Community health centers across Santa Clara County have served some of the poorest neighborhoods for decades, often as an entryway into health care for those who lack access, money or are undocumented and hesitate to visit larger clinics and hospitals.
But many are now experiencing the same financial struggles businesses across Silicon Valley are facing while residents shelter in place to mitigate the coronavirus crisis and some are making cuts to stay afloat through the coronavirus pandemic.
A product of civil rights movements in the 1960s and 70s, the organizations are often “one stop shops” for medical, dental, nutritional and mental health care. Visits have dropped between 50 percent and 95 percent as people are putting off non-urgent care or are too scared to come in. But when clinics physically can’t see patients or charge for care, providers don’t get paid.
“The patients we serve are poor. They were the first wave that lost their jobs, and they’re not able to either pay for their visit or they’re just not coming because of the shelter in place,” said Dolores Alvarado, CEO of Community Health Partnership, a consortium of 10 organizations boasting 40 sites from San Mateo to Gilroy. “They’re already marginalized, they’re already at the very bottom. That’s why it’s hitting us the hardest.”
In a typical year, Santa Clara County community health centers treat 135,000 people and about 80 percent sit not far from the federal poverty line, often earning less than $25,520 for an individual or $52,400 for a family of four. More than half of the families are covered by MediCal and 33 percent of patients are undocumented immigrants, according to Alvarado.
“We are a safe, trusted entry point,” Alvarado said. “We don’t ask you if you have documents, so there’s that sense of security.”
Each of the area’s 10 nonprofit community health centers has pursued fundraising, grant writing and stimulus funding if eligible, but that’s a short-term solution if operations take months to ramp back up.
Gardner Health Services – which had 620 staff members across 10 locations in the county – has already reduced its staff by 135 people, as it loses an average of $250,000 a week. That’s a $4 million deficit through the end of the fiscal year, despite previously being on track to have the best year in half a decade.
“Our goal is to get everybody back and build it up, but all those efforts are to give us the opportunity to survive – we’re looking at six to eight months out,” Gardner CEO Reymundo Espinoza said. “I think it’s a matter of who has the financial health to survive to maintain the capacity to provide the services, because the demand is only growing. There’s more people who are unemployed now who will need access to insurance like MediCal because of COVID-19.”
So far, $2 million of that deficit has been filled through lines of credit and other avenues, but Espinoza still loses sleep over the pressure to stay viable.
“The weight is that the community has organized for the last 50 years to create an organization to help itself survive and create a better future for our community,” Espinoza said. “Health care is an avenue to creating a better life. Having a healthy mind and body will hopefully help you fulfill your dreams.”
But why do people choose a community health center for care? In a word, accessibility.
Clinics sprinkled across the South Bay offer services in more than 40 different languages for non-native English speakers, including Spanish, Vietnamese, Hindi, Farsi and Mandarin. There’s also culturally catered services for Asian, Hispanic and Native Indian communities.
“Over the years we have honed this way of thinking, which is very culturally sensitive,” Sarita Kohli, CEO of Asian Americans for Community Involvement, said. “That’s something that’s front and center in the way that we do things, whether that is somebody coming from India, Ecuador or Iraq. The lens through which we look at our patients and our clients is that culture is a huge part of who they are and how they understand health care and how they behave.”
The organization was established in 1973 to support and advocate for Southeast Asian refugees coming to the area. As demographics of Silicon Valley changed over time, so have the growing underserved populations the organization serves.
A newly-opened center in East San Jose near Happy Hollow Zoo is now closed to streamline limited resources to the Moorpark health center during the COVID-19 pandemic. So far, the organization has sustained its 170 employees, which serve 3,000 patients and 18,000 community members through in-demand services like domestic violence shelters and senior meals.
Unfortunately, the funds won’t last forever, and staffing will be a challenge, Kohli said.
Luckily, being anxiously strapped for cash is not new for nonprofits – many with just two months of runway in the bank to weather a downturn – because making money isn’t the main concern.
“In the moment, when you’re serving the population and they have these very immediate needs, how do you say no? You just have to step up, that’s what you’re here for,” Kohli said. “Yes, we have to be paid to provide care, but at the same time, this is the time when the community needs us a lot.”
Santa Clara County officials are renegotiating contracts to help alleviate financial drops. Keeping these clinics afloat is a priority because they not only provide a critical safety net service for residents, but they supplement a complex system of public and private providers, including O’Connor Hospital, Stanford and Kaiser Permanente, said Santa Clara County Board of Supervisors President Cindy Chavez.
Closure of community health centers may inundate the rest of the health care system, she said. But that’s not a possibility Chavez wants to consider, because it would also be a direct hit culturally, financially and emotionally to the communities in which they’re rooted.
“They’ve been around a really long time, so they have these really trusted relationships with communities,” Chavez said. “We rely on them, and our job is to protect them, because they protect others.”
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