Nancy Harrison

Chaska resident Nancy Harrison received the COVID-19 vaccine last week after River Valley Health Services was notified that Carver County Public Health had extra doses. “It went just swimmingly,” Harrison said.

Eighty-three-year-old Nancy Harrison has ventured outside the one-bedroom apartment she shares with her son in Chaska precisely four times since March 14 of last year.

Harrison’s son suffers from diabetes and COPD, meaning both she and her son are at a higher risk of contracting a severe case of COVID-19. Harrison walled off a section of her living room to give her son a “bedroom,” and the only person they’ve come into contact with in nearly a year has been their personal care attendant.

“Sometimes you just have to do things that aren’t the easiest thing in the world,” Harrison said. “We’ve had a lifetime of being able to do whatever we want to do, and this is just a short-term thing we have to do to get through.”

Harrison said she was “frantic” to receive the vaccine when it was made available to seniors.

But many seniors eager to receive the shot have been hamstrung by a system that requires them to have the resources most of the country takes for granted: email addresses, cars, the ability to read English and a primary care doctor to tap them on the shoulder when it’s their turn to get in line.

In the southwest metro, River Valley Health Services, a free health clinic with locations in Shakopee and Chaska that is set out to provide free access to health care for vulnerable individuals with no questions asked, has helped many people with little access to resources breach those barriers. In the past year, the clinic has been forced to drastically change the way it conducts its operations, which has allowed it to reach far more individuals through phone calls and virtual visits.

After helping coordinate a vaccination for Harrison, the health clinic helped connect her with a free service to help her complete her taxes. That’s what comes with one connection to the little health clinic with two nurses and two interpreters on staff: it opens up doors for those who could never before find a key.

On the radar

Many clients who utilize RVHS are extremely underserved, Executive Director Bill Swanstrom said. That means they likely have a flurry of issues related to their health without adequate access to care, which is compounded by difficulties speaking English, unstable housing, a lack of transportation and inability to access or effectively use technology.

In a year when most every appointment and meeting has been forced to turn virtual, the clients RVHS most regularly worked with were at risk of slipping even farther through the cracks.

But the small staff working for RVHS saw to it that the most vulnerable individuals in the community were being taken care of. The health clinic works tightly alongside Scott and Carver counties and the Scott, Carver and Dakota County Community Action Partnership. When Scott or Carver County public health departments identified vulnerable individuals who had contracted COVID-19, the agencies notified RVHS, opening up more opportunities for the clinic to reach families in need.

At the beginning of the pandemic, RVHS delivered masks and hand sanitizer to the doors of clients. If a client tested positive for the virus, the clinic did its best to ensure they were in an environment where they could isolate themselves.

“We gave them educational instructions to make sure they were quarantined,” RVHS nurse Mary Klehr said. “If they needed food, we ordered it, and it was dropped off right at their house for them. We also gave them Tylenol or ibuprofen, and made frequent calls to make sure they were OK.”

Maritza Real, who is an interpreter for RVHS and also works for the CAP Agency, said the clinic also utilizes the food shelf and helped clients apply for the Supplemental Nutrition Assistance Program, or SNAP.

“These are people that aren’t on anyone’s radar,” Swanstrom said.

Going virtual

The pandemic has forced many people and businesses to adapt to virtual meetings, and RVHS was no exception. With the transition came many added benefits, though they didn’t come without obstacles.

Before the pandemic, RVHS was open two days a week: one day in Chaska and one day in Shakopee. Before the clinic went virtual, the nurses met with about 10 patients a week, “maybe less,” RVHS nurse Heidi Cianflone estimated.

But the pandemic prevented nursing staff from being able to meet patients face to face. This posed a challenge, since RVHS didn’t have the resources to seamlessly transition to remote appointments.

“We had to suddenly and abruptly convert to telehealth,” Swanstrom said, which “doesn’t cost a lot of money, but we don’t have a lot of money.”

The clinic received a grant from St. Francis Regional Medical Center in Shakopee, which allowed RVHS to quickly launch a telehealth program. Nurses were given work cell phones, so they became available to their clients 24/7 as opposed to twice a week.

“I’d get calls on a Sunday morning or at 10 at night that so-and-so needed approvals or had needs,” Swanstrom said.

The increased accessibility has allowed the clinic to reach substantially more people: from about 10 patient visits each week to 50 patient phone calls.

“We gave them our numbers, and they call us whenever they need anything,” RVHS nurse Heidi Cianflone said.

Another benefit to providing more virtual care has been the ability for patients to more easily access resources available to them, which they wouldn’t have otherwise known how to find. The digital-heavy year has created a more seamless channel through which the clinic can communicate with school districts and programs that might offer grants for certain qualifying patients.

“We’ve been a little more efficient at working through all the needs,” Cianflone said. “Helping people fill out those applications, signing those applications, working through whatever the need is.”

When a patient tests positive for COVID, the staff checks on the entire family, which multiplies the clinic’s reach.

“So now we’re trying to get those people doctor’s appointments and free vision appointments.”

RVHS staff said many of the free resources and services available to its patients would be difficult for anyone to find, let alone people who don’t speak English or aren’t tech savvy.

“We’re still learning about these services, so they would be lost without our help,” Klehr said.

For many community members who don’t speak English, having interpreters allows them to understand the different programs available to them.

“We’ve been able to reach more people, partner with different organizations, partnering with the CAP Agency, meeting a lot of needs for the community,” Real said.

Though the transition to virtual care has brought about many positives and helped RVHS reach more people, it could also be reflective of the greater need in the community since the pandemic began. Klehr said she’s “very concerned” about the needs of those without adequate access to care in the southwest metro, which she fears has been exacerbated by the pandemic.

“To keep them motivated, keep going to school, going back to work and finding jobs… I think that’s always been there, but more so now, because there aren’t as many jobs out there for them,” Klehr said.

Getting vaccinated

The challenge brought on in 2020 will be matched with an equally challenging task in 2021: helping those who slip through the cracks get access to a vaccine.

“One of the challenges now is there’s a lot of resistance to getting the vaccination, especially among the Hispanic community,” Swanstrom said, adding there’s a reluctance among about 25% of RVHS clientele to get the vaccine. The only thing RVHS can do about this issue, Swanstrom said, is educate clients.

“From a public health standpoint we strongly encourage everyone to get vaccinated,” Swanstrom said.

On top of that barrier are more practical problems: many clients aren’t computer savvy, Swanstrom said, meaning it’s confusing to sign up for a vaccination appointment online.

“There’s no way they could log into a system to make it work. So they need someone to do it with them, and they need an interpreter. The challenges right now with technology are essentially overwhelming. But our hope is it’ll get a little bit easier,” Swanstrom said.

Swanstrom said even if a client is tech-savvy and has access to technology, if they don’t speak English, “it’s hard to get scheduled for a vaccine in another language.”

“We don’t want our folks to fall through the cracks,” Swanstrom said. “We want to remove the barriers to health care for them. We want to be an advocate to help them get vaccinated.”

Cianflone said a few area residents like Nancy Harrison were able to get vaccinated because Carver County Public Health notified RVHS that it had a few vaccine slots left for any residents who needed it.

“It was just lickety-split,” Harrison, whose PCA drove her to the clinic, said. Her second vaccine is scheduled for the beginning of March.

For individuals without access to transportation, RVHS coordinates a public transit voucher to get them to their vaccination appointments.

On top of encouraging patients to get vaccinated and coordinating appointments, RVHS will prioritize connecting individuals with non-health care related resources.

“We’re trying to teach them how to keep up with what’s happening and not just let it go by, and trying to be good patients for survival in the financial system, as well,” Klehr said.