Joel Tyndall lives off a gravel road in northeast Nebraska, miles away from the nearest town. As a double amputee, his car has been collecting dust in his garage.
Some have suggested he could move closer to the biggest town in the area, Norfolk, where he has three dialysis appointments a week to manage his diabetes.
But it hasn’t come to that — thanks in part to the Cedar County Transit — which works a little like a rural Uber; anyone can call to schedule a ride.
“I'm gonna leave my home?” Tyndall asked. “No, as long as this transit continues to run I'll be using it for just about everything. These guys help me out more than you would believe.”
In rural areas, residents can be miles away from essentials like doctors and grocery stores instead of minutes. Without transportation, people who don’t have a car or can’t drive often have to move closer to services.
More than a third of state rural health offices reported lack of transit was the biggest barrier to elderly people staying in their homes, according to research from Carrie Henning-Smith, who studies rural health at the University of Minnesota.
Rural America tends to be sicker, poorer and older than its urban counterparts. Henning-Smith said the negative-but-true statistics make it even more important for rural residents to be able to access transit.
“There's greater need for transportation among older adults in rural communities, but more transportation challenges in getting people where they need to go,” she said. “And that will only increase as the years go on, and the population continues to age in rural places.”
Providers like Cedar County Transit help fill in the gap. The northeast Nebraska county has had some level of public transportation since about 1980, although it’s come a long way since then, according to manager Nikki Pinkelman.
They now have 15 vans, 15 drivers and a full-time scheduler. The operation recently launched services into a bordering county and moved into its own building.
Pinkelman said the community has embraced the expanded service.
“You used to rely on your neighbor, or maybe you relied on your wife or your kids. But most families now, both parents are working,” she said. “Or maybe your kids don’t live close, and you don’t have someone to take you.”
Anyone living in Cedar County and parts of Knox County can schedule a ride, as long as it’s within 200 miles and on a weekday from 6 a.m. to 6 p.m.
The service runs on money from the state and federal government, grants and contracts and local community funding, as well as fare for rides. In fiscal year 2021, that came to a total of nearly $382,000 with nearly $234,000 in federal funds; close to $61,000 from the state; about $59,000 in local funding and almost $28,000 in rider fees.
Fees are based on round trip mileage and range from $3 for an in-town destination to $75 for a 400-mile trip. Pinkelman said she’s conscious that some riders may be on fixed incomes and tries to keep costs as low as possible. The service can also bill Medicaid for recipients who use transit to get to health appointments.
Cedar County Transit has loadable fare cards that can also be given as gifts. That was Rita Meirose’s Christmas present this year from her kids. Now she books rides with the bus multiple times a week to grab groceries, pick up her prescriptions, get to hair appointments and play cards with friends.
She doesn’t like driving during the winter and says using the transit service is easier.
“We have a lot of elderly here, people like myself, and a lot of them just can't drive anymore,” Meirose said. “I can drive; I still have a whole year on my license. I’m not afraid of driving, but I don’t like to drive on ice.”
Providing public transit in rural areas is a difficult task, but a patchwork of services serves towns and counties throughout the Midwest and Great Plains.
Kansas was tied in 2019 for the most rural transit agencies in the nation, and in Iowa 35 providers serve riders across the state’s 99 counties. In 2020, Oklahoma developed a transit plan to help it become a “top 10 state in transit” by 2040.
Missouri’s “Operating Above the Standard” Transit, or OATS, is the largest agency in the country and operates in 87 counties. But it doesn't reach every corner of the state.
Sandra Morris realized transportation was a big barrier to rural health when she began working at the Ozarks Medical Center in West Plains, Missouri, where OATS does not have service.
The poverty, the rough terrain and the lack of nearby friends and family made it hard for people to keep their appointments. That’s especially true for people seeking help from the behavioral health center.
“Those patients have, for the most part, burned their bridges. So there’s no one to bring them in,” Morris said. “You can throw all the money at mental health you want, but until you provide a way for patients to get here and have return appointments, you’re setting them up for failure.”
The Missouri Rural Health Association administers HealthTran, which began in 2014 as a pilot program to get people to their medical appointments. Nearly 10 years later, it’s still in place and has expanded to cover more of the state and include rides to places like grocery stores, pharmacies and libraries.
Morris leads education and training at HealthTran and said rural transportation does not come easy or cheap.
“But how expensive is it if you don't provide it? What is the cost to your community?” she asked. “What is the cost to the citizens you're there to serve? It will pay its way, the services provided will pay its way.”
The National Transit Database reports 82% of counties nationwide had some level of rural transit available in 2019. Henning-Smith is quick to point out that still means 18% of counties don’t have a public option.
She said that may isolate people who usually have a deep knowledge about their hometown and often provide the intimacy and connection small towns are known for.
“In an era when some rural communities are losing population, it's really important to think about ways to make sure that everyone has a chance to feel socially connected, socially cohesive, active and engaged and vibrant,” Henning-Smith said.
Cherry County in western Nebraska was one of those counties. It’s the state’s biggest county, with a footprint larger than Connecticut. But for years, Cherry County had no public transit.
Assisted living facilities and a nursing home used to provide shuttle service to its residents in Valentine – Cherry County’s biggest town – but the owners shut down shop in 2021.
Peg Snell said she reached a breaking point after noticing elderly residents walking to the hospital in the heat, a few blocks away from Prairie Estates, the independent living center she manages.
Something had to change, and she quickly became an advocate for bringing transit to Valentine. Snell pushed city officials to ask Open Plains Transit, an agency covering the Nebraska panhandle, to expand their services into the town.
“It's like, why wouldn't we do this? It's going to be a cost, but it's going to keep our elderly in our community,” she said. “We could have a great system because right now we have nothing.”
Jonnie Kusek is director of transportation at Open Plains and said she knew the agency had to help when she got the call from Valentine. To Kusek, accessible transportation can change lives.
“It’s really important that we give people opportunities to go out and live in their communities,” she said. “Transit should revolve around what people’s needs and their lives are. People’s lives shouldn’t revolve around when transit is available.”
Representatives from Cherry County, a senior living center, the hospital, tourism, health and human services and residents packed a townhall and showed Kusek there was real interest and need in Valentine.
The bulk of funding for the service comes from state and local government, with certain costs requiring a local match of up to 25%. The project also received commitments from the Pestel Charitable Foundation in Valentine and the Cherry County Hospital.
In November, big white buses started appearing on Valentine’s streets.
Nearly half of the rides so far have been for medical appointments. Kyle Kellum leads Cherry County Hospital and said it’s helped the hospital’s bottom-line by reducing missed appointments, and he hopes it can improve the health of the entire community.
“If we can get folks in and do the preventative stuff, it really keeps folks out of the ER and keeps them healthier long term,” Kellum said. “But sometimes getting here is tough.”
Lorin Beel lives at Prairie Estates and said he put off a colonoscopy last fall because he didn’t have a way to get back to Valentine from the Veterans Affairs Medical Center in Fort Meade, South Dakota.
“I couldn’t find nobody to go with me. I have no family really to speak of, and I’m single,” Beel said. “Now I can say ‘I’ll get the heck out of your hair, just get that old bus up here and away I’ll go.’”
For some residents it’s meant the difference between staying or leaving their homes.
Jim Ducey teared up as he talked about what a tough winter it’s been. If not for the bus, he’s not sure he could have remained in the community.
“I did not want to leave Valentine,” Ducey said. “I'm still here and that is because the transit service arrived at the perfect time.”
Right now the service is only available within Valentine city limits, leaving the rest of Cherry County’s 6,000-square miles without a public transportation option.
But Snell said she hopes it’s only the beginning. There’s been interest from Cherry County commissioners on expanding the service area.
“This is such a great thing for this community,” Snell said. “But there’s a lot of people outside of Valentine. And I just hope we can keep it going, and it can continue to grow the way it has so far.”
Follow Elizabeth on Twitter: @Ekrembert
This story was produced in partnership with Harvest Public Media, a collaboration of public media newsrooms in the Midwest. It reports on food systems, agriculture and rural issues. Follow Harvest on Twitter: @HarvestPM.
This story was produced with the help of a grant from the Solutions Journalism Network.
