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Wednesday, 02 September 2009 14:45

Free clinics feel recession’s pinch

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Amy Street thought she could finally afford health insurance this year. But that was before Street’s employer slashed 25 hours from her 40-hour work week.

Street, a 62-year old Waynesville resident, recently applied for retirement and social security benefits, but said while that would help, it’s simply not enough.

When Street was recently told she might have kidney cancer, she fretted about more than her health. She worried she would lose her car and her home trying to scrape up enough money to pay for expensive treatment. Even worse for Street was the possibility of no one being around to care for her disabled daughter.

“I was in shock. Sometimes, I cried. Sometimes, I said wait and see,” said Street.

Luckily, Street learned she did not have cancer, but her continuing kidney problems have driven her to seek on-going care at the Good Samaritan Clinic of Haywood County, one of the few free clinics in Western North Carolina. While she waited for her appointment on a recent afternoon, a fellow patient who did not want to be named said she found out she had cancer just the day before.

Patients like Street represent almost 19 percent of Haywood County residents who are uninsured, a figure that includes 1,400 children.

While the number who can’t afford health insurance is on the rise, free clinics like the Good Samaritan are facing economic woes of their own due to funding cuts, forcing them to scale back services at a time they are needed most.

The Good Samaritan Clinic, which has offices in Waynesville and Canton, has reduced services by 40 percent and is no longer accepting new patients, who once came in droves of 40 each week.

The clinic had 4,500 patient visits last year, but can only afford to see 2,590 this year due to financial constraints.

Haywood County cut half of its funding to the clinic last year and ceased its funding completely this year, although it still allows the clinic to use one of its buildings for just $1 a year.

Donda Bennett, executive director of the clinic, said there’s little the clinic can do but step up fundraising efforts.

“Our budget is cut and dry, as bare as you can make it,” Bennett said. “There’s nowhere to cut it and still provide quality health care.”

 

No free ride

At a time of increasing need, free clinics across the area have had to turn away patients.

“We’re seeing a huge number of new patients coming to the clinic. People that have either lost their job or lost their insurance or both,” said Jerry Hermanson, executive director of the Community Care Clinic of Highlands-Cashier. Patients there are now waiting as long as three weeks for their appointment, and though the clinic does allow walk-ins, it has had to send away patients “more and more,” Hermanson said.

Haywood County’s Health Department, which sees 1,000 mostly uninsured, Medicare and Medicaid patients each month, no longer offers clinic hours on Tuesdays and Thursdays and has eliminated five positions. The department’s budget has decreased to almost $4.9 million, compared to about $5.7 million last year.

While government support is important to free clinics, contributions from individuals are just as vital. The Community Care Clinic of Highlands-Cashier has seen donations from individuals fall 20 percent below what was budgeted this year.

The Good Samaritan Clinic of Haywood County is reaching out to individuals and local churches but is still below target.

“A lot of people just think, we’ve been around since 1999, so surely we’ve figured it out and are able to support ourselves,” said Bennett. “Some people might not just realize it totally depends on individuals and organizations.”

While securing grants would certainly help, these types of clinics face tough competition.

“Most grantors want to fund something new and innovative and fun,” said Bennett. But when free clinics can’t even afford basic operational costs, it’s hard to pursue creative projects like the ones that attract potential grantors

Becky Olson, executive director of the Good Samaritan Clinic of Jackson County, also acknowledged that securing grants has been a bigger struggle this year with less money and more competition.

“At this moment, I’m working on four different grants to get a little piece for here, a little piece for there,” she said. The clinic is also trying to get more doctors to volunteer to expand the clinic and accommodate the increase in demand for services.

Meanwhile, the Community Foundation of Western Carolina has recognized the needs of clinics like Good Samaritan and the Community Care Clinic, and provided assistance through its Recession Response grants.

And the Good Samaritan Clinic of Haywood County is receiving help from churches that have stepped up and added the clinic to their budgets.

Dalton’s Christian Bookstore in Waynesville is teaming up with the clinic for nearly three months, to offer customers an opportunity to donate to the clinic, while the clinic will go in and do blood pressure checks on customers.

Good Samaritan continues to give presentations to a lot of churches to hopefully raise awareness about the clinic’s existence, as well as its troubles.

 

Turning to the big guys

Good Samaritan has been in talks with Haywood Regional Medical Center for two months now to see if the hospital can contribute financially to the clinic, as well as donate medical and office supplies.

HRMC already donates thousands of dollars annually in free laboratory and radiological services to the clinic each year.

“The hospital really realizes that we are struggling right now. By us cutting services, it puts them in a situation where they have to see more people who are uninsured,” said Bennett.

For every patient who does not pay up for an emergency room visit, it costs the hospital an average of $400, according to Good Samaritan’s research.

Carole Larivee, a retired nurse who works part-time at HRMC and volunteers at Good Samaritan, said helping the clinic would be beneficial for the whole community.

“The hospitals can’t turn people away who come to the ER. By the time they get to the ER, treatment is very, very expensive because they had to wait so long,” Larivee said. “Even before I was with Good Samaritan, I would see people admitted to the hospital because they couldn’t go to the doctor for preventative care. They had to get very, very sick.”

By the time the patient got to the ER, it would sometimes be too late, she said. “Whereas, if they had been seen regularly, what was wrong with them could have been treatable.”

Hermanson said about 10 to 12 percent of patients at Community Care Clinic would go to the emergency room if the clinic were not open. But most of the patients he sees at the clinic do not say they would have rushed to the nearest hospital.

“We ask every patient on every visit, ‘If we weren’t here, where would you have gone?’” Hermanson said. “The vast majority of patients say we wouldn’t have sought treatment.”

 

Catch-22 for the underserved

Carmine Rocco, health director at Haywood County Health Department, emphasized the need for the public to do their best to stay healthy, especially now.

“As more folks become uninsured, it’s even more crucial now that people do what they can personally to help reduce the risk factors that they have control over,” said Rocco.

The underlying issue, though, is that uninsured people who face a chronic condition have trouble managing what would be easy to handle — if they could afford care.

“Most people don’t worry about prevention if they feel well,” said Hermanson. “They may be diabetic and not treating it. Promoting wellness is a great thing, but getting it accomplished is another.”

Hermanson said one of the first patients at his clinic came in with a blood sugar level of more than 500, when 105 is the highest end of normal.

“It’s people like that who end up in the emergency room,” he said.

Street confirmed that it has been difficult for her to stay healthy without insurance.

“It’s really frustrating because you want to be ahead of the game to keep yourself healthy, but you can’t afford to do that,” she said. “It’s disheartening.

Even when patients get in through the door at swamped clinics, some have concerns about the quality of care.

Cynthia Teesateski, 49, said she worried that health care available to the uninsured might not stand alongside the care offered to patients backed by insurance companies.

Street said the urologist she was referred to did not fully inform her about her kidney troubles. It was only after she hunted down information on the Internet that she discovered more about her condition and decided to schedule another appointment at Good Samaritan.

Even if she wonders sometimes about the care she receives at clinics, Teesateski said she glad to have someplace to go to – for now. “As I get older, what’s going to happen? Will I have any place to go?” she asked.

Donna Brooks, a 46-year old patient at Good Samaritan in Canton, said she doesn’t worry about the care she receives at the clinic she refers to as her “lifesaver.” She has even become good friends with her doctor there.

Brooks is an avid supporter of the clinic and hopes it will make it through the recession.

“There should be no reason for these clinics not to stay open,” Brooks said. “If they don’t, not only me, but hundreds of people, are going to be in a world of hell.”

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