Outgrowing its space
Monroe clinic is struggling to meet community's needs
A small clinic in the city of Monroe has more patients than the town's population.
The health center is an access point for many different types of health care needs. It's where people can get primary care, prescriptions, vaccines, dental services as well as help applying for insurance plans, getting resources and even getting transportation for patients to receive care.
Outgrowing its space, the Monroe Health Center highlights some of the challenges of getting health care in rural areas.
Outgrown In a 1,600-square-foot modular building just across from Monroe Grade School, physicians' desks sit between copy machines and refrigerators full of vaccines. Every cabinet is put to use, filled with test tubes, needles, syringes and wound dressings.
Employees duck into open rooms to make space for patients passing by the long, narrow hallway that is the only way of getting around the building. During appointments, healthcare workers often use speech-to-text technology to maintain patient confidentiality – because the walls are so thin.
"We've outgrown the space and have just kept putting band-aids over it," said Christine Mosbaugh, health communication and strategy manager for Benton County.
More than 800 patients are served at the Monroe Health Center, while the city of Monroe has only about 647 residents, according to census data.
That's because the clinic doesn't just serve Monroe residents. It's become a health care hub for the rural parts of three counties: Benton, Linn and Lane, she said.
Looking at patient demographics, 43% are Monroe residents, 26% are from Junction City and 14% are from Harrisburg. Some also come from Corvallis, Eugene and Cheshire.
"It's the only access to primary care and dental services in a 15mile radius," Mosbaugh said.
Monroe isn't a unique case. Rural communities represent nearly two-thirds of the professional shortage in primary care health, according to a U.S. Department of Agriculture report released in 2019. Because only 14% of Americans live in rural communities, they are over-represented in this shortage.
Benton County is facing a shortage of dentists, said Carla Jones, executive director of Linn and Benton Community Health Centres.
The Monroe Health Centre is also one of the few places that offers behavioural health services, Mosbaugh said.
Another draw that has the small facility handling a big caseload is that it accepts Medicaid insurance, she said.
Quite a few patients only speak Spanish, and a handful of staff at the health centre are bi-lingual, which also addresses a need in the community, Mosbaugh said.
Transportation is a big issue in rural areas, and that's true here as well, said Lizdaly Cancel, the clinic's health navigation service manager.
Besides an urgent care in Junction City about 9 miles away, the Monroe Health Centre is the only health care option for a lot of people, Cancel said. And with no nearby public transit line serving the area, sometimes, staff will go out and pick up patients with the county-provided vehicles.
Another challenge has been communicating the role of preventative care versus emergency care, Mosbaugh said.
Although the clinic often helps in small incidents at the school across the street, such as wound care, there are certain things that should probably be brought to urgent care instead, she said. That's a difficult message to communicate when the clinic is one of the few health care options in the area, she said.
But the centre does have its limitations. For example, they don't have the equipment to take X-rays, she said.
Like other health care settings, staffing has also been an issue at the clinic. There's a mix of full-time, in-house and rotating health care professionals who come through the clinic.
"We have been feeling the pains of the workforce shortage," Jones said.
The Monroe Health Centre hasn't had a permanent primary care provider since January, Jones said. Right now, two part-time family nurse practitioners fill those shoes.
Ever since the pandemic, the trend among health care professionals, especially specialized, experienced workers, has been to decrease their hours to part time and not accept full-time positions, Jones said. Still, she is optimistic about having more long-term staff and concentrating efforts to attract talent from the area, she said.
Monroe is one of six rural health care centres in Linn and Benton counties. While one might think it would be able to partner with another rural health care centres to pool resources, Mosbough said, it's isn't that easy.
The nearest health care centre is Alsea, and although the two cities look close together on a map, the geography of the terrain puts a lot of distance between them, she said.
Over the years, mainly the last five, the clinic has seen an influx of patients, Jones said. Staff is hoping to get a new building, and Benton County officials are working on it.
The replacement still would be a modular building, but it would be much bigger so it wouldn't feel as cramped. Officials are projecting a new building being 3,400 square feet.
With a nearly $1.9 million price tag, the project is a candidate to receive $1 million from the U.S. House Appropriations Committee. The rest would be covered by grants and county funding, Jones said.
Mosbaugh hopes that the new building will also allow the opportunity for a trauma-informed design. Many studies have shown how the colour, lighting, furniture placement and layout of a room can create a more calming, welcoming mood.
That's something staff wants to encourage in their "person-cantered care," she said.
"The population we serve comes from all kinds of lived experiences and we want to create safe, comfortable places," Mosbaugh said.