A rural dialysis unit in Chadron, Nebraska, has closed due to financial challenges, leaving patients like Mark Pieper without critical treatment. Pieper expressed despair over the closure, fearing for his health and survival.
Key points
Dialysis unit in Chadron, Nebraska closed
Closure due to financial challenges
Patients left without critical treatment
Mark Pieper fears for his health
Pieper had been receiving treatment for 3½ years
Mentioned in this story
Chadron, NebraskaMark Pieper
Mark Pieper sits in his pickup after receiving one of his last dialysis treatments in Chadron, Nebraska, before the rural hospital there shut down that service due to financial challenges. “I guess I’ll just bloat up and die in a month,” Pieper remembers thinking when he heard the news.
Mark Pieper sits in his pickup after receiving one of his last dialysis treatments in Chadron, Nebraska, before the rural hospital there shut down that service due to financial challenges. "I guess I'll just bloat up and die in a month," Pieper remembers thinking when he heard the news.
Arielle Zionts/KFF Health News
Arielle Zionts/KFF Health News
HAY SPRINGS, Neb.— The sun was just warming the horizon as Mark Pieper left his house near his cattle ranch on a crisp February morning.
It's not unusual for the rancher to wake up early to tend to livestock, but at 5:45 a.m. this day his cattle wouldn't come first. For the past 3½ years, three days a week, Pieper has made an early-morning commute to get dialysis at the nearest hospital.
Pieper lives outside Hay Springs, which has 599 residents, according to a sign at the edge of town. He makes sure not to forget his chocolate-brown cowboy hat before starting up his pickup truck for the half-hour drive to Chadron.
That February morning was one of his last dialysis sessions there before the hospital shuttered the service at the end of March.
"I guess I'll just bloat up and die in a month," Pieper remembered thinking when he learned the center was closing, eliminating the only option near his home.
He needs dialysis to survive after cancer treatment damaged his kidneys.
Q&A
Why did the dialysis unit in Chadron, Nebraska close?
The dialysis unit closed due to financial challenges faced by the rural hospital.
What are the consequences of the dialysis unit's closure for patients?
Patients like Mark Pieper are left without access to critical dialysis treatment, which could severely impact their health.
How long had Mark Pieper been receiving dialysis treatments?
Mark Pieper had been receiving dialysis treatments for 3½ years before the unit's closure.
What options do patients have after the closure of the Chadron dialysis unit?
Patients may need to travel further for dialysis treatments or seek alternative care options, which can be challenging in rural areas.
She waited decades for Scotland to make the World Cup. At 93, she'll be cheering in person
At 93, Moira Brown will attend her fourth World Cup, celebrating Scotland's qualification for the tournament after nearly 30 years. She'll cheer for her team during their group stage matches in the U.S.
See every story in News — including breaking news and analysis.
WASHINGTON, DC - JANUARY 16: (L-R) U.S. President Donald Trump speaks as U.S. Secretary of Health and Human Services Robert F. Kennedy Jr. and Administrator for the Centers for Medicare & Medicaid Services Mehmet Oz look on during a rural health roundtable on January 16, 2026 in Washington, DC.
Pieper and 16 other patients relied on Chadron Hospital for the life-sustaining therapy that filters waste and fluid from their blood — a job their failing kidneys could no longer do. Treatment lasts about four hours.
The closure is just one example of the long decline of health care services in rural America, where people have higher rates of many chronic conditions but less access to care than elsewhere.
The Trump administration promised to address this problem when it launched the $50 billion federal Rural Health Transformation Program last fall. It may not be enough to stop the trend.
"[President Donald] Trump says he is going to help the rural health care," Pieper said. Dialysis "is one thing that we really need here."
Some patients have moved to live closer to care, including several nursing home residents. Their new facilities may be farther from their families.
Jim and Carol Wright rented this small house near Rapid City, South Dakota, to live there on weekdays so Jim can get dialysis in town. They say they’ll eventually have to sell their house near Chadron, Nebraska, and move to a new city to be closer to care. (Arielle Zionts/KFF Health News)
Jim and Carol Wright rented this small house near Rapid City, South Dakota, to live there on weekdays so Jim can get dialysis in town. They say they'll eventually have to sell their house near Chadron, Nebraska, and move to a new city to be closer to care.
Arielle Zionts/KFF Health News
Arielle Zionts/KFF Health News
Others are making long drives to other dialysis centers. Pieper eventually found treatment in Scottsbluff, which, with about 14,000 residents, is the biggest city in the rural Panhandle region of western Nebraska. The one-and-a-half hour drive will triple his time on the road to more than nine hours each week.
Jim Wright and his wife reduced their drive time — but are spending more money — by renting a small home near Rapid City, S.D., and living there on weekdays so he can get dialysis. Wright said he understands that rural hospitals face financial challenges.
"But we're talking about something that's lifesaving. It's not a matter of, 'Oh, I would like to be there'" getting treatment, he said. "It's a case that if you don't, you die."
Jon Reiners, CEO of the independent, nonprofit Chadron Hospital, wrestled with the decision to end dialysis services. He and several patients said that the closure was announced as Nebraska officials celebrated the $219 million the state will receive in first-year funding from the Rural Health Transformation Program.
But the five-year program is aimed at exploring new, creative ways to improve rural health, not to help existing services stay afloat. States can use only up to 15% of their funding to pay providers for patient care.
At least 11 states — Nebraska is not among them — have mentioned using funding for rural dialysis programs, according to a KFF Health News review of applications. Their ideas include starting a mobile dialysis unit and helping people get treatment at home or in long-term care facilities.
Reiners said Chadron Hospital lost $1 million a year on its dialysis service due to low reimbursement rates that didn't cover operational costs.
The facility is a critical access hospital, a designation that allows certain small, mostly rural hospitals to get increased reimbursement rates for their Medicare patients. While most of the affected patients were on Medicare, the critical access program doesn't cover outpatient dialysis, Reiners said.
Reiners said the hospital worked for more than a year to find solutions, such as reaching out to four private companies to potentially take over the center. But he said they all passed after realizing they would lose money.
Nephrologist Mark Unruh said the dialysis closure in Chadron reflects a wider trend of staffing and funding challenges.
"You do end up in situations where you have people who are displaced like this, and it's just sad," said Unruh, chair of the Internal Medicine Department at the University of New Mexico.
The best way to address this is to focus on prevention, Unruh said. He pointed to a tele-education program that helps primary care doctors in rural and other underserved areas prevent end-stage renal failure.
Another idea, Unruh said, is boosting the rate of kidney transplantation for rural patients. He's part of a study looking at whether it's helpful to "fast-track" tests patients need to get approved for a transplant by scheduling all of them over a couple of days to limit travel time.
Unruh said the U.S. health system also needs to recruit more staff who can train patients and their caregivers to administer dialysis at home.
The closure of the dialysis unit at Chadron Hospital upended the lives of its patients in rural Nebraska. Some have moved to be closer to care. One is living in a rental in another city on weekdays. Another is driving more than four hours round-trip for care.
The closure of the dialysis unit at Chadron Hospital upended the lives of its patients in rural Nebraska. Some have moved to be closer to care. One is living in a rental in another city on weekdays. Another is driving more than four hours round-trip for care.
Arielle Zionts/KFF Health News
Arielle Zionts/KFF Health News
Exploring the option of home dialysis
Rural dialysis patients are more likely than urban ones to get home dialysis, according to data from the National Institutes of Health. In 2023, the rate was nearly 18% for rural patients and about 14% for urban ones.
One type of home dialysis requires surgery to get a catheter placed in the abdomen and up to 15 days of training. The other kind requires up to eight weeks of training. The nearest facility to Chadron that offers training for the first option is in Scottsbluff. The nearest that offers training for the latter kind is three hours away in Cheyenne, Wyoming.
Pieper said doctors told him he's not a candidate for home dialysis or a transplant. The Panhandle has a nonprofit, rural transit system, but its schedule won't work for Pieper. He said that leaves him with no choice but to get treatment in Scottsbluff, a 200-mile round trip.
It takes Linda Simonson even longer — more than four hours round trip — to drive her husband, Alan, from their ranch to his treatment in Scottsbluff.
Linda sat in the waiting room with a yellow legal pad during one of Alan's final treatments in Chadron. The paper was scrawled with phone numbers of politicians to call and driving distances to dialysis centers in the region. She said facilities closer to their ranch either don't have room for new patients or lack good spots along the route to take a driving break in bad weather.
"It's just unreal," she said.
She said even if Alan took a bus, she'd have to ride along to support him during the trip and his treatment.
Jim and Carol Wright, the couple staying near Rapid City on weekdays, said they can't afford to rent a second home forever. Their weekly commute is already taking a physical and emotional toll. They said they'll eventually have to move to a bigger city, giving up the house they love in the scenic Nebraska National Forest.
Carol said she feels for the dialysis staffers in Chadron, who are wonderful.
"It just doesn't seem right to sacrifice one unit that's so vital," she said while standing next to a pile of moving boxes stacked inside their rental.
The Wrights wrote letters to politicians and hospital leaders to share their concerns and ideas for keeping the unit open, including using the federal rural health funding.
Simonson said she spoke with aides for the governor and her state representatives but none of the leaders called her back.
"It feels like they don't know that we exist at this end of the state," she said.
KFF Health Newsis a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs atKFF.
