like the Flathead Valley.

He said that will help him and his team narrow down where to look next so they can let the public know when deer ticks — and the diseases they can carry — arrive.

This article is part of a partnership with and

Â鶹ŮÓÅ Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at Â鶹ŮÓÅ—an independent source of health policy research, polling, and journalism. Learn more about .

USE OUR CONTENT

This story can be republished for free (details).

Mientras caminaba por el sendero, Hokit cargaba una herramienta hecha a mano con tubos de plástico pegados entre sí que sostenían un enorme rectángulo de franela blanca.

Se burlaba de lo “sofisticado” de su dispositivo, pero el estudio científico era muy serio: pasaba la tela por encima de los arbustos y la hierba, con la esperanza de que las garrapatas se agarraran a ella.

Durante el verano, estas garrapatas cuelgan de las hojas, estirando sus patas mientras esperan que pase un mamífero.

“Tenemos una”, dijo Hokit.

“Esta salió de este arbusto”, explicó. “Al resto simplemente las recogemos con los dedos. Tenemos un frasquito donde las guardamos”.

Las garrapatas capturadas irán al laboratorio de Hokit en Helena, la capital del estado, para ser identificadas. La mayoría probablemente será clasificada como “garrapatas de la madera” de las Montañas Rocosas.

Pero Hokit también quería saber si han llegado nuevas especies al estado.

El cambio climático provocado por los humanos ha acortado los inviernos, lo que hace que las garrapatas pasen menos tiempo en hibernación y tengan más meses de actividad para engancharse a animales y personas. A veces, las garrapatas se trasladan —junto con que acarrean— a nuevas regiones del país.

Este año, Hokit (o garrapatas de patas negras) en el noreste de Montana. Esta especie es conocida por transmitir la enfermedad de Lyme, y también puede infectar a las personas con .

Saber que una nueva especie como la garrapata del ciervo ha llegado a Montana y a otros estados es muy importante para los médicos.

, especialista en enfermedades infecciosas en Billings Clinic, en el este de Montana, explicó que la mayoría de los pacientes no van al médico justo después de haber sido picados por una garrapata.

Por lo general, buscan atención más tarde, cuando ya se sienten enfermos por una enfermedad transmitida por estos parásitos.

“Fiebre, escalofríos, simplemente se sienten mal, como sucede con muchas infecciones que pueden presentarse a lo largo del año”, señaló.

Es poco común que las personas relacionen esos síntomas con una picadura de garrapata, y aún más raro que conserven la garrapata que los picó. Por eso, identificar si alguien tiene una enfermedad transmitida por garrapatas puede ser complicado.

Conocer qué tipos de garrapatas hay en una región ayuda a los médicos a identificar enfermedades nuevas relacionadas con estas picaduras, dijo Ku.

Esa es una de las razones por las que el estado busca nuevas especies de garrapatas.

“Cuanto más sepamos sobre lo que hay en Montana, mejor podremos informar a los médicos y mejor atención podrán brindar”, afirnó , epidemióloga del Departamento de Salud Pública y Servicios Humanos de Montana, especializada en enfermedades zoonóticas transmitidas por vectores (infecciones que se propagan de animales a humanos a través de garrapatas o mosquitos que pican a un animal infectado y luego a una persona).

Cozart recolecta y analiza las garrapatas obtenidas en los estudios de campo en Montana para detectar si portan algún patógeno.

La capacidad de una garrapata para enfermar a una persona depende de la especie, pero también influye el tipo de mamífero del que se alimenta.

“Por lo general es un roedor que puede portar, por ejemplo, la fiebre maculosa de las Montañas Rocosas”, explicó. “Entonces la garrapata se alimenta de ese roedor y adquiere el patógeno”.

Como la presencia de una enfermedad puede variar según la población de mamíferos, las garrapatas en una parte del estado pueden representar más, o menos, riesgo para las personas. Esta también es información relevante para los profesionales de salud, agregó Cozart.

Este tipo de vigilancia y análisis no se hace en todos los condados ni en todos los estados. , realizada a casi 500 departamentos de salud en el país, halló que apenas una cuarta parte lleva a cabo algún tipo de monitoreo de garrapatas.

No todas son iguales, dijo , directora de salud ambiental en la Asociación Nacional de Funcionarios de Salud de Ciudades y Condados.

Los estudios de campo pueden ser costosos. Por eso, muchos departamentos de salud estatales y locales dependen de un enfoque más económico y pasivo: pacientes preocupados, veterinarios y médicos deben recolectar y enviar las garrapatas para su identificación.

“Eso da un poco de información sobre qué garrapatas están en contacto con personas y animales, pero no permite conocer lo comunes que son en determinada zona ni con qué frecuencia portan patógenos”, explicó Gridley-Smith.

Agregó que más departamentos de salud quieren empezar a vigilar a las garrapatas, pero conseguir financiamiento es difícil. Y podría volverse aún más complicado si se reducen los fondos federales para salud pública, como los que otorgan los Centros para el Control y Prevención de Enfermedades (CDC).

Montana recibe unos $60.000 al año a través de una subvención federal, pero la mayor parte de ese dinero se destina a la vigilancia de mosquitos, que es más intensiva y costosa. Lo que queda se utiliza para realizar salidas en busca de garrapatas.

Hokit comentó que no cuenta con suficiente financiamiento para que su pequeño equipo pueda hacer estudios en todo el estado, que es muy extenso. Eso significa que no puede monitorear de cerca las poblaciones emergentes de garrapatas del ciervo como quisiera.

Encontró estas nuevas garrapatas en dos condados de Montana, pero no tiene suficientes datos para determinar si ya están reproduciéndose allí y formando una población local.

Mientras tanto, Hokit usa datos sobre el clima y la vegetación para predecir en qué zonas del estado podrían prosperar estas garrapatas. Está observando áreas específicas del oeste de Montana, como Flathead Valley.

Dijo que eso ayudará a su equipo a enfocar la búsqueda y a informar al público cuando lleguen las garrapatas del vciervo y las enfermedades que pueden transmitir.

Â鶹ŮÓÅ Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at Â鶹ŮÓÅ—an independent source of health policy research, polling, and journalism. Learn more about .

USE OUR CONTENT

This story can be republished for free (details).

Like many people who live in this remote town about 80 miles from the U.S.-Canada border, the 81-year-old Benefield has , or scarring of the lungs from asbestos exposure.

Her father worked at a now-closed mine that supplied most of the world’s vermiculite, a mineral with a wide variety of uses in insulation, fireproofing, and even gardening. The mine closed in 1990, and in 1999, a publicly revealed the connection between the asbestos-contaminated mineral and the increasing number of sick Libby residents.

Benefield remembered the white dust that covered her father’s clothes when he got home from work, and she learned later that the whole family had been exposed to asbestos, a tiny fiber that lodges in the lining of the lungs.

“Eventually, that scarring will fully surround your lungs,” Benefield said, “and slowly strangle you.”

The Environmental Protection Agency declared parts of Libby a in 2002. Seven years later, the agency declared a public health emergency for the town — a first in U.S. history. A study found that 694 Libby residents had died of an asbestos-related cause from 1979 to 2011. Additionally, health providers in the town of 3,200 estimate that 1 in 10 residents have an asbestos-related illness.

That estimate is from the , or CARD, a 501(c)(3) nonprofit clinic that has provided free lung screenings for locals. The clinic, which operates primarily through U.S. government funding, has screened . Because asbestos-related disease symptoms can take 30 years or longer to appear, nearly a third of the clinic’s screenings are for new patients, according to a 2024 CARD report.

But now, Libby residents can no longer get that care because a judgment in a lawsuit brought by BNSF Railway closed the CARD clinic in May. Clinic leaders are fighting the court order and have vowed to reopen its doors, but the lawsuit isn’t the only threat to the clinic’s survival.

The federal grant that provides 80% of the clinic’s operating revenue is the Trump administration is considering. If the $3 million grant is cut, the clinic would likely close for good, CARD executive director Tracy McNew said.

The grant was frozen then unfrozen, after the Office of Management and Budget issued then rescinded a memo freezing grants having to do with nongovernmental organizations; diversity, equity and inclusion; and other areas. But White House officials have said they will continue reviewing those grants for potential cuts, leaving McNew uncertain of the grant’s status even as clinic officials — and Department of Justice attorneys — fight in court to recover the CARD assets seized in the BNSF lawsuit.

The Office of Management and Budget, the White House. and the Department of Health and Human Services did not respond to NPR and Â鶹ŮÓÅ Health News’ request for comment on the status of the clinic’s grant.

Cutting the grant might not be easy, said Tim Bechtold, an attorney who represented the clinic in the BNSF case. The Affordable Care Act gave Libby asbestos patients access to Medicare and calls on the federal government to offer grants to fund diagnostic services for them.

In 2020, the that BNSF could be held liable for spreading asbestos along its tracks when the railroad shipped Libby vermiculite across the country.

The year before, under the False Claims Act, arguing that CARD defrauded the government by erroneously diagnosing patients and helping them apply for Medicare benefits. The law allows private parties on behalf of the federal government if federal prosecutors decline to take the case. Money awarded in those cases goes back to the federal government, but private parties keep a portion of the winnings.

A jury that CARD falsified the records of more than 300 patients who received federal benefits. CARD officials said those patients did not receive a diagnosis of asbestos-related disease, but the clinic determined them eligible for Medicare under the ACA based on abnormal radiology readings.

In a statement to NPR and Â鶹ŮÓÅ Health News, BNSF denied the lawsuit was an attempt to avoid legal liability for asbestos contamination along its tracks.

In 2023, the clinic filed for bankruptcy, . In May, BNSF persuaded a county court to nearly all of CARD’s property to collect its share of the roughly $6 million court judgment. It took control of nearly everything, from the clinic’s building to its lawn mower.

The federal government is . In a court filing, the office of the U.S. Attorney for Montana, Kurt Alme, said that because CARD property was largely purchased with federal grant funding, BNSF cannot seize it.

The case has moved to federal court and the judge is expected to rule on whether BNSF can seize CARD assets to collect its portion of the judgment. In the meantime, CARD patients will have to look elsewhere for screening and treatment, services that could be difficult to find.

Diagnosing people with asbestos-related disease or showing that other conditions are tied to asbestos exposure requires expertise, said , an oncologist at the University of Minnesota who studies cancers tied to asbestos.

“Most physicians would be modestly clueless about what to look for,” he said.

Kratzke explained X-rays or CT scans need to be done in a specific way and read by specialized doctors, known as , to diagnose patients.

Kratzke said rebuilding the expertise of the CARD clinic would be difficult in a small town like Libby.

“It would be very, very hard for the physicians and hospitals in Libby to follow these people as they would need to be followed for the rest of their lives,” Kratzke said.

Jenan Swenson is the only one of Gayla Benefield’s five children who hasn’t yet been diagnosed with an asbestos-related disease.

She received the results of her last screening at the CARD clinic the day before it closed in May. For now, the 62-year-old is in the clear.

Swenson expects to eventually develop breathing problems from her asbestos exposure as a child. Her mom, for whom she is a caregiver, also needs ongoing screenings for lung cancer.

She worries they’ll have to travel out of state to find that care if the CARD clinic doesn’t reopen, which Swenson said they can’t afford. She doesn’t think her family will be the only one.

“There’s going to probably be a lot of people just lost out there with no place to go,” Swenson said.

This article is part of a partnership with and .

Â鶹ŮÓÅ Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at Â鶹ŮÓÅ—an independent source of health policy research, polling, and journalism. Learn more about .

USE OUR CONTENT

This story can be republished for free (details).

They couldn’t afford it. Their Social Security payments couldn’t cover the cost of any apartments in northwestern Montana’s Flathead Valley.

Hilton’s partner was able to move into her daughter’s studio apartment. There wasn’t enough space for Hilton, so they reluctantly split up.

At 68 years old, he moved into his truck — a forest-green Chevy Avalanche.

Hilton quickly found out how hard it would be to survive. Hilton has diabetes. That first night, his insulin froze, rendering it useless.

Things didn’t get any easier that winter. On the coldest nights, temperatures dropped to about minus 20 degrees. Hilton kept the truck running, but eventually his fuel pump failed. He was on his own in the cold.

Hilton is incredibly optimistic, but in that moment, he said, his spirit broke.

“I just said I want to go to sleep and not wake up and I won’t have to worry about anything. I’ll just sit here and be a little popsicle in the truck,” Hilton recalled.

Hilton was one of tens of thousands of seniors in the U.S. who became homeless for the first time in 2022. A dramatic increase in the number of homeless seniors nationwide is overwhelming services for unhoused people.

Older Montanans especially are struggling because housing costs have skyrocketed since 2021, in part because of the rise of remote work. The state has one of the nation’s , according to federal data.

University of Pennsylvania researcher estimated that the number of homeless people age 65 and up in the U.S. would triple between 2019 and 2030. He recently updated that estimate using federal data for a .

“We are on track to meet that prediction. In fact, the growth has been slightly higher than we predicted,” he said.

According to Culhane’s research, the number of people 65 and older jumped by a little over a third between 2019 and 2022 alone. By 2022, there were about 250,000 people over 55 who were unhoused. About half of this population are homeless for the first time.

What researchers and advocates call the “gray wave” of homeless seniors is overwhelming service providers trying to help.

Wendy Wilson is seeing the gray wave coming firsthand. She’s a case manager at that helps Flathead residents struggling to meet their medical needs. In the past, that meant helping them get free meals or finding a ride to the doctor’s office.

Increasingly, Wilson helps older people like Hilton find housing.

“They have medical issues. It’s not easy for them to be living in a truck or at the homeless shelter when you have medical issues going on,” she said.

Wilson found Hilton a spot in early 2023 at the Samaritan House in Kalispell, which has private rooms. But after five months of living in his truck, Hilton’s health had gone downhill fast. He had several fainting episodes at the shelter, then-manager Sona Blue said.

“It scared us because we have no medical care in this facility,” she said.

That’s not usual for shelters. Finally, Hilton took a bad fall, and shelter staff sent him to an emergency room.

The doctor who treated Hilton discovered he had developed pressure wounds from sitting for months in the same position in his truck. Because of the neuropathy in his limbs from his diabetes, Hilton couldn’t feel the pain. Those wounds never healed and became infected, another common complication of diabetes. 

Hilton had one leg amputated. Later, his other leg was amputated as well. Returning to the shelter in a wheelchair wasn’t an option: There were no shelter staffers or medical personnel available to help with his basic needs.

A handful of homeless service providers, including shelter staffers and other medical case workers, tried to help Hilton find another place to go. They put him on waiting lists for the limited supply of subsidized housing in the area.

Wilson secured one of the few slots in a Medicaid program that helps pay for assisted living for Hilton. But it can take a year or more for units to open. So Wilson crossed her fingers that Hilton would get lucky before he was released from the hospital after his second amputation.

Many seniors across the country are stuck playing the same dangerous waiting game, said with the National Health Care for the Homeless Council.

“Sometimes they can’t be safely served in a shelter because they have issues with incontinence or cognition. Then they’re more likely to be on the streets, and their conditions will worsen quite a bit,” she said.

Communities are looking for solutions.

To serve aging people with complex medical needs, homeless shelters for seniors are cropping up in such cities as and , Florida.

Montana recently got approval from federal health officials to use Medicaid funding to temporarily help people with medical conditions make rent.

But that’s not enough, according to Synovec. She said the real solution is building more affordable housing so older Americans don’t become homeless in the first place.

That housing will need to be accessible, too. Older homeless people like Hilton need homes they can safely navigate. Because of his new wheelchair, he needed a ground-floor apartment.

In the fall, Hilton finally got a spot in a facility that would take his Medicaid waiver. He also got an electric wheelchair to make it easier to get to doctor appointments in town.

Hilton said he hasn’t pushed his new wheelchair to its top speed yet. “It goes fast for a wheelchair. I’m going to find out when I go down to dinner. I’ll stretch it out, break it in,” he said with a laugh.

Hilton is grateful to finally have stable housing. Wilson is grateful too. She said it was one of the few times she’s been able to help a senior regain housing.

“It was a woo-hoo moment,” she said.

As long as the facility stays open and the Medicaid waiver program isn’t cut, she’s confident Hilton will have made it through homelessness.

This article is part of a partnership with and .

Â鶹ŮÓÅ Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at Â鶹ŮÓÅ—an independent source of health policy research, polling, and journalism. Learn more about .

USE OUR CONTENT

This story can be republished for free (details).

It has been difficult for residents to adapt to the warming climate and new seasonal swings. Many don’t have air conditioning and are unprepared for the new pattern of daytime temperatures hovering in the 90s — for days or even weeks on end. Dehydration, heat exhaustion, heatstroke, and abnormalities in heart rate and blood pressure are among the many health complications that can develop from excessive exposure to high temperatures.

It can happen anywhere and to anyone, said Missoula firefighter Andrew Drobeck. He remembers a recent 911 call. The temperature that day had risen to over 90 degrees and a worker at a local dollar store had fainted. “She’s sensitive to the heat. Their AC wasn’t working super good,” Drobeck said. “I guess they only get a 15-minute break.”

Drobeck said many of the heat calls his department receives are from seniors who struggle to stay cool inside their older homes. Montana’s population is among the oldest in the country. are over 60. Those over 65 are to heat-related illness, according to the Centers for Disease Control and Prevention. As people age, their bodies don’t acclimate to heat as well as they did when they were younger, including not producing as much sweat.

In July, a heat dome that settled over much of the western U.S. baked the region and shattered two types of temperature records: daily highs, and number of consecutive days over 90 degrees. Although the Northwest, including western Montana, is typically cooler, the region experienced record-breaking heat this summer.

Emergency responders like Drobeck have noticed. Drobeck says 911 calls during heat waves have ticked up over the last few summers. But Missoula County officials wanted to know more: They wanted better data on the residents who were calling and the communities that had been hardest hit by the heat. So the county teamed up with researchers at the University of Montana to comb through the data and create a map of 911 calls during heat waves.

The team paired call data from 2020 with census data to see who lived in the areas generating high rates of emergency calls when it was hot. The analysis found that for every 1 degree Celsius increase in the average daily temperature, 911 calls increased by 1%, according to researcher , who co-authored

Though that may sound like a small increase, Barsky explained that a 5-degree jump in the daily average temperature can prompt hundreds of additional calls to 911 over the course of a month. Those call loads can be taxing on ambulance crews and local hospitals.

The Missoula study also found that some of the highest rates of emergency calls during extreme heat events came from rural areas, outside Missoula’s urban core. That shows that rural communities are struggling with heat, even if they get less media attention, Barsky said. “What about those people, right? What about those places that are experiencing heat at a rate that we’ve never been prepared for?” she said.

Barsky’s work showed that communities with more residents over 65 tend to generate more 911 calls during heat waves. That could be one reason so many 911 calls are coming from rural residents in Missoula County: Barsky said people living in Montana’s countryside and its small towns tend to be older and more vulnerable to serious heat-related illness.

And aging in rural communities can pose extra problems during heat waves. Even if it cools off at night, an older person living without air conditioning might not be able to cope with hours of high temperatures inside their home during the day. It’s not uncommon for rural residents to have to drive an hour or more to reach a library that might have air conditioning, a community center with a cooling-off room, or medical care. Such isolation and scattered resources are not unique to Montana. “I grew up in the Upper Peninsula of Michigan,” Barsky said. “There are no air-conditioned spaces in at least 50 miles. The hospital is 100 miles away.”

Heat research like the Missoula study has focused mostly on , which are often hotter than outlying areas, due to the “” effect. This phenomenon explains why cities tend to get hotter during the day and cool off less at night: It’s because pavement, buildings, and other structures absorb and retain heat. Urban residents may experience higher temperatures during the day and get less relief at night.

By contrast, researchers are only just beginning to investigate and understand the impacts of heat waves in rural areas. The impacts of extreme heat on rural communities have largely been ignored, said , an environmental engineering professor at the University of Vermont. Doran is leading an in Vermont that is revealing that towns as small as 5,000 people can stay hotter at night than surrounding rural areas due to heat radiating off hot pavement. “If we as a society are only focused on large urban centers, we’re missing a huge portion of the population and our strategies are going to be limiting in how effective they can be,” Doran said.

Brock Slabach, with the , agrees that rural residents desperately need help adapting to extreme heat. They need support installing air conditioning or getting to air-conditioned places to cool off during the day. Many rural residents have mobility issues or don’t drive much due to age or disability. And because they often have to travel farther to access health care services, extra delays in care during a heat-related emergency could lead to more severe health outcomes. “It’s not unreasonable at all to suggest that people will be harmed from not having access to those kinds of services,” he said.

Helping rural populations adapt will be a challenge. People in rural places need help where they live, inside their homes, said , director of Missoula County’s Office of Emergency Management. Starting a cooling center in a small community may help people living in town, but it’s unrealistic to expect people to drive an hour or more to cool off. Beck said the Missoula County Disaster and Emergency Services Department plans to use data from the 911 study to better understand why people are calling in the first place.

In the coming years, the department plans to talk directly with people living in rural communities about what they need to adapt to rising temperatures. “It might be as simple as knocking on their door and saying, ‘Would you benefit from an air conditioner? How can we connect you with resources to make that happen?’” Beck said.

But that won’t be possible for every rural household because there simply isn’t enough money at the county and state level to pay for that many air-conditioning units, Missoula County officials said. That’s why the county wants to plan ahead for heat waves and have specific protocols for contacting and assisting vulnerable rural residents.

“Ideally we’d be in a situation where maybe we have community paramedics that can be deployed into those areas when we know that these events are going to happen so they can check on them and avoid that hospital admission,” Beck explained. She added that preventing heat-related hospitalizations among rural residents can ultimately save lives.

This article is from a partnership that includes , , and Â鶹ŮÓÅ Health News.

Â鶹ŮÓÅ Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at Â鶹ŮÓÅ—an independent source of health policy research, polling, and journalism. Learn more about .

USE OUR CONTENT

This story can be republished for free (details).

Within a week, she asked her provider about getting the procedure done.

Ferst, 28, said she has always known she doesn’t want kids. She also worries about getting pregnant as the result of a sexual assault then being unable to access abortion services. “That’s not a crazy concept anymore,” she said.

“I think kids are really fun. I even see kids in my therapy practice, but, however, I understand that children are a big commitment,” she said.

In Montana, where Ferst lives, lawmakers have passed several , which have been tied up in court. Forty-one states on abortion, according to the Guttmacher Institute, and anti-abortion groups access in recent years.

After Roe was overturned in June 2022, doctors said a wave of young people like Ferst started asking for permanent birth control like tubal ligations, in which the fallopian tubes are removed, or vasectomies.

New research published this spring in JAMA Health Forum shows how big that wave of young people is nationally.

University of Pittsburgh researcher Jackie Ellison and her co-authors , a national medical record database, to look at how many 18- to 30-year-olds were getting sterilized before and after the ruling. They found in both male and female sterilization. from June 2022 to September 2023, and vasectomies increased over three times during that same time, Ellison said. Even with that increase, women are still getting sterilized much more often than men. Vasectomies have leveled off at the new higher rate, while tubal ligations still appear to be increasing.

Tubal ligations among young people had been slowly rising for years, but the ruling in Dobbs v. Jackson Women’s Health Organization had a discernible impact. “We saw a pretty substantial increase in both tubal ligation and vasectomy procedures in response to Dobbs,” Ellison said.

The data wasn’t broken out by state. But at least in states, like Montana, where the future of abortion rights is deeply uncertain, OB-GYNs and urologists say they are noticing the phenomenon.

Kalispell, Montana-based OB-GYN said she’s seeing women of all ages, with and without children, seeking sterilization because of the Supreme Court’s Dobbs decision.

She said the biggest change is among young patients who don’t have children seeking sterilization. She said that’s a big shift from when she started practicing 30 years ago.

Nelson said she believes she is better equipped to talk them through the process now than she was in the 1990s, when she first had a 21-year-old patient ask for sterilization. “I wanted to respect her rights, but I also wanted her to consider a number of future scenarios,” she said, “so, I actually made her write an essay for me, and then she brought it in, jumped through all the hoops, and I tied her tubes.”

Nelson said she doesn’t make patients do that today but still believes she is responsible for helping patients deeply consider what they’re requesting. She schedules time with patients for conversations about the risks and benefits of all their birth control options. She said she believes that helps her patients make an informed decision about whether to move forward with permanent birth control.

The American College of Obstetricians and Gynecologists .

, an assistant professor of obstetrics at Harvard Medical School, who helps lead ACOG’s ethics committee, said providers are coming around to the idea of listening to their patients, not deciding for them whether they can get permanent contraception based on age or whether they have kids.

King said some young patients who ask about sterilization never go through with the procedure. She recalled one of her own recent patients who decided against a tubal ligation after King talked with them about an IUD.

“They were scared of the pain,” she said. But after she reassured the patient that they’d be under anesthesia and unable to feel pain, they went ahead with the intrauterine device, a reversible birth control method.

sees a divide between younger and older providers when it comes to female sterilization. O’Leary finished her residency six years ago. She said older providers are more reluctant to sterilize younger patients.

“I will routinely see patients that have been denied by other people because of, ‘Ah, you might want to have kids in the future.’ ‘You don’t have enough kids.’ ‘Are you sure you want to do this? It’s not reversible,’” she said.

That’s what happened to Ferst when she first tried to get a tubal ligation.

She asked her doctor for one after having an IUD for about a year. Ferst recalls her male OB-GYN asking her to bring in her partner at the time, who was a male, and her parents to talk about whether she could get sterilized.

“I was shocked by that,” she said.

So Ferst stuck with her IUD. But the uncertainty of abortion rights in Montana persuaded her to ask again.

She has found a younger OB-GYN who has agreed to sterilize her this year.

This article is from a partnership that includes , , and Â鶹ŮÓÅ Health News.

Â鶹ŮÓÅ Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at Â鶹ŮÓÅ—an independent source of health policy research, polling, and journalism. Learn more about .

USE OUR CONTENT

This story can be republished for free (details).