Balancing Country Homes Against Hospital Proximity SCENIC vistas and room to roam provide the serenity that retirees like Jim and Ava Higgins thrive on. The view from their one-acre property overlooks the town of Libby, Mont., with the craggy peaks of the Cabinet Mountains in the background. "We see grizzly bears, mountain lions, the whole nine yards," Mr. Higgins said of visiting the federally designated wilderness area nearby. But as idyllic as the setting has been for them for the last 10 years, the Higginses lately have thought about moving out. They don't mind that there is not much to do in nearby Libby, population about 3,000, with a hardware store, a few mom-and-pop shops and precious little else. What bothers them, as the years pass, is the area's lack of advanced medical care, Mr. Higgins says. The 25-bed St. John's Lutheran Hospital in town is considered a frontier, or critical access, hospital. And that has the couple wondering if they would be better off moving closer to a bigger, more advanced hospital. "What I would seek is a place with access to healthy lifestyle opportunities to include easy access to medical care," Mr. Higgins, 67, said. They drive to Kalispell, Mont., an hour and a half away, for some medical needs and to shop at the Costco there, he said. Otherwise, Spokane, Wash., is the nearest big city, about three hours away, while Missoula, Mont., is four hours away. Access to medical care and emergency services is a big concern for retirees living in rural areas. But not everyone can just pick up and move, said Mr. Higgins, who volunteers for AARP Montana. In fact, AARP statistics show that most Americans "retire in place." And with 72 million Americans, or 23 percent of the American population, already living in rural areas, the number of rural retirees is only expected to grow as the population ages and even more baby boomers opt for rural settings, an influx projected in the Agriculture Department's Atlas of Rural and Small-Town America. So how far out in the sticks can the rural retiree afford to safely live? It is difficult to provide a rule of thumb for acceptable emergency response times in every rural setting. And that may be the wrong question anyway. A better one might be: How prepared can I be? Specialists point out the obvious: every minute counts. And that means virtually all remote areas have a disadvantage when it comes to emergency responses. Consider the so-called golden hour, the critical time window for treatment of major traumatic injuries. That period remains constant whether trauma care is 1 minute or 59 minutes away. Other emergencies, like cardiac arrest and acute allergic reactions, demand even faster responses, according to Dr. Charlotte Yeh, chief medical officer for AARP Services. Emergency numbers stuck on the refrigerator or on speed dial aren't enough. She suggests that people planning to retire in a remote area improve their odds by taking a first aid and cardiopulmonary resuscitation class, or making sure their caregivers are trained. She added that those susceptible to life-threatening allergic reactions should have an epinephrine autoinjector or pen (EpiPen is one brand) for quick treatment. Beyond typical rural health outreach programs, some communities are taking more elaborate steps. A case in point is Whisper Mountain, a fledgling community about 19 miles, or 25 minutes, from downtown Asheville, N.C. The development offers home sites with views of the Blue Ridge Mountains - and what could be the ultimate hedge for retirees to the country: a new helipad, certified by Mission Hospital in Asheville for emergency landings and takeoffs by the hospital's helicopter. Troy Ball, one of the development's founders, said it was designed for people in their 50s and 60s who would "care how far they were from the hospital" - people like Meredith and Bob Stroud of Charlotte, N.C. They are several years from retiring, and yet when they build their home on the lot they bought, Mrs. Stroud, 53, said, they can do so with confidence, thanks to the helipad's access to advanced care an 18-minute flight away. "It's very reassuring to have it," she said. "You often hear residents of western North Carolina refer to them as "MAMA helicopters," " said Rowena Buffett Timms, the area health system's senior vice president for government and community affairs. MAMA stands for Mountain Area Medical Airlift. It's not uncommon to hear someone comment as Mission's helicopter flies over that "MAMA just saved another life." " The emergency helicopters reach patients at hundreds of designated landing pads in rural western North Carolina, she said. Among other concerns of rural retirees, the risk of fire is a challenge home occupants often face alone. When Jackie Martin, 57, and her husband, Steve, 61, moved to Cody, Wyo., from Indianapolis in 2008, Cody officials told them straight away, "Don't ever expect fire protection," Mrs. Martin said. So the couple, both retired police officers, installed Xeriscaping, water-conserving landscaping including cactuslike plants, which also enhances fire safety. They surrounded the house with creek rock to prevent prairie fires from getting too close and installed cement board on the outside of their house. Cody has only a volunteer fire department some 12 miles away, Mrs. Martin explained, and "it could be 30 to 45 minutes before they get here." When it comes to deterring crime, Charles Sczuroski, a senior trainer for the National Crime Prevention Council, cited normal precautions like alarms, medical alert devices, and the proper locks for doors and windows, which apply especially to older people in remote areas. Still, the council's advice now focuses on telemarketing, computer fraud and identity theft. "You can have the best alarm system, the best locks, the best windows," Mr. Sczuroski said, "but as soon as you go on the Internet, you are open to anybody who can scam you." A criminal can take more money in an online crime than if he broke into a home, he added. And what about getting a dog, a gun or pepper spray, all common in rural areas? "It is never a bad idea to have a dog or at least a sign that indicates that you may have a dog," said Mr. Sczuroski, a retired Rhode Island police officer. "Laws vary from state to state for possession of a firearm, pepper sprays etc.," he added. So, I would suggest folks check on local laws before they purchase anything. I am a big proponent of receiving proper training before using any of the devices you have mentioned. The training should be completed before the purchase is made. Attractive as rural living is, moving too far away from a safety net is not for everyone. When Ilona and Mike Sena moved to Asheville from New York City in 2004 in their mid-to-late 60s, their goal was to be near medical providers. They settled on a home set on two private acres just seven minutes from downtown, which their real estate agent said gave them "the illusion of seclusion," Mrs. Sena said. Two years into retirement, she added, they were glad they moved close to medical care. Mrs. Sena came down with the nervous disorder Guillain-Barré syndrome, experiencing weakness in her legs, trouble walking, acute pain and facial paralysis. After treatment at Mission Hospital and with the help of a specialist and physical therapy, she now walks with braces, drives with hand controls and leg presses 90 to 100 pounds at the gym. In spite of it all, Mrs. Sena said, "I love my life in Asheville, and we're very fortunate to be living here."