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After more than two years of unprecedented challenges brought on by the Covid-19 pandemic, U.S. safety net health centers, which serve the nation’s most vulnerable populations, are now facing several of the same pandemic-era problems but with a twist, due to inflation – which is now at its highest level in 40 years.
Many community health centers around the nation have reported staffing shortages, and a majority reported increasing demand from their patients for services in addition to primary care, such as mental health care and food banks, according to a recent Kaiser Family Foundation survey that was conducted at the end of last year. Community health centers also reported that patients continue to experience transportation-related issues.
June’s Consumer Price Index showed an increase of 9.1% from June 2021, according to data from the Labor Department. Medical care services and costs have increased by 4.8% and 3.2% respectively during that same time. However, this seemingly good news is mitigated by the fact that the medical care sectors have increased more than 109% since 2000, whereas all goods and services have increased by about 70% since then.
Since Jan. 1, 2022, Direct Relief has provided U.S. health facilities, including community health centers, with more than $121.6 million worth of medical aid and grants of more than $19.1 million to support health efforts.
Transportation Challenges
As an example of how long-time issues, which were exacerbated by the pandemic, have continued to confront health care centers in the current inflationary environment, health care providers at safety net clinics have reported that patients are reluctant to drive to their appointments due to the high price of gasoline.
“Gas prices have risen, and that’s a very big concern (for patients). I have a few clients who prefer to stay with telehealth because of the commute,” said Brooke Serrano, a clinical social worker at Utah Partners for Health.
Utah is facing one of the highest rates of inflation in the U.S., according to a report from the U.S. Congress Joint Economic Committee. That report showed inflation in Utah was tied for the highest in the U.S. at 14.9% in June.
Transportation concerns, along with several other ongoing challenges facing patients and staff, have been tracked by the National Association of Community Health Centers, or NACHC, the national-level advocacy, support, and research group for community health centers, over the past few months.
“We’re concerned patients will cancel (appointments) because they can’t afford to get there,” said Ben Money, senior vice president for public health priorities at NACHC, about patients throughout the country during an interview with Direct Relief in May.
“Efforts to utilize telehealth to provide services are important now. During a pandemic, we found telehealth provided good access and continuity to care,” he said.
Along with transportation issues, NACHC also noted that the overall economic environment could lead to more people seeking care at safety net clinics care at a time when the job market remains very competitive– which is leading to staffing shortages.
“There’s not a legislative bill in congress to shore up any debts health centers have,” Money said.
Federally qualified health centers are funded by a base grant from the federal government, which is about $650,000 annually. Additional grants, including from states, are available for certain add-on services and initiatives. These clinics, which all offer care on a sliding scale based on a client’s income, are able to bill Medicaid, Medicare, and commercial insurance companies.
“Health centers have to just figure it out,” he said.
Struggling to hire staff
Though providing services for more people, without additional funding, remains a concern, many clinics reported that staffing shortages are their most immediate problem.
“Our biggest challenge has been with regards to staff and wages. We have done multiple wage increases over the last two years, but those are not keeping pace with inflation, and we are really struggling to keep up,” said Janida Emerson, CEO of Fourth Street Clinic in Salt Lake City. She said some top staff members were forced to relocate because they could no longer afford to live in Salt Lake City.
“As those staffing shortages become more pronounced we have to close provider schedules, and that means reducing access to care,” she said.
Fourth Street Clinic’s Pamela Atkinson Center in Salt Lake City (Photo courtesy of Fourth Street Clinic)
Community Health Center, Inc., or CHC, also located in Utah, is also facing higher turnover than is typical for them.
“We have also found it extremely challenging to find candidates,” said Jennifer Thomas, executive director of CHC.
Thomas said that CHC has been forced to train staff while on the floor due to staffing pressures and their reluctance to reduce the number of appointments available to their patients. She said they have not had to increase copays or charges, even as they have increased salaries for staff.
At Utah Partners for Health, Serrano said staff members have been coming in to take turns staffing the desk on their off days.
barriers to health, Reduced
Among many of her patients, who range from three years old to 73 years old, Serrano said that inflation has hit hard.
“[Patients] come in and are crying about not having money to eat or for housing,” she said.
With such concerns about survival, she said “it’s nearly impossible” for her and her colleagues to help patients focus on taking care of themselves, especially when it comes to managing chronic conditions.
For her younger patients, Serrano said socializing has been impacted once again.
“Teens are coming in and saying they want to hang out with friends but don’t have money to do it, or get there, with gas prices,” she said.
Brooke Serrano, a clinical social worker at a community health center in Utah. (Photo courtesy of Brooke Serrano)
With such massive, structural issues, Serrano said she tries to focus on what she can do to help people on an individual basis. She recounted one story about a patient with diabetes, which can be very expensive to treat. He holds a minimum-wage job and lives with his parents. A monthly shot that his doctor prescribed was quoted at $500 per month.
“I can’t really help with housing, and I can’t necessarily fix his situation, but I can offer that empathy and other support,” she said.
Serrano called the patient’s doctor and explained his situation. Utah Partners for Health is also able to sometimes call insurance companies and negotiate on behalf of their clients. After the doctor’s discussion, she could help her patient secure a more affordable alternative, billed on a sliding scale.
Asked why she does not seek a higher-paying job, Serrano said that she continues to work at her clinic because she saw the importance of its services firsthand after she completed her undergraduate program and moved to Utah without insurance.
“I was struggling, I was a patient, and I recognized this is such a need in our community. When I continued on to my master’s program, I knew I wanted to serve this community,” she said
While inflation shows few signs of abating, Serrano said her goal at work will remain the same.
“I can’t solve all your problems, but how can I help and support you?” she said.
Since the start of the Covid-19 pandemic in 2020 and through current inflationary pressures, Direct Relief has shipped $615 million worth of medical aid to safety net health organizations in the United States, including community health centers. The organization has also provided more than $115 million in grants to support health services for vulnerable patients.
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