The Cove House Free Clinic lost 15% of its volunteers and saw a dramatic drop in donor funding — its only source of revenue — during the pandemic. But there was no reduction of people in their hometown of Copperas Cove, Texas, who needed care.

“We are still filling the same healthcare gap,” said Brian Hawkins, executive director of Cove House, which operates four emergency homeless shelters and a free clinic in the central Texas town. Last year, Cove House helped move 31 people into permanent housing, according to the Copperas Cove Leader Press.

According to Hawkins, the free clinic, which operates one night per week, was created out of necessity since many people staying at the shelter are uninsured or otherwise unable to receive health care from other sources. The clinics, all staffed by volunteers, focus on general health, women’s health, cardiac care, and mental health care.

Cove House’s response and challenges during the pandemic are reflective of free clinics across the country, according to Nicole Lamoureux, president and chief executive officer of the National Association of Free and Charitable Clinics.

“We are the community’s response to the health care needs in our area,” said Lamoureux.

The United States has about 1,400 free and charitable clinics that serve approximately 2 million people. Unlike federally qualified health centers, free and charitable clinics receive “little to no federal or state funding,” according to NAFC.

Most free clinics are not yet offering the Covid-19 vaccine because many vaccine-related grants and programs are through state and federal funding sources. To help fill this gap, Direct Relief granted $2 million to NAFC to support their member clinics’ vaccination efforts. An additional $250,000 Direct Relief grant to NAFC was for operational expenses. These followed a $1 million grant from Direct Relief to NAFC last year.

Though overall charitable giving grew by 2% last year, according to the Blackbaud Institute, nonprofits with under $1 million in fundraising revenue saw a 4% annual decrease from March 2020 to March 2021. Healthcare-related nonprofits saw a 4.2% decline during that same time.

Lamoureux said that NAFC clinics experienced a 40% decrease in funding last year.

“Once Covid hit, and the economy weakened, donations dropped,” she said.

In Copperas Cove, Hawkins saw this dynamic as well.

“Last March, with job insecurity, people kind of reeled in their giving, and they haven’t unreeled it,” he said. “We’re having challenges with fundraising in general.” Cove House had to reduce their clinic to one night per week instead of two.

Action During the Pandemic

Though most free clinics are not offering the Covid-19 vaccine yet, they are helping support vulnerable populations in their communities on several fronts. Chief among them, according to Lamoureux, are care coordination, testing, and holistic support.

Lamoureux identified that CDC documents are often written at about a 12th-grade reading level or higher, making them difficult to understand for many people. She said NAFC clinic patients read at a 4th-grade level, on average. As such, clinic volunteers and staffers focus on helping patients understand the latest guidance – and how they can receive care in their community.

For the clinics that can distribute the vaccine, some give it in ways that help make it easier for their patients. Some examples include mobile clinics and drive-thru clinics, depending on the needs of the community. Clinics are also offering tests through these methods, as well as on-site.

As the pandemic has also had a significant financial impact on many people, some free clinics have also stepped up to help their patients with food, clothing, and access to social workers.

Despite current challenges, Hawkins said that he is working on expanding the services his clinic provides, especially regarding mental health care, which he said is lacking in his area. Cove House was able to partner with a local hospital for a long-term lease, something which came about, partly due to the savings Cove House can provide for the hospital through its primary care services, Hawkins said. Texas has the 6th highest average emergency room cost per visit in the United States, at $2,318.

Hawkins said that while he is glad to reduce the strain on the health care system, his focus remains on giving people the basics they need to help themselves.

“If we can’t keep them healthy, we can’t help them work to improve their situation,” he said.

Since 2019, Direct Relief has supported Cove House with $5 million worth of medicines, medical supplies, and personal hygiene items.