Charitable Care in the Age of COVID-19

By Cari Wade Gervin
Tuesday, September 8, 2020

Clinics and organizations are struggling to serve patients as coronavirus cases rise and the number of people with health insurance declines.

Angie Settle, DNP, APRN, BC, FNP, knows about tough times. As the CEO of West Virginia Health Right — a charitable care organization that provides mobile medical, dental, pharmaceutical, vision, behavioral health and health education services to approximately 28,000 West Virginians, Settle has seen impoverished patients in Charleston, West Virginia, having rough times for more than 23 years. But she’s never seen anything like 2020.

“We have a population that’s already in need due to chronic diseases, and then you have the pandemic on top of it — it’s distressing,” Settle says.

West Virginia Health Right is a member of the National Association of Free & Charitable Clinics (NAFCC). The consortium of clinics had been serving an estimated 2 million patients out of the nation’s 28 million uninsured. Now, given the massive job losses across the country, both numbers are likely to rise.

“There’s going to be a lot of need beyond just the pandemic,” Settle says.

Catching Up After Closures

The pandemic ruined months of plans for Remote Area Medical (RAM), a self-described nonprofit provider of free pop-up clinics that operates domestically and abroad.

“We started up 2020 prepared to bring more than 70 clinics to communities across the U.S. to provide much-needed free health care,” says Jeff Eastman, the CEO of RAM. “We had to suspend these clinic operations until the end of July, and the decision to suspend clinics didn’t come lightly to us.”

Based in East Tennessee, RAM hosts weekend-long clinics in rural and underserved areas to offer free dental, vision and medical care. In the past, people would wait in long lines for hours to get services. Since that’s no longer safe due to the threat of the coronavirus, RAM had to scramble to determine a timed appointment system, along with new procedures and protocols to ensure social distancing and safety, including a new air flow sanitation processes.

After two small test clinics in July and August, RAM planned to host just eight clinics over the fall. But it has begun to offer telemedicine for the first time ever, which has tremendous implications for patients who sometimes travel hours and spend the night in parking lots to gain access to clinic services.

“What’s really neat about that is patients won’t need to come to our clinics physically,” Eastman says. “They’ll be able to call in to get medical advice and treatment without leaving their home.”

“There’s going to be a lot of need beyond just the pandemic because so many businesses have closed, and people have been out of work for a long time. You cannot just recover from that quickly. It’s a long row to hoe.”
— Angie Settle, DNP, APRN, BC, FNP, CEO of West Virginia Health Right

Volunteers and Funds Needed

One of the biggest problems facing charitable care during the pandemic is a drop in both donations and volunteers. Every kind of nonprofit has been hit hard financially this year, but medical clinics have newly increased costs.

“We had huge new pain medication costs, because all of a sudden we’re treating so many people, and then there’s all these other people [who lost employment and health benefits due to the pandemic] that suddenly don’t have insurance,” Settle says.

The need for new and expanded PPE has also added expenses, but Settle has had to cancel and postpone West Virginia Health Right’s two annual fundraisers, which were expected to add around $100,000 to the clinic’s $5 million budget.

“We’re accustomed to relying on grants,” Settle says. “If we’re somewhat financially sound and there’s an emergency and we need to do something, we do it. We kind of go out on faith and say, well, the money’s going to come. … So far we’ve been okay … but the bad part is you hate to get people out of the habit of coming to yearly events. So we worry about the long-term ramifications of that as well.”

Eastman says the temporary loss of some of their all-volunteer physician and nursing staff has made it harder for their clinics to operate.

“Not having clinics has certainly impacted our visibility, which inevitably makes it harder to recruit volunteers and receive donations,” Eastman says. “Due to the COVID-19 pandemic, a lot of our volunteers are not able to show up in the same way.”

“We’re all in this together. RAM has always been about neighbors helping neighbors, and this is certainly true during this time. Now more than ever, people need access to health care.”
— Jeff Eastman, CEO, Remote Area Medical

Looking to the Future

Is it possible anything good could come out of this stressful time for charitable clinics? Settle is skeptical.

“The need for charitable care is going to skyrocket with the economy the way that it is, the long-term ramifications of unemployment and so many places not reopening,” Settle says. “That’s probably been my biggest fear as far back as when this started.”

Eastman says he’s doubtful any healthcare policy changes will happen at the federal level any time soon, despite the increased need for medical care.

“No matter where we go with our with our clinics, whether it’s states that have expanded or have not expanded Medicare, whether it’s the hills of Appalachia or Baltimore or the middle of Florida or one of the richest counties we have in the United States — Orange County, California — the need is always there. We always have people lined up to receive care, and we always have to turn people away,” Eastman says. “I would love for us to be out of the business of providing health care to everyone in the United States who needs it ... but at this point in time, I don’t think it’s going to happen.”