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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.
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.
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
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.
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.
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.
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.
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.
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.
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
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.”
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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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.
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.
“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
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.”
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.
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.
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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Man accused of plot to assassinate Trump testifies Iran pressured him, says Biden and Haley were other possible targets
The allegation sounded like the stuff of spy movies: A Pakistani businessman trying to hire hit men, even handing them $5,000 in cash, to kill a U.S. politician on behalf of Iran ‘s powerful paramilitary Revolutionary Guard.
It was true, and potential targets of the 2024 scheme included now-President Donald Trump, then-President Joe Biden and former presidential candidate and ex-U.N. Ambassador Nikki Haley, the man told jurors at his attempted terrorism trial in New York on Wednesday. But he insisted his actions were driven by fear for loved ones in Iran, and he figured he’d be apprehended before anything came of the scheme.
“My family was under threat, and I had to do this,” the defendant, Asif Merchant, testified through an Urdu interpreter. “I was not wanting to do this so willingly.”
Merchant said he had anticipated getting arrested before anyone was killed, intended to cooperate with the U.S. government and had hoped that would help him get a green card.
U.S. authorities were, indeed, on to him – the supposed hit men he paid were actually undercover FBI agents – and he was arrested on July 12, 2024, a day before an unrelated attempt on Trump’s life in Butler, Pennsylvania. During a search, investigators said they found a handwritten note that contained the codewords for the various aspects of the plot, CBS News previously reported.
Merchant did sit for voluntary FBI interviews, but he ultimately ended up with a trial, not a cooperation deal.
“You traveled to the United States for the purpose of hiring Mafia members to kill a politician, correct?” Assistant U.S. Attorney Nina Gupta asked during her turn questioning Merchant Wednesday in a Brooklyn federal court.
“That’s right,” Merchant replied, his demeanor as matter-of-fact as his testimony was unusual.
The trial is unfolding amid the less than week-old Iran war, which killed Iranian Supreme Leader Ayatollah Ali Khamenei in a strike that Trump summed up as “I got him before he got me.” Jurors are instructed to ignore news pertaining to the case.
The Iranian government has denied plotting to kill Trump or other U.S. officials.
Merchant, 47, had a roughly 20-year banking career in Pakistan before getting involved in an array of businesses: clothing, car sales, banana exports, insulation imports. He openly has two families, one in Pakistan and the other in Iran – where, he said, he was introduced around the end of 2022 to a Revolutionary Guard intelligence operative. They initially spoke about getting involved in a hawala, an informal money transfer system, Merchant said.
Merchant testified that his periodic visits to the U.S. for his garment business piqued the interest of his Revolutionary Guard contact, who trained him on countersurveillance techniques.
The U.S. deems the Revolutionary Guard a “foreign terrorist organization.” Formally called the Islamic Revolutionary Guard Corps, the force has been prominent in Iran under Khamenei.
Merchant said the handler told him to seek U.S. residents interested in working for Iran. Then came another assignment: Look for a criminal to arrange protests, steal things, do some money laundering, “and maybe have somebody murdered,” Merchant recalled.
“He did not tell me exactly who it is, but he told me – he named three people: Donald Trump, Joe Biden and Nikki Haley,” he added.
In 2024, multiple sources familiar with the investigation told CBS News Merchant planned to assassinate current and former government officials across the political spectrum.
Merchant allegedly sketched out the plot on a napkin inside his New York hotel room, prosecutors said, and told the individual “that there would be ‘security all around’ the person” they were planning to kill.
“No other option”
After U.S. immigration agents pulled Merchant aside at the Houston airport in April 2024, searched his possessions and asked about his travels to Iran, he concluded that he was under surveillance. But still he researched Trump rally locations, sketched out a plot for a shooting at a political rally, lined up the supposed hit men and scrambled together $5,000 from a cousin to pay them a “token of appreciation.”
He even reported back to his Revolutionary Guard contact, sending observations – fake, Merchant said – tucked into a book that he shipped to Iran through a series of intermediaries.
Merchant said he “had no other option” than to play along because the handler had indicated that he knew who Merchant’s Iranian relatives were and where they lived.
In a court filing this week, prosecutors noted that Merchant didn’t seek out law enforcement to help with his purported predicament before he was arrested. He testified that he couldn’t turn to authorities because his handler had people watching him.
Prosecutors also said that in his FBI interviews, Merchant “neglected to mention any facts that could have supported” an argument that he acted under duress.
Merchant told jurors Wednesday that he didn’t think agents would believe his story, because their questions suggested “they think that I’m some type of super-spy.”
“And are you a super-spy?” defense lawyer Avraham Moskowitz asked.
“No,” Merchant said. “Absolutely not.”
The bombing of an Iranian elementary school that killed some 165 people, many of them schoolgirls, included more targets near the school than has been initially reported, a review of commercial satellite imagery by NPR has found.
The images suggest that the school was hit on Saturday as part of a precision airstrike on a neighboring Iranian military complex — and that it may have been struck as a result of outdated targeting information.
The new images come from the company Planet and are of the city of Minab, located in southeastern Iran. They show that a health clinic and other buildings near the school were also struck. Three independent experts confirmed NPR’s analysis of the additional strike points.
The strike points “look like pretty clean detonation centroids,” said Corey Scher, a postdoctoral researcher at the Conflict Ecology laboratory at Oregon State University.
“These certainly appear like detonation sites,” agreed Scher’s colleague, Oregon State associate professor Jamon Van Den Hoek.
Jeffrey Lewis, a professor at Middlebury College who specializes in satellite imagery, said the imagery was consistent with a precision airstrike.
The images show “very precise targeting,” Lewis told NPR. “Almost all the buildings [in the compound] are hit.”
A satellite image of an Iranian Revolutionary Guard compound taken on March 4, several days after an airstrike destroyed a school on the edge of the compound. The image reveals that half a dozen other buildings in addition to the school were struck.
Planet Labs PBC
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Planet Labs PBC
Iranian state media said 165 people died in the bombing, which struck a girls’ school. The school was located within less than 100 yards of the perimeter of an Iranian Revolutionary Guard naval base, according to satellite images and publicly available information. The clinic was also located within the base perimeter, although both facilities had been walled off from the base.
Israel has denied involvement. “We are not aware at the moment of any IDF operation in that area,” Israel Defense Forces spokesperson Nadav Shoshani told NPR on Monday. “I don’t know who’s responsible for the bombing.”
At a press conference Wednesday morning, U.S. Defense Secretary Pete Hegseth said that the U.S. is looking into what happened at the school. “All I know, all I can say, is that we’re investigating that,” Hegseth said. “We, of course, never target civilian targets.”
Given Minab’s location in the southeastern part of Iran, Lewis believes it’s more likely the U.S. would have conducted the strike than Israel. As one gets farther south and east in Iran, “a strike is much more likely to be a U.S. strike than an Israeli strike because of the type of munitions and the geographic location,” he said.
Esmail Baghaei, the spokesman for Iran’s Foreign Ministry, called the strike “deliberate” and said that the U.S. and Israel bombed the school in part to tie up Iranian forces in the region with rescue efforts. “To call the attack on the girls school merely a ‘war crime’ does not capture the sheer evil and depravity of such a crime,” he said.
But Lewis said it’s more likely that the strike was the result of an error. Satellite images show that the school and clinic buildings were both once part of the base. The school was separated from the base by a wall between 2013 and 2016. The clinic was walled off between 2022 and 2024.
Lewis believes it’s possible American military planners had not updated their target sets.
“There are thousands of targets across Iran, and so there will be teams in the United States and Israel that are responsible for tracking those targets and updating them,” he said. “It’s possible that the target didn’t get updated.”
The Pentagon did not immediately respond to NPR’s request for additional information about the strike.
NPR’s Arezou Rezvani and NPR’s RAD team contributed to this report.
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