After discovering nearly 1 in 10 of their older neighbors drop out of medical care because they can’t find transportation to doctor’s appointments, a group of concerned Iosco County residents got to work.
Calling themselves the Rural Health Group, the four friends started interviewing emergency medical service agencies and plan to develop a guidebook detailing available resources, including ones that provide non-emergency medical transportation.
“It's a big issue,” said Jim Mortimer, a Rural Health Group member with experience in health care benefits. “We're trying to make it clearer what the problems are and see if we can find some solutions to improve it in our part of the northern side of Michigan.”
The Rural Health Group started out with four retirees with health industry experience. It currently has seven members.
Richard Douglass moved to Tawas City after his wife passed away shortly before the coronavirus pandemic.
“Almost immediately, I was contacted by the health officer, who said, ‘Wow, I'm glad we've got an epidemiologist in the county,’ even though I had been technically retired since 2014,” he said. “That's a typical story for our group.”
The group began researching what Douglass described as a health care desert.
The study began in June 2023 after the group saw Iosco County’s poor health stats in the University of Wisconsin’s County Health Rankings and Roadmap, which tracks health stats county by county across the US. The Roadmap shows Iosco County has more poor physical and mental health days and higher rates of premature death, unemployment and childhood poverty than the typical American county.
To better understand why their neighbors fared worse than residents of other counties, the Rural Health Group partnered with Central Michigan University’s Rural Health Excellence Institute to interview 84 recipients of home-delivered meals in Iosco County and found 26% of them struggled to get to appointments and 9.4% dropped out of medical care.
“If you don't manage a chronic disease, then it becomes an acute medical crisis,” said Douglass. “You end up having an emergency run to an emergency bed in a hospital. It's incredibly more expensive. Often, you get much less positive medical outcomes when you find care.”
The group had a place to start.
‘Definitely a barrier’
The findings of the Rural Health Group study reflect a growing need in central and northern Michigan.
Separate from the Rural Health Group, a survey by the Northern Michigan Public Health Alliance, a coalition of seven local health departments representing 31 counties in northern lower Michigan, found about 24% of residents said transportation to care is lacking. The need was especially great across Emmet, Lake and Oscoda counties, where more than 40% identified transportation as lacking in their communities.
“If you live really close in Traverse City, that's great, right? It’s easy,” said Dan Thorell, health officer for the Benzie-Leelanau District Health Department. “But a lot of people live an hour away, maybe even longer. So that is definitely a barrier.”
Douglass, the Rural Health Group member, said emergency medical service professionals say a lack of funding is a roadblock to expanded transportation options.
“What's difficult now is, where do we get the money?” Douglass said. “A lot of our early interviews have already told us they're willing to break their backs making this happen if we can help them find the money.”
Another reason cited is a lack of staffing in rural area transit systems.
“Some of them don't have, internally, even the administrative staff to be able to negotiate those agreements (and) handle the billing,” said John Dulmes, head of the Michigan Public Transit Association. “It takes a whole team to basically set up those kinds of arrangements and make it possible. There often needs to be cooperation between transit agencies in different counties when a patient may be traveling into a different area.”
‘Increased like five times’
Despite the obstacles, some groups are trying to expand their offerings.
In Benzie County, in the northwest Lower Peninsula, Benzie Bus offers a service called HealthRides, which provides rides to care in Benzie, Grand Traverse, Leelanau, Manistee and Wexford counties.
Rob Scott, the Benzie Bus mobility manager, says the service helps 35 to 50 riders per week and is a lifeline for many.
“I won't give a name of one of our passengers, but he suffered a stroke and was in his house for over a week and a half without being discovered … miraculous enough to be able to survive,” Scott said. “He shared with us, only through the HealthRides program is he able to have any hope of being able to recover and have a normal life.”
Benzie Bus is funded through local property taxes, as well as federal and state funds. The service plans to expand, Scott says.
“We're going to be expanding our fleet by three additional cars and one minivan, all wheelchair-accessible,” he said “Starting early in January 2027 is when we're going to be able to get downstate to larger health care centers.”
The Northern Michigan Public Health Alliance’s Community Connections program provides free services to residents across its 31-county region. People are often referred to the service if they indicate needing help with housing, transportation or other needs in a health screening.
“I believe it was December of 2023, that's when health care systems started requiring the social determinant of health screening,” Thorell, of the Benzie-Leelanau District Health Department, said. “The number of referrals have increased like five times since that time.”
The service had 1,723 referrals related to transportation last year. Thorell hopes to expand the services. The alliance applied for money from the $50 billion federal Rural Health Transformation Fund.
Thorell hopes the expansion can help seniors with disease prevention and other public health initiatives.
As for the Rural Health Group, Douglass says helping the community is a key motivating factor.
“We don't handle any of the money and none of us get paid. We're all pro bono,” he said. “I'm busier right now than I've been in 30 years, and I think that's a good thing. It's probably keeping me alive … so many things being so wrong right now in America is sort of an all-hands-on-deck to me.”
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