BROKEN BOW, NEB- In the first months after her husband's fall, Marlene had helped Earl Kennedy move into a nursing home three minutes from their house in Broken Bow, a town of 3,000, close enough that she could visit him twice a day. But then that nursing home went bankrupt and closed in May, one of more than 260 rural nursing facilities across the country to shut down for financial reasons in the past three years, sending another family on a desperate search for the basic medical care that is disappearing from rural America.

Marlene tried to get Earl into the only other nursing home in Broken Bow, but that facility had managed to stay solvent in part by limiting the number of residents on Medicaid, as Earl was, because the federal program pays nursing homes in Nebraska about $40 less per day than the cost of providing care. The nursing homes in Ainsworth and Minden had already closed, and the one located next to a grain elevator in Callaway was running a waiting list. The best option Marlene could find was a shared room in the town of Cozad, more than 50 miles away down remote two-lane roads, and Marlene had been making the trip back and forth several times each week ever since.

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