PHOTO ESSAY: Are Medicaid cuts responsible for this New England health care center closing?

FRANCONIA, N.H. (AP) — For more than two decades, residents in this tiny tourist town in the shadow of the White Mountains knew they could just drive a few minutes down the road to their community health center for a physical, a Vitamin B-12 shot or to get checked out for a case of the sniffles or high blood pressure.

But that changed last month, when this site of the Ammonoosuc Community Health Services in Franconia closed.

The nearly 1,400 patients, who are often older and with more health problems than others in New Hampshire, will have to drive farther for their health care — a tricky prospect for some, especially during the winter months. More importantly, they will lose the close-knit bonds they forged with staffers like Diane LaDuke, who greets everyone with a smile from her perch at the front desk.

On the center’s last day, longtime patient Susan Bushby, a 70-year-old housekeeper, stopped by to check her blood pressure — and to get a hug from LaDuke. Bushby had come to rely on LaDuke’s comforting words over the years and admits she is worried about finding the same kind of reception when she goes to one of Ammonoosuc’s other centers.

“I just really like it there. I don’t know, I’m just really going to miss it. It’s really hard for me to explain, but it’s going to be sad,” Bushby said.

Exhausted from working several weeks straight at a nearby inn, Bushby was talking about the center as she relaxed on her couch at her modest home in Lisbon. She often ends her day with cigarette and a glass of champagne. An avid angler, Bushby’s house was filled with photos and other Native American memorabilia and her dog Smiley was a constant presence.

As she talked about the center closing, Bushby had a basket of apples on the kitchen counter ready for the deer that show up in her backyard almost every day. She joked that the center’s doctor, Dr. Melissa Buddensee, doubles as her therapist at times because she “listens to her where other people don’t.”

For another patient, Marsha Luce, it’s mostly about ensuring her husband gets the kind of care he had come to rely on over the years. Recovering from cancer that resulted in him losing part of his left ear and jaw, Luce worries about longer waits to see his doctor and the loss of relationships built up over decades in Franconia.

The family, who moved to Franconia about 25 years ago, live in an old farmhouse that they renovated. Much of Luce’s time is spent caring for her husband, including keeping track of his appointment dates and all the various medications he needs to take. She also is a regular presence in the community, playing mahjong weekly with friends at the library and volunteering with the Head Start program.

Having to switch to another health center, she said, puts at risk the trust she and her husband have built up over the years at Ammonoosuc.

“It’s going to be hard,” said Luce, who was wearing a mask because she had a cold. “It’s a relationship that you can talk to people and you tell them something and you go, yeah, well, I’ve had cancer. Oh, let’s see. Oh, yeah. There it is in your chart. Do you know what I mean?”

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This is a documentary photo story curated by AP photo editors.