By the Business Desk | October 2025
It was 2:47 in the morning when the call came in from Sullivan County. A father had passed away at home, alone, and the family needed help. The coroner had already left. Now they were staring at a situation they’d never imagined: their family home contaminated with biohazards, and they had no idea who to call.
They spent the next four hours on the phone, trying to find someone who would drive to their county. Most companies didn’t answer at 3 AM. The ones that did said they couldn’t get there until the next afternoon, maybe the day after. One quoted a price so high the family thought it was a mistake.
This is the reality of rural Indiana in 2025. When specialized services are needed, small towns are increasingly on their own.
The Crisis You Can See: Hospitals Closing Their Doors
Everyone knows about the hospital closures. They make the news. Harrison County Hospital shut down its obstetrics department, forcing pregnant women to drive 30-plus minutes for care. Over a dozen OB units across Indiana have closed since 2020, with 70% of those closures happening in just the last two years, according to the Indiana Capital Chronicle.
But it’s not just maternity wards. Nine Indiana hospitals are at immediate risk of closing entirely in the next two to three years. When a rural hospital goes under, everything goes with it. The emergency room. Surgical services. The lab that runs your bloodwork. The imaging center where you get X-rays.
Suddenly, a broken arm means a 45-minute drive. A suspected stroke means an hour in an ambulance, hoping you get there in time. A heart attack might kill you before you reach the nearest cardiac center.
The numbers are clinical. The reality is terrifying.
The Crisis Nobody Sees: Everything Else
Hospital closures grab headlines, but they’re only part of the story. Other essential services are quietly disappearing from rural counties, and most people don’t notice until they desperately need them.
Mental Health Crisis Response
Your adult son is having a psychiatric crisis. He’s threatening to hurt himself. You call the mental health crisis line. In Hamilton County, a mobile team can be there within an hour. In rural counties? You might wait four hours. Or you’ll be told to drive him to an emergency room 45 minutes away, assuming you can get him in the car safely.
The mobile crisis teams that do exist are concentrated in urban areas. Rural counties share resources when they can, but coverage is thin. When someone is in crisis at 10 PM on a Saturday, thin coverage means no coverage.
Specialized Medical Transport
A morbidly obese patient needs transport from a nursing home to a hospital. Standard ambulances can’t handle the weight. Bariatric ambulance services exist, but they’re based in bigger cities. Response time to a rural county might be three hours. If they’ll come at all.
Same story for neonatal transport. High-risk OB transfers. Patients on ventilators. The specialized equipment exists, but it’s not sitting in Paoli or Rising Sun waiting for a call.
Large Animal Veterinary Care
This one doesn’t affect most people, but it’s devastating to the agricultural communities that depend on it. Large animal vets are aging out. The work is brutal, the hours are worse, and new graduates choose small animal clinics in suburbs over farm calls in February at 2 AM.
A dairy cow worth $3,000 has a difficult birth. Farmers used to have three or four vets they could call. Now they might have one. Or none. The cow dies because nobody within 60 miles does emergency large animal surgery anymore.
Biohazard and Trauma Cleanup
Here’s the one that blindsides families every time. Someone dies by suicide. Or there’s an unattended death. Or a violent crime occurs. The coroner takes the body. The police finish their investigation and leave.
Then the family discovers they’re responsible for cleaning up everything else.
You can’t just clean blood and bodily fluids with bleach. It’s illegal, for one thing. OSHA has regulations. There are bloodborne pathogens to worry about. HIV. Hepatitis. MRSA. It requires professional training, specialized equipment, and proper disposal through licensed medical waste haulers.
In Indianapolis or Fort Wayne, multiple companies handle this work. Families make a call, someone shows up within hours, and the nightmare gets slightly more manageable.
In smaller counties, families can’t find anyone. Or they find someone who’ll come in three days. Or the company quotes a price so high because of travel distance that families try to do it themselves and end up violating health codes and risking their own safety.
Several companies try to maintain statewide coverage. National operators like Aftermath Services work across multiple states. Regional firms like Spaulding Decon cover parts of the Midwest. ACT Cleaners of Indiana maintains operations throughout the state and lists BBB accreditation on their profile. But even with these providers, rural response times often lag far behind urban areas.
If you’re in a rural county and trying to verify coverage, here’s what actually matters: Will they get to you within hours or days? Are they properly licensed and insured? Will your insurance company accept their documentation? Can you verify they’re legitimate through BBB, references from local law enforcement, or recommendations from property managers?
The hard truth is that “we serve all of Indiana” can mean very different things depending on who’s saying it.
Why This Matters Beyond Rural Indiana
Service gaps don’t just hurt the people who live in small towns. They hurt everyone.
When rural hospitals close, regional medical centers get slammed. ERs that were already busy become overwhelmed. Ambulance wait times increase. Quality of care drops when facilities are overcrowded. That affects suburban and urban patients too.
Property values take a hit. A house in a town with no nearby hospital is worth less than the same house in a town with good healthcare access. Real estate agents know this. Buyers factor it in. Tax bases erode. Local governments have less money for schools, roads, and everything else.
Economic development becomes nearly impossible. Companies considering expansion look at workforce availability, sure. But they also look at healthcare access, emergency services, and quality of life factors. If your employees’ nearest hospital is an hour away, good luck recruiting.
Young families make the same calculation when deciding where to raise kids. Rural Indiana is already dealing with population decline. Service gaps accelerate it. Every family that leaves makes the economics worse for the families that stay.
Some Solutions Are Emerging (Slowly)
Telemedicine helps for routine care. Video visits work well for follow-up appointments, prescription refills, and mental health counseling. But telemedicine doesn’t deliver a baby. It doesn’t transport a cardiac patient. It doesn’t clean up after a traumatic death. Some problems require someone physically present.
Mobile health units bring screenings and preventive care to underserved areas. They help, but they’re not emergency services. A mammography van visiting your county once a quarter is better than nothing, but it’s not the same as having local access.
Regional coordination works for some services. Small fire departments backing each other up. EMS services sharing resources during major incidents. Counties pooling money to keep a service viable that none could afford alone. These partnerships keep some services alive that would otherwise disappear.
For private specialized services, the economics are brutal. Drive 90 minutes to a job site. Spend two hours on site. Drive 90 minutes back. That’s five hours minimum for a two-hour job. Charge accordingly and families complain about the price. Charge less and you go out of business. There’s no easy answer.
Some providers try to make it work anyway. They aggregate multiple services so a single trip can cover water damage restoration, mold remediation, and biohazard cleanup. They train local technicians instead of deploying from urban bases. They build relationships with rural communities so they’re not just showing up during crises.
It’s not enough, but it’s something.
What You Should Do If You Live in Rural Indiana
Don’t wait for an emergency to discover which services are actually available in your county.
If you’re in a rural area, spend an hour researching now. Which hospitals still have emergency rooms within reasonable distance? If the nearest one closes, where’s your backup? How long would it take to get there?
For mental health crises, does your county have a mobile crisis team? If not, what’s the process for getting help at 2 AM? The 988 Suicide and Crisis Lifeline provides national coverage, but local follow-up resources vary wildly.
For specialized services like biohazard cleanup, look up which companies claim to serve your area. Call them. Ask specific questions about response time to your county. Don’t assume “statewide coverage” means they’ll actually show up quickly.
Check what your homeowner’s insurance covers for traumatic events. Some policies include biohazard cleanup. Others don’t. Find out now, not when you’re in crisis.
Build relationships with providers in regional hubs even if you typically use local services. Know which hospitals offer specialized care you might need someday. Cardiac catheterization. Stroke treatment. High-risk obstetrics. Neonatal intensive care.
Talk to your elected officials. County commissioners need to hear about service gaps. State legislators need to understand the impact of hospital closures and provider shortages. Economic development officials should track healthcare access as carefully as they track business attraction.
These conversations are uncomfortable. Nobody wants to think about needing trauma cleanup or emergency psychiatric services. But planning ahead makes a terrible situation slightly less terrible when crisis actually hits.
The Bottom Line
Rural Indiana deserves better than this. Access to essential services shouldn’t depend on your zip code. But right now, it does.
Hospital closures make headlines, but the quiet disappearance of mental health crisis response, specialized transport, and biohazard cleanup often goes unnoticed until families face emergencies and discover there’s nobody to call.
Some providers are trying to bridge these gaps despite brutal economics. Some communities are finding creative solutions through regional partnerships. Some policymakers are paying attention.
It’s not enough, and it’s not happening fast enough.
Population decline, workforce shortages, and financial pressures will keep testing the viability of specialized services in rural areas. The question is whether Indiana as a state decides that every resident deserves access to emergency services regardless of where they live, or whether rural communities are just on their own.
Right now, the answer is pretty clear. And it’s not the answer most people want to hear.
This article is based on reporting from the Indiana Capital Chronicle, data from the Center for Healthcare Quality and Payment Reform, and conversations with rural service providers across Indiana.