What Four Care-Proximity Measures Found Across 765 U.S. Destinations
We examined four separate registry based proximity measures in a frozen Retirement Lists release. The findings identify destinations where no qualifying source record fell within a defined straight line radius, not whether care exists, is available, or is suitable for an individual.
Written and researched by Grant Gibson
Research extraction tested August 5, 2026
Independently researched using government, academic, and other authoritative sources.
Retirement decisions can connect money, housing, healthcare, daily life, and place. When people consider where they may live, the proximity of hospitals, primary care sites, emergency-service hospitals, and nursing homes can help frame questions for further research.
Proximity alone cannot answer those questions. A nearby registry record does not establish provider availability, appointment capacity, care quality, insurance acceptance, operating hours, or whether a service meets a particular person’s needs. An absent nearby record does not prove that healthcare is absent.
This report presents four narrow findings from a frozen Retirement Lists metric release. Each finding uses its own official source, qualification rules, and straight-line radius. The measures are reported separately and are not combined into a score.
What this research examined
The analysis used the locked release:
metric-release-2026-08-05T23:02:43.942Z-4d008d4ca3a5fb81bacde2929101e46dd3f5cebe5686fd5f6d620dea65c39cb2
The complete release contains 987 destinations and 93,532 metrics. This report examines the frozen U.S. cohort of 765 destinations.
For each destination, the analysis checked four distinct measures:
- Available open FEMA RAPT/HIFLD hospital points within 12 straight-line kilometers.
- Available qualifying permanent HRSA adult-primary-care-likely sites within 15 straight-line miles.
- Available Medicare-registered hospitals reporting
Emergency Services=Yeswithin 30 straight-line miles. - Available currently active CMS-certified nursing homes within 15 straight-line miles.
Distances were measured from the destination coordinate. Destination coordinates are reference points for places, not home addresses, individual residences, or promised travel origins.
What a zero means
A zero has one exact meaning in this report:
No qualifying record from the named registry and source contract fell within the specified straight-line radius from the destination coordinate in this frozen release.
It does not mean:
- the destination is a care desert;
- no healthcare, hospital, provider, emergency service, or nursing home exists;
- care is unavailable;
- a source contains a complete local inventory;
- nearby facilities have capacity or appointments;
- a provider accepts a particular insurance plan;
- services are open when needed;
- care quality is poor;
- a destination lacks practical access; or
- the straight-line distance represents driving distance or travel time.
Registry presence also does not establish access, availability, capacity, suitability, or quality.
How records qualified as zero
A destination counted as zero only when all of the following were true:
- the metric was present;
- availability was available;
- the value was finite;
- the value was nonnegative;
- the value was exactly zero; and
- the sourceKey matched the required source contract.
Missing, unavailable, null, suppressed, negative, nonnumeric, duplicate, and wrong-source records never became zero.
The locked extraction test passed on August 5, 2026. It is designed to fail closed if the release identifier does not match the locked release.
The four measures
Open FEMA hospital points within 12 kilometers
This measure used open hospital points from the FEMA Resilience Analysis and Planning Tool/HIFLD source contract. The radius was 12 straight-line kilometers from each destination coordinate.
The official references are the FEMA ArcGIS item and its hospital feature layer.
Qualifying HRSA primary care sites within 15 miles
This measure used qualifying permanent HRSA sites classified under the research contract as adult-primary-care-likely. The radius was 15 straight-line miles.
The source was the HRSA Primary Health Care Facilities query service, interpreted with HRSA’s GIS developer documentation and health-center background information.
This is a registry-based site measure. It does not establish which services are available at a particular time or whether a site can accept a particular patient.
Medicare-registered emergency-service hospitals within 30 miles
This measure used Medicare-registered hospitals reporting Emergency Services=Yes. The radius was 30 straight-line miles.
The CMS hospital dataset contained 4,498 records, of which 4,454 had coordinates, or 99.02%. Only HIFLD/Census-assigned coordinates were used where coordinates needed to be assigned.
Active CMS-certified nursing homes within 15 miles
This measure used currently active CMS-certified nursing homes. The radius was 15 straight-line miles.
The CMS nursing-home dataset was modified June 1, 2026. It provided 14,695 active rows after deduplication by CMS Certification Number, with valid coordinates for every included row.
Findings
The four results below remain separate because they rely on different registries, qualification rules, service categories, and radii.
| Measure | Exact radius | Destinations with exactly zero available qualifying records |
|---|---|---|
| Open FEMA RAPT/HIFLD hospital points | 12 straight-line km | 96 |
| Qualifying permanent HRSA adult-primary-care-likely sites | 15 straight-line miles | 99 |
| Medicare-registered hospitals reporting Emergency Services=Yes | 30 straight-line miles | 2 |
| Currently active CMS-certified nursing homes | 15 straight-line miles | 9 |
Among the two larger zero sets, 18 destination slugs appeared in both the FEMA hospital-point zero set and the HRSA primary-care-site zero set. This is only a set intersection. It does not combine the measures, establish a broader condition, or support a composite care-access classification.
- 96 destinations had exactly zero available open FEMA RAPT/HIFLD hospital points within 12 straight-line kilometers.
- 99 destinations had exactly zero available qualifying permanent HRSA adult-primary-care-likely sites within 15 straight-line miles.
- 18 slugs were present in both of those separate zero sets.
- 2 destinations had exactly zero available Medicare-registered hospitals reporting
Emergency Services=Yeswithin 30 straight-line miles. - 9 destinations had exactly zero available currently active CMS-certified nursing homes within 15 straight-line miles.
These counts describe qualifying records within fixed radii in one frozen release. They do not determine whether a destination has adequate care, whether an individual can obtain care, or whether one place is a better retirement choice than another.
Download the 206-row CSVWhy these measures stay separate
Each measure answers a different, tightly bounded question. The sources identify different kinds of facilities, apply different qualification rules, and use different straight-line radii.
A FEMA RAPT/HIFLD hospital point within 12 kilometers is not equivalent to a qualifying HRSA primary care site within 15 miles, a Medicare-registered hospital reporting emergency services within 30 miles, or an active CMS-certified nursing home within 15 miles.
The 18 destination slugs found in both the FEMA and HRSA zero sets are therefore reported only as a set intersection. Their overlap does not create a combined measure, establish a care desert, or support a broader care-access classification.
Examples selected by a fixed rule
To avoid choosing examples for effect, this report uses predetermined selection rules.
For the 18 slugs in both the separate FEMA hospital-point and HRSA primary-care-site zero sets, the examples are the first three destination names in alphabetical order: Bethany Beach, Delaware; Colonial Beach, Virginia; and Ellijay, Georgia.
The emergency-service hospital zero set contains exactly two destinations, so both are named: St. Simons Island, Georgia, and Truth or Consequences, New Mexico.
For the nine destinations in the nursing-home zero set, the examples are the first three destination names in alphabetical order: Bar Harbor, Maine; Bisbee, Arizona; and Cape Charles, Virginia.
These examples show source-specific results in the frozen release. They are not city-level care reports and do not establish whether care is available, accessible, suitable, or high quality in any named destination.
How the findings were produced
The analysis used the locked release:
metric-release-2026-08-05T23:02:43.942Z-4d008d4ca3a5fb81bacde2929101e46dd3f5cebe5686fd5f6d620dea65c39cb2
The current release contains 987 destinations and 93,532 measures. This research is limited to the frozen United States cohort of 765 destinations.
A result counted as zero only when the metric was present, its availability was available, its value was finite and nonnegative, its value was exactly zero, and its source key matched the required source contract.
Missing, unavailable, null, suppressed, negative, nonnumeric, duplicate, and wrong-source records never became zero.
The extraction test passed on August 5, 2026. It fails closed when the release identifier does not match the locked release.
Source and coverage notes
The hospital-point measure used open records from the FEMA RAPT/HIFLD hospital item and its hospital feature layer. The finding covers qualifying points within 12 straight-line kilometers of each destination coordinate.
The primary-care-site measure used the HRSA Primary Health Care Facilities query, interpreted with HRSA’s GIS developer documentation and health-center background information. Eligible records were permanent sites; locations reported under 20 weekly hours were excluded, as were dental-only, school-based, mobile, pediatric, behavioral-only, WIC, pharmacy, vision, recovery, and similar sites not specific to adult primary care. The measure counted qualifying records within 15 straight-line miles of each destination coordinate. It is a bounded registry-based measure, not a complete inventory of primary care.
The emergency-service measure used the CMS hospital dataset. It contained 4,498 records, with coordinates for 4,454, or 99.02%. A hospital qualified only when the CMS record reported Emergency Services=Yes.
HIFLD and Census were used only to assign coordinates where applicable. They were never used to infer, supply, or alter emergency-service availability. Emergency-service status came from the CMS field.
The nursing-home measure used the CMS nursing-home dataset, modified June 1, 2026. The input contained 14,695 currently active rows after deduplication by CMS Certification Number, and every included row had valid coordinates.
Limitations
A zero means only that no qualifying record from the named registry and source contract fell within the stated straight-line radius of the destination coordinate in this frozen release.
Destination coordinates are reference points, not home addresses. Straight-line distance is not road distance, driving distance, travel time, transit time, or emergency-response time.
A registry record does not prove that a facility is open when needed, accepting patients, offering appointments, operating at sufficient capacity, accepting a particular insurance plan, suitable for an individual, or providing high-quality care. Absence from the counted records does not prove that healthcare or a provider is absent.
The registries may not be complete inventories of every local service. Their definitions, reporting practices, update schedules, and facility categories differ. The four measures also use different sources, rules, units, and radii, so their counts must not be blended or treated as directly equivalent.
The findings apply only to the identified release and frozen U.S. cohort. They do not account for a person’s health needs, mobility, transportation, finances, insurance, support network, preferred providers, or willingness to travel. They do not rank destinations or determine whether any place is a good retirement choice.
How to use these findings
Use a zero as a reason to investigate further, not as a conclusion about local care. Check current providers directly, measure routes from a potential home, ask about services and appointment availability, and confirm insurance participation.
Consider care proximity together with housing, household finances, transportation, daily support, and other retirement decisions. These findings are screening inputs, not personalized recommendations.
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