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In a rural small town, a group of locals steps up to support senior health

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In a rural small town, a group of locals steps up to support senior health

Don Fitterer, 81, sits for a portrait at his home in Glen Ullin, N.D., on May 23. Fitterer is a participant in the Western Morton County Aging in Community program, which connects older adults in the medically underserved area of western Morton County with a variety of resources that can improve their quality of life.

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GLEN ULLIN, N.D. — When small rural towns get smaller, the challenges for those who remain get bigger. 

It’s especially true for older residents and those who care for them in this shrinking North Dakota town.

Adults age 65 and older make up a third of Glen Ullin’s roughly 700 residents. The town’s retired teachers, accountants and health care workers are making every effort to age at home, but one big obstacle for them is the ability to access medical care — without it, they are often forced to move to a larger city.

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Rural health care has been facing a crisis for years. But in rural towns such as Glen Ullin, older adults are getting help to manage, thanks to the handful of community members working to fill the gaps.

This photo shows a roadside sign saying

A welcome sign stands alongside Highway 49, leading into Glen Ullin on May 24.

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Each person plays a separate role — from keeping lonely older adults company to springing into action when a health emergency arises. In rural towns experiencing a loss of people, jobs and resources, this network of support can make a big difference.

NPR visited some of them to see what obstacles they encounter when trying to make sure the community’s older adults have the care they need.

The program coordinator, a jack-of-all-trades

This photo shows Kyla Sanders helping 94-year-old Leona Staiger set up a medical alert device at her home in Hebron, N.D., on May 23. Both women are seated at a kitchen table, with Sanders on the right. Sanders, who has long hair and is wearing glasses and a horizontal-striped, short-sleeved shirt, is touching the device, which sits on the kitchen table. Staiger, who has short, silvery hair and is wearing a light-colored sweatshirt and glasses, is learning forward to look at the device. Kitchen cupboards, countertops and a fridge are in the background.

Kyla Sanders, the program coordinator for the Western Morton County Aging in Community program, helps program participant Leona Staiger, 94, set up a medical alert device at her home in Hebron, N.D., on May 23. Sanders wears many hats in her role.

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It typically starts with a concerned neighbor.

“They’ll say, ‘I haven’t seen him outside for six weeks,’ or something like that, and I’ll go tap on their door,” said Kyla Sanders, a coordinator for the Aging in Community program in western Morton County, where Glen Ullin is located.

It’s a pilot program at North Dakota State University Extension to support older people living alone in rural areas. The idea behind the initiative is that older adults living alone are at the greatest risk of struggling under the radar. They are also the most likely to move out of town to be closer to resources.

This photo shows Kyla Sanders delivering a meal to a resident at the Marian Manor senior apartments in Glen Ullin, N.D., on May 23. An older man wearing a plaid shirt and suspenders is seated at a kitchen table with his back to the camera. Sanders is standing next to the table with a hand near a brown paper bag. Kitchen cupboards and a stove are in the background.

Sanders helps deliver meals to a resident at the Marian Manor senior apartments in Glen Ullin on May 23.

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There’s no catch-all term for the work Sanders does. A former nurse and lifelong farmer, Sanders has the official title “program coordinator,” but her list of responsibilities changes every day — from setting up internet at an older person’s home to leading a flower arrangement class for a group of seniors to helping an older adult apply for Medicaid.

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She’s a firm believer that there are small, affordable ways to keep older people aging at home and that they don’t have to relocate to a large town or city to thrive.

This photo shows Kyla Sanders helping to deliver meals to residents at the Marian Manor senior apartments in Glen Ullin, N.D., on May 23. Wearing khaki pants and a striped, short-sleeved shirt, she's standing in front of a doorway on the right side of a hallway and is holding a brown paper bag and a container of food. Also in the hallway is a silver-haired woman wearing blue pants and a blue shirt. She's bending down toward a blue wagon to retrieve a brown paper package from it.

Sanders helps deliver meals to residents at Marian Manor on May 23. She says there are small, affordable ways to help older adults age at home.

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There are about 150 older adults whom Sanders visits or talks with regularly on the phone. According to Sanders, more than half the program’s participants don’t have family members living nearby or able to help. She suspects even more seniors are living alone in the greater region, and she hopes to expand the program out to 200 miles — about five times more than the distance she typically travels now.

“I think it’s such a treasure to be able to have older adults stay in place and that it just can’t be overlooked,” she said.

Kyla Sanders helps Don Fitterer, 81, fill out a health directive for local EMTs at his home in Glen Ullin, N.D., on May 23. Wearing dark pants and a dark red shirt, Fitterer sits near a kitchen counter on the right side of the photo. Sanders sits on the left side of the photo, wearing khaki pants and a short-sleeved shirt. She's holding papers in one hand; her other hand rests on an opened red folder on the countertop.

Sanders helps Don Fitterer, 81, fill out a health directive for local EMTs at his home in Glen Ullin. According to Sanders, many of the Western Morton County Aging in Community program’s participants don’t have family members living nearby or able to help.

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The nurse practitioner, aka the primary care provider

Rhonda Schmidt’s official title is “nurse practitioner.” But like in many small rural communities, she’s Glen Ullin’s main primary care provider.

On a regular day, Schmidt sees somewhere between 15 and 20 patients. Her core staff is made up of two other people — a nurse’s aide and a receptionist. Another nurse practitioner fills in once a week. Together, they handle medication refills and acute infections. But the clinic could do so much more if it had the staff, Schmidt said.

This photo shows the downtown of Glen Ullin, N.D., reflected in the window of the town's pharmacy on May 24. In the reflection is a low-slung brown brick building, a portion of which is labeled

A quiet downtown Glen Ullin is seen reflected in the window of the town’s pharmacy on May 24.

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For instance, X-ray tests can help identify pneumonia, a disease common in adults over 65. The clinic has the X-ray equipment but no technician to run the machine, according to Schmidt. A doctor from an affiliated hospital used to help fill that gap, but that is no longer the case.

CT scans are another service that’s limited at the clinic. Staff members who operated a mobile CT scanner used to visit once a week, according to Schmidt. Now, they come once a month.

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Dark rainstorm clouds skirt the horizon near Glen Ullin, N.D., on May 25. Below the clouds stretch green fields with occasional farm buildings.

A rainstorm skirts the horizon near Glen Ullin on May 25. Inclement weather and long travel distances to medical providers are barriers to health care access for older people in Glen Ullin and many parts of the rural United States.

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In North Dakota, only six out of 53 counties are considered to have enough health care workers, according to the Rural Health Information Hub.

Schmidt was born and raised in Glen Ullin. Of her four siblings, she’s the only one still in town, and she lives on the same dairy farm that she grew up on.

“I just feel it’s my job to make sure they get what they need,” she said of her patients. “If I can’t figure out how to see them, they’re going to have to drive or find a driver.”

The volunteer EMT crew

This photo shows Glen Ullin Ambulance Service EMTs Wade Kottre, Lori Kottre, Dwight Kuntz and Rita Wallin posing for a portrait on a county road in Glen Ullin, N.D., on May 25. Two of them are standing in front of an ambulance parked on the dirt road. One EMT sits in the ambulance's driver's seat, and the fourth EMT stands to the side of the ambulance. Behind them, the land slopes upward.

Glen Ullin Ambulance Service EMTs Wade Kottre (from left), Lori Kottre, Dwight Kuntz and Rita Wallin pose for a portrait on a county road in Glen Ullin on May 25. The ambulance service is staffed entirely by volunteers and provides an essential service for Glen Ullin and the surrounding area.

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Lori Kottre may work 9 to 5 as the office manager at Glen Ullin’s nursing home, but she serves around the clock as the town’s emergency responder.

“I have my pager on 24/7,” she said. “And if I’m gone from the office three or six hours a day, I make up my time here so that my job here isn’t neglected.”

This photo shows Glen Ullin Ambulance Service EMT Dwight Kuntz driving the team's vehicle through Glen Ullin, N.D., on May 25. He is seated with his hands on the steering wheel and is wearing a dark shirt, sunglasses and a baseball cap. Through the vehicle's windshield, one can see a couple of houses.

Glen Ullin Ambulance Service EMT Dwight Kuntz, who has been on the crew for 48 years, drives the team’s vehicle through Glen Ullin on May 25.

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This photo shows Wade Kottre on the left and his mother, Lori Kottre, on the right. Both are Glen Ullin Ambulance Service EMTs, and both are wearing dark polo shirts that say

Son and mother Wade and Lori Kottre, both Glen Ullin Ambulance Service EMTs, are pictured in Glen Ullin. Many of the ambulance volunteers are older adults themselves and have been on EMT crews for decades, but some younger locals have stepped up to join the team in recent years.

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Kottre has worked as a volunteer EMT for nearly 30 years, alongside her son, daughter, daughter-in-law and five others. Like Kottre, all of them have day jobs. In the U.S., more than half of rural EMS agencies are staffed by volunteers, compared with 14% in urban areas.

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The ambulance squad receives 120 to 150 calls a year — a majority of which involve older adults, Kottre said. This means that the calls the EMTs receive are almost always serious, such as cardiac arrest and strokes. But they are limited in how they can help.

The ambulance carries aspirin, EpiPens and medications to help treat chest pain and asthma. But with no paramedic on the squad, there is no one certified to insert an IV or place a breathing tube. In those cases, the EMT crew calls the ambulance service in Bismarck, North Dakota’s capital, to meet on the highway, typically about 17 miles out of town, and take over.

According to Kottre, the EMT crew wouldn’t be able to afford a paramedic. Many rural communities face that challenge as a result of a national paramedic shortage.

“They don’t stick around the small towns,” she said.

Still, Kottre tries to do the best with what she has.

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“I feel more responsible for trying to take care of the patients as good I can, because we know all of them — we know all of their children, all of their grandchildren,” she said.

The priest making home visits

This photo shows the Rev. Gary Benz offering Holy Communion to Marianne and Jim Schaaf, both in their 90s, at their home in Glen Ullin, N.D., on May 24. Both Schaafs are seated in armchairs in their living room, and Benz is standing in front of them, facing them. Many pictures hang on the wall behind them.

The Rev. Gary Benz offers Holy Communion to Marianne and Jim Schaaf, both in their 90s, at their home in Glen Ullin on May 24. Benz works to support homebound, often socially isolated older adults who are dealing with health concerns by offering them Communion and an opportunity to connect with someone each week.

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When he’s not at church, the Rev. Gary Benz spends his weekdays traveling to the homes of his aging parishioners who are too ill or weak to attend services. He makes about seven to nine trips a week. Initially, the purpose was to bring them Holy Communion, but he quickly learned that they needed something else — connection.

“They say, ‘Father, this illness or condition is weighing on me and it just takes away my joy,’ or ‘It gets lonely being alone here all day,’” he said. “Some of them have family and friends who come visit, which is good, but some, they’re the only person in their house.”

The photo on the left shows the Rev. Gary Benz sitting in a pew at the Sacred Heart Catholic Church in Glen Ullin, N.D., on May 24. His face is directed to the right, and he's wearing a dark top and clerical collar. The photo on the right shows people seated at the Sacred Heart Catholic Church with their backs to the camera, facing the front of the church.

Benz poses for a portrait at the Sacred Heart Catholic Church in Glen Ullin on May 24.

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Rural towns are often celebrated for their tight-knit communities and close bonds between neighbors. But even in areas where that holds true — like Glen Ullin — they face unique barriers to social connection, like distance, neighbors moving away and few opportunities to gather. According to the University of Minnesota Rural Health Research Center, older adults in rural areas report being lonelier than their counterparts in urban areas.

Loneliness can have detrimental effects on physical health, including increased risk of heart disease, stroke and dementia, according to a report from the U.S. surgeon general.

This photo shows the Rev. Gary Benz bidding farewell to Viola Weinhardt, 94, at her home in Glen Ullin, N.D., on May 24. Weinhardt is seated on a sofa with a blanket draped over her legs. A walker is on the left side of the photo. Benz is standing on the right side of the photo, with his hand outstretched and holding Weinhardt's hand.

Benz bids farewell to Viola Weinhardt, 94, at her home in Glen Ullin on May 24.

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Benz, who leads three congregations in neighboring counties, sees the need firsthand. It’s why home visits are important to him. On top of daily Mass and confessionals and leading the youth ministry, Benz rarely misses a home visit or room visits with nursing home residents.

“These people — it’s not just a euphemism — they become part of my family,” he said.

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This photo shows the Rev. Gary Benz greeting parishioners after a Saturday afternoon Mass at the Sacred Heart Catholic Church in Glen Ullin, N.D., on May 24. Five older adults stand around him, with their backs to the camera. Benz is wearing a religious garment and is speaking to them. A bulletin board is behind him on the wall, displaying various flyers.

Benz greets parishioners after a Saturday afternoon Mass at the Sacred Heart Catholic Church on May 24. Benz leads three congregations in neighboring counties but says he rarely misses a home visit.

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This story was supported by the Pulitzer Center on Crisis Reporting.

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New Epstein files mention Trump. And, SCOTUS rules on National Guard in Chicago

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New Epstein files mention Trump. And, SCOTUS rules on National Guard in Chicago

Good morning. You’re reading the Up First newsletter. Subscribe here to get it delivered to your inbox, and listen to the Up First podcast for all the news you need to start your day.

Today’s top stories

The Justice Department yesterday released about 30,000 pages of new documents, including flight logs, memos and letters, related to disgraced financier and convicted sex offender Jeffrey Epstein. The files contain hundreds of references to President Trump.

President Donald Trump in the Oval Office of the White House in Washington, Dec. 15.

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  • 🎧 It’s well established that Epstein was well-connected and knew many influential figures, including Trump and former president Bill Clinton, NPR’s Sarah McCammon tells Up First. She emphasizes that Trump has not been accused of any wrongdoing, but notes that the documents continue to highlight the relationship between Trump and Epstein, raising questions about how much Trump knew about Epstein’s activities. She adds that it’s unclear which documents are credible and which aren’t. On social media, the DOJ has claimed that one of the files — a letter from Epstein to convicted sex offender Larry Nassar — is fake.

The Supreme Court has ruled that National Guard troops must stay out of Chicago — for now. The decision is one of several “emergency docket” cases in which the conservative majority court has ruled against Trump since he began his second term as president. The justices ruled 6-3, stating that the president failed to explain why the situation in Chicago warranted an exception to a law called the Posse Comitatus Act, which limits the military’s ability to execute laws on U.S. soil.

  • 🎧 Because the ruling came through an emergency decision, it does not set precedent, NPR’s Kat Lonsdorf explains. The decision applies only to this specific case in Illinois, not to troop deployments elsewhere. But deployments in other cities are currently tied up in litigation in lower courts, and Lonsdorf says lower court judges tend to look to these emergency decisions for guidance.

The U.S. economy grew faster than economists expected from July through September, according to a delayed report from the Commerce Department on the nation’s gross domestic product (GDP). The agency usually releases this report in October, but it pushed it to this month due to the government shutdown.

  • 🎧 Two factors helped drive the growth, NPR’s Alina Selyukh reports. The first was people and companies spending money on artificial intelligence and other technologies. The other is what Selyukh called the “perpetual motion machine” that is the American consumer. Americans are continuing to spend, despite recent polling showing growing uncertainty about their financial prospects. A new Conference Board report on consumer confidence found that sentiment declined for the fifth consecutive month, as Americans worry about inflation, the political landscape, and the labor market.

Today’s listen

Mariah Carey’s “All I Want for Christmas Is You” first hit No. 1 in 2019 and has topped the chart every holiday season since.

Mariah Carey’s “All I Want for Christmas Is You” first hit No. 1 in 2019 and has topped the chart every holiday season since.

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Christmas stirs a mix of joy, anticipation and … yearning. That tender longing runs through holiday classics like Mariah Carey’s “All I Want For Christmas Is You” and Judy Garland’s version of “Have Yourself A Merry Little Christmas.” Slate music critic Carl Wilson speaks with Morning Edition about why the holiday evokes this sense of yearning, and why these songs still resonate. Listen and grab some inspiration for your Christmas playlist.

Picture show

Mason "Bric" LaDue, a hip-hop music industry professional turned cattle rancher, takes the reins off of his horse, Valero, on Feb. 5, 2025, at his family's ranch in Marquez, Texas.

Mason “Bric” LaDue, a hip-hop music industry professional turned cattle rancher, takes the reins off of his horse, Valero, on Feb. 5, 2025, at his family’s ranch in Marquez, Texas.

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As the year comes to a close, NPR photojournalists are sharing a collection of images that defined 2025. The photographs capture the biggest headlines and quiet, powerful human scenes across the U.S. They’re representative of the fact that journalism not only documents factual events but also conveys the experiences and emotions felt in the many places we call home. Here’s a look at some of the images that resonated with the photographers this year.

3 things to know before you go

A family at their Victorian-era Christmas dinner, circa 1840.

A family at their Victorian-era Christmas dinner, circa 1840.

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  1. Today, the word “yule” conjures up images of cozy Christmas cheer. But Yuletide traditions got their start in wild parties and animal sacrifice. On this week’s Word of the Week, dive into the pagan origins of Yule festivals.
  2. The Middle Collegiate Church, a centuries-old space in New York City, will hold its first Christmas Eve service tonight after a six-alarm fire destroyed the building in 2020. The church officially reopened on Easter this year.
  3. At the Ground Zero Hurricane Katrina museum in Waveland, Miss., an exhibit showcasing letters written to Santa in the wake of the storm tells stories of resilience and recovery. (via New Orleans Public Radio)

This newsletter was edited by Majd Al-Waheidi. Brittney Melton contributed.

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U.S. and Ukraine reach consensus on key issues aimed at ending the war

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U.S. and Ukraine reach consensus on key issues aimed at ending the war

Ukraine’s President Volodymyr Zelenskyy speaks during a media conference at the EU Summit in Brussels, Thursday, Dec. 18, 2025.

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KYIV, Ukraine — The United States and Ukraine have reached a consensus on several critical issues aimed at bringing an end to the nearly four-year conflict, but sensitive issues around territorial control in Ukraine’s eastern industrial heartland, along with the management of the Zaporizhzhia nuclear power plant, remain unresolved, Ukraine’s president said.

Volodymyr Zelenskyy spoke as the U.S. showed the 20-point plan, hammered out after marathon talks in Florida in recent days, to Russian negotiators. A response is expected from Moscow on Wednesday, Zelenskyy said.

The Ukrainian president briefed journalists on each point of the plan on Tuesday. His comments were embargoed until Wednesday morning. The draft proposal, which reflects Ukraine’s wishes, intertwines political and commercial interests to safeguard security while boosting economic potential.

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At the heart of the negotiations lies the contentious territorial dispute concerning the Donetsk and Luhansk regions, known as the Donbas. This is “the most difficult point,” Zelenskyy said. He said these matters will be discussed at the leaders level.

Russia continues to assert maximalist demands, insisting that Ukraine relinquish the remaining territory in Donbas that it has not captured — an ultimatum that Ukraine has rejected. Russia has captured most of Luhansk and about 70% of Donetsk.

In a bid to facilitate compromise, the United States has proposed transforming these areas into free economic zones. Ukraine insists that any arrangement must be contingent upon a referendum, allowing the Ukrainian people to determine their own fate. Ukraine is demanding the demilitarization of the area and the presence of an international force to ensure stability, Zelenskyy said.

How the Zaporizhzhia nuclear power plant, the largest plant in Europe which is under Russian occupation, will be managed is another contentious issue. The U.S. is proposing a consortium with Ukraine and Russia, with each party having an equal stake in the enterprise.

But Zelenskyy countered with a joint venture proposal between the U.S. and Ukraine, in which the Americans are able to decide how to distribute their share, presuming it would go to Russia.

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“We did not reach a consensus with the American side on the territory of the Donetsk region and on the ZNPP,” Zelenskyy said, referring to the power plant in Zaporizhzhia. “But we have significantly brought most of the positions closer together. In principle, all other consensus in this agreement has been found between us and them.”

A free economic zone compromise

Point 14, which covers territories that cut across the eastern front line, and Point 12, which discusses management of the Zaporizhzhia plant, will likely be major sticking points in the talks.

Zelenskyy said: “We are in a situation where the Russians want us to leave the Donetsk region, and the Americans are trying to find a way so that it is ‘not a way out’ — because we are against leaving — they want to find a demilitarized zone or a free economic zone in this, that is, a format that can provide for the views of both sides.”

The draft states that the contact line, which cuts across five Ukrainian regions, be frozen once the agreement is signed.

Ukraine’s stance is that any attempt to create a free economic zone must be ratified by a referendum, affirming that the Ukrainian people ultimately hold the decision-making power, Zelenskyy said. This process will require 60 days, he added, during which time hostilities should stop to allow the process to happen.

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More difficult discussions would require hammering out how far troops would be required to move back, per Ukraine’s proposal, and where international forces would be stationed. Zelenskyy said ultimately “people can choose: this ending suits us or not,” he said.

The draft also proposes that Russian forces withdraw from Dnipropetrovsk, Mykolaiv, Sumy, Kharkiv regions, and that international forces be located along the contact line to monitor the implementation of the agreement.

“Since there is no faith in the Russians, and they have repeatedly broken their promises, today’s contact line is turning into a line of a de facto free economic zone, and international forces should be there to guarantee that no one will enter there under any guise — neither ‘little green men’ nor Russian military disguised as civilians,” Zelenskyy said.

Managing Zaporizhzhia power plant

Ukraine is also proposing that the occupied city of Enerhodar, which is connected to the Zaporizhzhia power plant, be a demilitarized free economic zone, Zelenskyy said. This point required 15 hours of discussions with the U.S., he said.

For now, the U.S. proposes that the plant be jointly operated by Ukraine, the U.S. and Russia, with each side receiving dividends from the enterprise.

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“The USA is offering 33 percent for 33 percent for 33 percent, and the Americans are the main manager of this joint venture,” he said. “It is clear that for Ukraine this sounds very unsuccessful and not entirely realistic. How can you have joint commerce with the Russians after everything?”

Ukraine offered an alternative proposal, that the plant be operated by a joint venture with the U.S. in which the Americans can determine independently how to distribute their 50 percent share.

Zelenskyy said billions in investments are needed to make the plant run again, including restoring the adjacent dam.

“There were about 15 hours of conversations about the plant. These are all very complex things.”

A separate annex for security guarantees

The document ensures that Ukraine will be provided with “strong” security guarantees that mirror NATO’s Article 5, which would obligate Ukraine’s partners to act in the event of renewed Russian aggression.

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Zelenskyy said that a separate bilateral document with the U.S. will outline these guarantees. This agreement will detail the conditions under which security will be provided, particularly in the event of a renewed Russian assault, and will establish a mechanism to monitor the ceasefire.

This mechanism will utilize satellite technology and early warning systems to ensure effective oversight and rapid response capabilities.

“The mood of the United States of America is that this is an unprecedented step towards Ukraine on their part. They believe that they are giving strong security guarantees,” he said.

The draft contains other elements including keeping Ukraine’s army at 800,000 during peace time, and by nailing down a specific date for ascension to the European Union.

Elections and boosting the economy

The document proposes accelerating a free trade agreement between Ukraine and the U.S. once the agreement is signed. The U.S. wants the same deal with Russia, said Zelenskyy.

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Ukraine would like to receive short-term privileged access to the European market and a robust global development package, that will cover a wide-range of economic interests, including a development fund to invest in industries including technology, data centers and artificial intelligence, as well as gas.

Also included are funds for the reconstruction of territories destroyed in the war.

“Ukraine will have the opportunity to determine the priorities for distributing its share of funds in the territories under the control of Ukraine. And this is a very important point, on which we spent a lot of time,” Zelenskyy said.

The goal will be to attract $800 billion through equity, grants, loans and private sector contributions.

The draft proposal also requires Ukraine to hold elections after the signing of the agreement. “This is the partners’ vision,” Zelenskyy said.

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Ukraine is also asking that all prisoners since 2014 be released at once, and that civilian detainees, political prisoners and children be returned to Ukraine.

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A 3-D Look Inside Trump’s Revamped Oval Office

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A 3-D Look Inside Trump’s Revamped Oval Office

Mr. Trump spends a great deal of his public and private time in the Oval Office. Here, he fields phone calls from allies, hosts hourslong staff meetings and takes questions from reporters while cameras roll.

It’s not unusual for presidents to decorate the space to their own tastes. They often choose art or items meant to evoke meaning and a historical connection to past political eras.

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But in his second term, Mr. Trump has placed a connection to his lavish decorating style above all else. His tastes veer toward the gilded, triumphal style of Louis XIV, a theme that shows up in his own properties.

Mr. Trump has regularly added to or swapped out items in the Oval, according to Karoline Leavitt, the White House press secretary. Some of Mr. Trump’s changes go beyond the decorative — he has installed a red button on his desk that lets him instantly order a Diet Coke.

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Most objects on the walls are from the White House archive. But a few things, including gold angel statuettes placed above two of the doorways, were brought in from Mar-a-Lago, his estate in Palm Beach, Fla.

A golden angel statuette was placed above a doorway leading to the West Wing. Doug Mills/The New York Times

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Donna Hayashi Smith, the White House curator, and several members of her team spend time pulling portraits and other items from an archive to show Mr. Trump for approval. The president has also traveled to a vault below the White House to see items in person before choosing to display them in the Oval, Ms. Leavitt said.

Mr. Trump was recently shown a portrait of the former first lady Jacqueline Kennedy, which now hangs near the fireplace. Ms. Leavitt said the president added this portrait, the only one of a woman in the office, because he “admires” Mrs. Kennedy.

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The Oval Office makeover is among the many changes Mr. Trump has ordered at the White House, including paving the Rose Garden, remodeling the Lincoln bathroom and demolishing the East Wing to build a massive ballroom.

The Golden Stage

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Why all the gold?

“He’s a maximalist,” Ms. Leavitt said, citing Mr. Trump’s background in real estate and hospitality. “So he loves showing people who come in, the renovations, his office, his gift shop.”

She added that when traveling overseas, Mr. Trump proudly talks about the White House to world leaders as he invites them to visit him in Washington. “This is the people’s house. It is also the epicenter of the world,” Ms. Leavitt said. “And he genuinely does have a great respect for the White House.”

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Almost as soon as he took office, Mr. Trump began adding gold accents to the Oval. By his first bilateral meeting, with Prime Minister Benjamin Netanyahu of Israel in February, there were five gold-framed portraits surrounding the fireplace and nine gold antiques on the mantel. By his October meeting with President Alexander Stubb of Finland, the gold had proliferated.

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Mr. Trump also added ornately framed mirrors on two doors leading to other parts of the West Wing. One of them, shown below, covers a peephole where the president’s aides have, in the past, looked through to monitor the progress of meetings.

Now, if the door is closed, they can no longer see what is happening inside the Oval.

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An aide to President Barack Obama watched the progress of an Oval Office meeting from an adjacent room on Nov. 24, 2009. Pete Souza/The White House

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A large mirror now covers the peephole from within the Oval. Doug Mills/The New York Times

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The sheer amount of gilded appliqués on the walls of the Oval Office has sparked internet rumors that they are plastic furnishings purchased from Home Depot, painted in gold. Mr. Trump has denied those claims, saying that the appliqués are authentic gold.

A White House official, speaking on the condition of anonymity to describe the process, said that the underlying materials are made of plaster or metal, then covered with real gold leaf. A craftsman from Florida regularly travels to Washington to gild the appliqués by hand, often when the president is away on the weekends, that official said.

Gold is a metaphor the president uses to visually show his success, said Robert Wellington, an art historian at the Australian National University and author of “Versailles Mirrored: The Power of Luxury, Louis XIV to Donald Trump.”

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“He’s really setting up a kind of stage — a gilded stage for his presidency,” Mr. Wellington said. “His style is to amass things together to make this look of ‘rich.’ ”

Aside from the gold, Mr. Trump has hung more than 20 portraits in the Oval Office. In addition to Mr. Washington’s above the fireplace, portraits of John Adams, Benjamin Franklin, Andrew Jackson, William Henry Harrison, Abraham Lincoln, James Monroe and Franklin D. Roosevelt are also on the walls.

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Mr. Trump has ruminated about the fate of Mr. Harrison, who died shortly after he was inaugurated, to people who have visited the Oval Office. He has said that the portraits of his predecessors are there to remind him of how quickly fate can change.

Most other presidents had just a few portraits or scenery paintings in the Oval.

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George W. Bush, June 2005

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Doug Mills/The New York Times

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Barack Obama, October 2014

Doug Mills/The New York Times

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Doug Mills/The New York Times

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Even the lighting in the Oval has not gone untouched.

During his first term, Mr. Trump had lights replaced in the Oval to make sure he was better lit during televised appearances.

Now, between the gold and the overhead lights, the room is very bright. The president has recently discussed installing chandeliers, a White House official said.

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The Resolute Desk

In this space, Mr. Trump has ceremonies, like awarding medals to the Kennedy Center honorees or the 1980 Olympic hockey team. He has also hosted business leaders, like Apple’s Tim Cook, or other politicians, like New York City’s mayor-elect Zohran Mamdani.

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Mr. Trump has recently taken to sitting at the Resolute Desk while people stand behind him at events.

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Mr. Trump met with Zohran Mamdani, the mayor-elect of New York City on Nov. 21. Eric Lee/The New York Times

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Mr. Trump met with members of the 1980 U.S. Olympic men’s hockey team on Dec. 12. Eric Lee/The New York Times

Other presidents have used the Oval Office in a more structured, organized way than Mr. Trump does.

President Joseph R. Biden Jr. used it as a space for briefings with his staff; the list of attendees was tightly controlled by his senior aides. President Barack Obama often arrived at the office in the late morning, worked there until dinner and continued his evening working in the executive residence. President George W. Bush would reach the Oval by early morning, and in the days and months after the Sept. 11, 2001, terror attacks, the office became the backdrop of some of his most significant national addresses.

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Mr. Trump treats the Oval Office as something akin to a boardroom or center stage. His most loyal aides are often in the room with him, helping workshop social media posts or fetching documents at his request. Meetings often run long, and sometimes get folded into unrelated events, because the president enjoys looping in more people as the day goes on.

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On Nov. 12, Mr. Trump displayed a bill he had just signed to end the government shutdown. Doug Mills/The New York Times

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Kid Rock was a guest when Mr. Trump signed an executive order meant to combat concert ticket scalping and price gauging on March 31. Doug Mills/The New York Times

One day this month, Mr. Trump welcomed a conga line of reporters, political allies and at least one cabinet secretary for meetings. He took phone calls and diverted to other subjects, including his plans for the East Wing ballroom. By the end of the day, he was several hours behind his official schedule, according to a person familiar with his schedule.

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Mr. Trump, seated at the Resolute Desk, with a model of the East Wing Ballroom. Doug Mills/The New York Times

Smaller details in the Oval Office were still in the works recently. A gold statuette of an eagle flying over the Constitution was added last month near the flags behind the desk.

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Doug Mills/The New York Times

But Mr. Trump is most likely finished putting up new items, Ms. Leavitt said.

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The Oval Office in 360

Tap and drag the image to explore on your own.

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Additional photo credits:

George Washington portraits above the fireplace: White House Historical Association (Richard Nixon, Gerald Ford and Ronald Reagan administrations); Everett Collection, via Alamy (Jimmy Carter administration)

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Photo of gold coasters and Diet Coke button: Doug Mills/The New York Times

Gifts to Trump: Doug Mills/The New York Times (plaque from Apple); Tom Brenner for The New York Times (FIFA Peace Prize trophy); Eric Lee/The New York Times (Washington Commanders football); Doug Mills/The New York Times (Rolex desk clock)

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