Lack of access to care is definitely the primary factor. I've since moved away, but my elderly parents still live in Hampshire County. I've been horrified by the way my mom is treated by her providers and she doesn't have any choice to go to someone else because there is no one else or the wait lists make it impossible.

Big Y is expensive. Good stuff, but expensive. For cheaper groceries, I usually do Trader Joe's or Aldi. Try Mom's House for specialty Asian ingredients.

Farm stands: Atkins, North Hadley Sugar Shack, Barstow's on Rte 47