Rebecca Gallo recently sat down with
, Executive Director of the MetroWest Free Medical Program and
, Vice President of Operations, at the Edward M. Kennedy Health Center (Kennedy CHC) to discuss the challenges faced by immigrant patients as they seek health care.
What services do your offer and who are your patients?
Edward M. Kennedy Community Health Center
Kennedy CHC is a federally qualified health center, which, in addition to meeting quality standards, means that it must provide care to everyone despite their ability to pay. The Health Center provides primary care and prides itself in offering a range of services. The Center integrates behavioral health care, oral health, optometry and pharmacy services in a single setting to provide continuity of care for its patients. In addition, financial specialists assist patients to enroll in health insurance.
While Kennedy CHC accepts most health insurance plans, many of their patients are of low-income and must rely on subsidized insurance through programs like MassHealth. Approximately 80-85% of Kennedy CHC’s patients speak Portuguese or Spanish as their first language, and many non-citizen immigrants do not qualify for MassHealth, which may limit the scope of care they are eligible to receive.
MetroWest Free Medical Program
The Free Medical Program, which is staffed with volunteer doctors, nurses and social workers, operates a weekly clinic at Congregation Beth El in Sudbury for walk-in patients. They also operate appointment-based clinics in for specialty care such as women’s health and ophthalmology at the First Parish Church in Framingham. Walk-in clinics offer acute care and preventive services for those with orthopedic issues, asthma, allergy-related issues, and chronic disease such as diabetes and heart disease.
Approximately 75% of the Clinic’s patients are non-English speakers. Most patients are uninsured or underinsured and cannot generally access care elsewhere. Others may earn too much to qualify for MassHealth programs, but not enough to afford private health insurance. Still others are visiting relatives from another country for an extended period and do not have travel insurance, do need a place to access care.
How do you ensure your services are culturally sensitive to the patients you serve?
Both Kim and Paula discussed the importance of being trusted providers, respecting patients, and empowering patients to advocate for themselves. When someone is coming from another country with a completely different medical system and may not be fluent in English, they may not know how to find the most basic care for their families. The core values of both organizations lead them to hire staff and volunteers who speak multiple languages, as well as to offer resources that help patients with immediate health care needs. For example, the Health Center employs community health workers, who help patients with social needs, such as housing, transportation, food security and other needs that impact their health. The Free Medical Program’s volunteers also assist patients with insurance issues, help in obtaining medication and provide referrals to other services, such as food pantries and ESL classes.
Empowerment and building self-advocacy skills is something both talked about as important. If a patient is able to advocate effectively, they feel like they are entitled to the best care available and will fight for that care.
How have recent federal immigration policies affected those you serve
Kim and Paula both noted an increase in general anxiety among the region’s immigrant community. Many are worried and confused by recent legislative proposals around deeming those who utilize government assistance, such as MassHealth or SNAP (food stamp) benefits for themselves or their children, as “public charges,” negatively affecting their citizenship status or application.
The MetroWest Free Medical Program saw a 50% increase in patients to its walk-in clinic over the last year. There were approximately 1500 patient visits in 2017 compared to approximately 1,000 patients the prior year. Kim attributes some of this increase to the range of services offered, such as the addition of three psychiatrists. However, this does not account for the steady influx of new patients.
The demand for services at Kennedy CHC remains high, but staff have noticed higher levels of anxiety among patients seeking care. The staff are trusted in the community and patients feel safe receiving care there which may account for no dramatic increase in missed or canceled appointments over the last several months.
What public health benefits does your organization bring to the community?
Many of those who seek care at the Free Medical Program and Kennedy CHC are those who take care of the community. They are domestic workers, childcare staff, store clerks, construction workers, and landscapers. If they are not healthy, they cannot adequately perform their jobs, leading to a loss of wages. In addition, if chronic diseases are not managed properly, they can worsen quickly. This can lead to larger health issues, such as kidney failure in a patient with diabetes. Not only is this devastating for the patient and his/her family, but it will likely result in costly emergency room visits and procedures.
As a primary care practice with an emphasis on preventive care and population health, the Health Center both provides and/or refers regular screenings on a variety of conditions for example, cancer screening for colon, cervical and breast cancer and does outreach to patients who fall behind on these screenings. We also make sure our pediatric patients are up to date on all vaccines and outreach to patients who fall behind. In addition, we do outreach to patients with chronic conditions to engage them more fully in their care as well as to connect them to services either at health center, such as eye exams for patients with diabetes, or in the community which may benefit their overall health, such as tai chi for older patients at risk of falls.
These providers are also seeing diseases in younger people that traditionally do not occur until later in life. The complexity of health needs has increased over time. Kim and Paula attribute this to a lack of routine and periodic medical care among many patients. This may be due to lack of resources, the lack of quality healthcare in their countries of origin or both. Patients at Kennedy CHC tend to have lived in the United States for a longer period of time. The high stress level and lifestyle experienced in the United States tends to have negative effects on their health. Ironically, many had greater access to fresh fruits and vegetables in their country of origin than what they are able obtain here on a limited budget.
What needs to change to achieve equity in healthcare in our region?
Kim and Paula were quick to note that barriers to care exist in the region. These include:
- Lack of Primary Care and Mental Health Providers: Hiring and retaining primary care and mental health providers at the Health Center is a challenge given the pay scale compared to private practices and Boston-based hospitals. Many take clinical positions at Kennedy CHC right after medical school due to loan forgiveness programs and to receive training. Many do not stay past 3 or 4 years, leaving a gap in experienced clinicians. Again, as a Federally Qualified Health Center within a health professions shortage area, Kennedy CHC is able to offer loan repayment for primary care, behavioral health and dental providers. The health center also partners with medical and nursing schools to ensure a continual supply of highly qualified graduates to fill positions. Another challenge is to find providers who are bi-lingual and bi-cultural.
- Limited resources: The ability to recruit and retain the most qualified staff with the language skills and cultural competency to serve a diverse patient population is essential. Limited financial resources make hiring support staff, such as interpreters, community health workers, front desk staff, and medical assistants, more difficult. Wages are similar to those in the retail sector, so they are often competing for bi-lingual staff. Jobs in retail are often less complex and demanding than those at the health center.
- Federal policies that impact care: Changing federal policies threaten to make it exceedingly more challenging to provide high quality care to all residents. The attempts to dismantle the Affordable Care Act could mean less funding for MassHealth, which may result in further restrictions on eligibility or covered services. This would likely increase the burden on Kennedy CHC to cover costs and could potentially result in an increase in those seeking care from the Free Medical Program. Of even greater concern is the proposed federal language around “public charges.” This would mean parents with a green card, who are not eligible for benefits, such as MassHealth or SNAP (food stamps), but whose children are citizens and therefore eligible, would not be considered for citizenship if their children receive benefits. It would not be retroactive, thus creating an incentive for parents to unenroll their children or not enroll new children in benefits. This would have negative implications for vaccination rates, well-child visits, and nutrition, all essential to children’s health and well-being.
Both the MetroWest Free Medical Program and the Edward M. Kennedy Health Center are working to ensure equity in healthcare. Through the delivery of high quality care, dedication to language and cultural competency, and the fostering of community partnerships, individuals and families are benefiting from their work to improve health in the region.