The New York Times covered the wave of rural nursing home closures, which come amid financial problems and aging Americans’ changing preferences, in a deep dive published Monday.

The article zeroed in on the closure of a nursing home in Mobridge, S.D., which was taken over by Black Hills Receiver after former operator Skyline Healthcare fell apart in several states, including Nebraska, Kansas and Pennsylvania. Representatives for Skyline cited lease issues and reimbursement problems as causes of the collapse at the time.

Over the last 10 years, more than 440 rural nursing homes have closed or merged, according to research from the Cowles Research Group cited by the Times. This often leaves residents without options for care in their communities, since home health aides are hard to find and difficult to afford, while senior-citizen apartments frequently have waiting lists, the Times reported.

Most of the closures stemmed from financial reasons, while 36 have been forced to shutter because of a failure to meet health and safety standards, the Times noted. The financial reasons include changing policies that encourage seniors to choose independent apartments, assisted living, or home care; staffing struggles; and losses from falling occupancy rates and low Medicaid funding.

South Dakota pays less than any other U.S. state for long-term care residents on Medicaid, and the low payment level has led to a crisis, Mark Deak, executive director of the South Dakota Health Care Association, told the Times. Nursing homes in the Mount Rushmore State are facing a $42 million yearly shortfall in Medicaid reimbursement, The Argus Leader reported in January. While South Dakota Gov. Kristi Noem proposed a 5% increase in the state’s Medicaid rate, Deak told the Times that will not be enough to cover the losses.

The problem for South Dakota and rural states is that while they have enough long-term care beds to meet statewide needs, individual communities do not have enough options, the Times said. Available beds can be far away from a closed facility, and the transferred residents can be placed in SNFs far away from their friends and family.

One former resident of the Mobridge facility, for instance, was moved to a nursing home 20 miles away from his wife, while another ended up in Aberdeen, S.D., which is 100 miles east. Some went to other states altogether.