Dunkirk residents’ struggles reflect widespread issues in accessing health care
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The congregants of Assembly of Christian Churches in Dunkirk, NY, don’t just attend weekly services together. They are a community. Members know each other’s families and understand their aspirations and challenges. They share rides, meals, and advice.
Recently, several members came together, thanks to Pastor Rosa Estevez-Rosario, to discuss the barriers to good health they witness in their small community in Chautauqua County.
One of their most prevalent issues is one faced by many rural (and urban) areas: poor transportation options.
Transportation to medical appointments is hard to access, unreliable, and sometimes requires complex insurance approval. Related issues like a shrinking number of primary and specialty care doctors and an insufficient direct care workforce compound transportation woes.
Their group agrees: people in Dunkirk need broad change and investment in their community in order to achieve better health.
“Medical transportation is really becoming a nightmare,” said Ivette Quiñones. “People need treatment for a medical condition, but their condition gets deteriorated because they miss so many appointments. Not because they choose to, but because they can’t get there.”
In a town like Dunkirk where the poverty rate is nearly 27 percent, many residents rely on Medicaid-covered transportation services or public programs like the Chautauqua Area Regional Transit System (CARTS.) But accessing those options is not always simple or easy.
Ivette cares for her sister who has complex medical issues. Recently, her sister had an 11:30 am doctor’s appointment – but because of a scarcity of transportation options, the only available ride picked her up at 7:30 am and couldn’t bring her back home until several hours after the appointment ended.
“This is a person who uses a walker. It’s difficult for her to get around, and having to travel for so many hours is very uncomfortable,” said Ivette.
Blanca Rivera, another congregant, has faced similar issues. Blanca suffers from asthma, and has had her asthma triggered by having to share Medicaid transportation with other patients or drivers who smell of cigarette smoke. But she does not have many other choices to get to her doctor’s appointments.
Mary Adorno shared that at times, transportation companies will cancel right before an appointment without notification. She only finds out about the cancellation when she calls to ask why they aren’t there. Her friend and fellow congregant Debbie Ocasio sometimes takes days off work to help Mary get to the doctor.
A greater availability of home health aides would help with these issues by allowing people to receive some care at home, said Debbie, but there aren’t enough aides in the local workforce to meet those needs.
“Our senior citizens need programs. They need help.”
Ride troubles happen often for another reason: confusion and bureaucracy around insurance approval forms. People who need their transportation paid for by Medicaid must have their primary care physician complete a form, known as Form 2015, and submit it for approval. The form’s approval expires every three months. Missing that expiration date, or being unable to contact your doctor for a renewal, means patients will often be left in the lurch when they try to get to appointments.
Transportation within Dunkirk isn’t the only issue. Because of the lack of specialized services locally, resident Johanna Narváez has to travel up the Thruway to Buffalo to find mental health care for her children.
“Sometimes specialists have a six-month wait before you can get an appointment,” said Debbie. “Then you miss your appointment because you can’t get there, or your ride doesn’t show up, and so you have to wait another six months.” Missed appointments typically also result in the patient being charged a fee by the doctor’s office—an additional financial hardship.
Beyond medical appointments, lack of transportation has a broad health impact on residents.
“Without the ability to get around, it’s harder for people to be outside, visit the park, go to the library. If there is a big storm and you’re not supposed to go outside, how do you get groceries or medication?” said Pastor Rosa. “We have a church member who is in her 80s and still lives alone. She walks in town to get her groceries or anything else she needs. What will happen if she falls or gets hurt when she’s out? These things are all connected.”