In October, a new community health center and pharmacy will be coming to Wheeler, Oregon. The Nehalem Bay Health Center and Pharmacy will replace an aging clinic that provided services to the region since the early 1980s. The new 16,000 square feet facility will double the capacity of the old clinic and will now provide some new services, such as dental care and x-rays. Marc Johnson is the president of Nehalem Bay Health District. Gail Nelson is the CEO of the new center. They join us to share more on what this new facility will mean for the community.
Note: The following transcript was transcribed digitally and validated for accuracy, readability and formatting by an OPB volunteer.
Dave Miller: From the Gert Boyle Studio at OPB, this is Think Out Loud. I’m Dave Miller. We’ve heard a lot recently about the challenges that health care providers are facing. There are real fears that a bunch of hospitals and health centers could close in the coming years. But a new community health center is going to open next month in Wheeler on Oregon’s North Coast. The Nehalem Bay Health Center and Pharmacy will replace an aging clinic that’s provided services in the region since the early 1980s.
Marc Johnson is the president of the Nehalem Bay Health District – that is the nonprofit that developed the new building. Gail Nelson is the CEO of the Nehalem Bay Health Center. They both join me now. It’s great to have both of you on the show.
Marc Johnson: Thank you, Dave. Pleasure to be with you.
Gail Nelson: Thank you, Dave.
Miller: So Marc, to start with you, I just want to start with the big picture. Why do you think Oregonians all over the state should know, should care about an expanded but still relatively small health clinic on Oregon’s North Coast?
Johnson: Well, that’s a great question. I think maybe there is a lesson for other communities about thinking big, about addressing local problems and concerns, and finding a way to mobilize community support to try to move the needle on those problems. And I think that’s what we have been able to do in a large way in a small community. You mentioned the health district being the smallest in the state. There are only a few more than 4,000 residents in the district, although we draw patients and residents to our skilled nursing facility from a much bigger area than that. But nonetheless, it’s a very small, very rural community that bought into a vision to create a modern health center and pharmacy with expanded facilities … and Gail can talk about some of the things that’ll be coming with the new facility when it opens next month.
I think the lesson is it really does take a village. It takes a huge effort by a lot of people to get behind a vision to improve the community and build for the future.
Miller: I want to hear more about that and how you, as you say, mobilized public support for this, including people getting them to say, yes, I will pay more in property taxes for this. But, Gail, why was it necessary to build a bigger and new health center? What were the limitations of the old one?
Nelson: Well, thank you, Dave. The old facility that we will be moving from has been here for a number of years. It was built, you could say before HIPAA was a factor. The walls are very thin, the hallways are very narrow. There is very limited space for our providers to expand. We actually had no room to provide dental services here at this facility, something that is sorely needed in this community. The other nearest dental facilities are 25 miles north or south of us, or over the ridge and closer to Portland. And it’s long been a vision of the governing board of directors to have a new facility so that we could better provide for the community in an expanded way.
Miller: When you started answering that question and started with HIPAA, I didn’t know where you were going. It hadn’t even occurred to me that pre federal requirements for confidentiality or privacy about health care and health care records, that an architect might need to consider how thick the walls are. So are you basically saying that somebody in room one, they could hear what was going on in room two?
Nelson: Yes, this is exactly what I’m saying and it’s very challenging, especially as we all get older and some have to speak louder when we’re communicating.
Miller: You mentioned dental services. My understanding is that there’s now going to be dental care there as opposed to, as you said, going 25 miles away or further.
Nelson: Yes.
Miller: What other kinds of services will you now be able to provide that you haven’t been able to provide in the past?
Nelson: Well, dental is for sure an additional service. We will also have the capability for radiology services for x-rays. And the other services that we currently provide, those will continue – primary care, well visits, immunizations, women’s health exams, behavioral health care, integrated behavioral health care – directly right here. We don’t have to send anyone to anyone else for behavioral health support. And some procedures, sports physicals and vision screenings. And we also have the only local provider for acupuncture and naturopath medicine, and of course our pharmacy.
Our pharmacy then will be in a much larger space where we will be able to have more over-the-counter items to sell. We’re also an open door pharmacy. That means that anyone can use our pharmacy. You do not have to be a patient here.
Miller: Marc, I’ve heard you in the past describe your nonprofit as, as you said earlier, the smallest health district in Oregon but one with the biggest plans. We cannot fact check that kind of a statement, but I do want to …
Johnson: You just have to take my word on that, Dave.
Miller: Well, I want to hear about the plans and the way they were developed. My understanding is it was back in 2018 that the district undertook what was a really a major strategic plan update. What was going on back then? It’s seven years ago now.
Johnson: Yes, exactly right. It wasn’t just an update of a strategic plan, it was the creation of a strategic plan, really for the first time for the district. We engaged a great team from Portland State University’s Nonprofit Center to help us do a lot of things, really do a deep dive into the demographic trends of our area [and] try to understand through community engagement. We held several town hall meetings and design charrettes where people could offer ideas about what they’d like to see in a new facility.
From that process, that strategic plan, three basic things came forward. One, the need that Gail has already addressed, to substantially upgrade facilities for local primary care, particularly dental services and a better pharmacy. So we will by the time this facility opens next month, have largely addressed that priority.
The second priority was to improve the quality and availability of care for an increasingly-aging population in our part of the coast. We, the district, in addition to owning this new facility, also owns a 50-bed skilled-nursing and rehabilitation facility in Wheeler, but it’s gone many, many years without renovation or upgrades. And that’s the second leg of our three-legged stool, so to speak, of trying to address better healthcare here. So we’re in the process of beginning the renovation of the care center, the Nehalem Valley Care Center.
The third leg of that is understanding that one of the great challenges throughout Oregon, maybe particularly on the North Coast, is the availability of workforce housing to provide alternatives for the people who are employed in these facilities. Between the care center and the new health center, we’ll have 75-80 employees in North Tillamook County working in health care. And virtually none of those folks are able to find a place to live in the three villages of Wheeler, Nehalem and Manzanita, which is the core of the health district. So the district’s third priority, in addition to the other two, would be to try to come up with a plan to create some options for workforce housing for health care and other essential workers in the community. So that’s what we’re working on and those are the big plans.
Miller: Well, to stick with the housing piece for a second, where does that stand right now?
Johnson: Well, the district owns a fairly dilapidated, old hospital building in Wheeler. It was built in the early 1950s and operated as a community hospital until 1989, but it’s fallen into disrepair. The district’s vision is to demolish that old hospital building and repurpose the property, which is owned free and clear by the health district, to create an opportunity to develop some workforce housing. It would be housing literally within walking distance for employees of the nursing home and our new health center.
So, we’ve enjoyed great support from the city of Wheeler in envisioning what that housing might look like. We’re in the stage of doing environmental remediation, or soon we’ll be doing environmental remediation, because it’s an old building. It’s got asbestos and lead paint that needs to be dealt with. Then we’ll move on to the demolition phase of that building, and hopefully be able to attract the attention and support of a developer that would be interested in developing maybe 26 to 36 really nice housing units that could be primarily dedicated toward workers in health care and other essential services here on the North Coast.
Miller: It reminds me a little bit of a conversation we had not long ago in Newport. We were talking with the then-director of the Hatfield Marine Science Center. And it’s this curious case where employers now are taking it upon themselves to create housing for their employees because it doesn’t seem like anybody else is doing it. So I would like to hear more about that in the coming years as you move forward with that.
But I want to go back to the other piece of this sort of three-legged stool of what you heard from residents when you said, what do you want for the future of this health district? And that’s this skilled nursing facility. You mentioned this briefly, but I want to dig deeper into this. What are the demographics of your area in terms of age?
Johnson: Well, it’s pretty simple, really. It’s an emerging retirement community in many ways. I mean, we have a very diverse population in many respects, a lot of people working in the service industry, taking care of visitors who come to the coast, working in the agricultural arena. So there’s a definite segment of the population that fits that demographic. But there are a lot of us like myself, for example, who have made a choice that this is where we want to live. It’s a great community in a beautiful part of the world, but that demographic is causing the bell curve, so to speak, to bend in the direction of a more senior population.
We’re trying to think ahead a little bit and try to anticipate the needs of that segment of the population. Eventually, some folks are going to need skilled nursing. They’re going to need additional rehabilitation services when they have a knee replacement and need the opportunity to have the rehabilitation that allows them to get back to independent living. So we’re trying to address that with the renovation of this facility, which is so critical to the community, Dave, because it’s really the only facility of its kind between Astoria and Newport on the coast. So it draws from a large area. We need to improve it and make it more attractive both for residents and for employees who are working there providing the care.
Miller: Gail, how do you think about the provision of health care, given the aging population that you’re serving that Marc was just outlining?
Nelson: And Marc is 100% correct. What we do here at the health center is we take a wrap-around approach to serving the individuals who come to receive care from us. And to Marc’s point, what we see is complexity in the type of care that we need to provide.
We also need to eliminate barriers for patients when they come to receive our services. We identified that some folks are no longer able to drive or do not have transportation, so we have a patient transportation program. We have two vehicles and we will go out and assist patients and get them here to the health center. We also know that some folks have food insecurities, so we have established a food box distribution program and we’re currently serving 150 individuals through a partnership with the Oregon Food Bank and Moon River Farms for fresh local produce.
I’d like to add one more point, Dave. You mentioned what we will be able to do in a larger facility and what additional services or partnerships are we able to form? And to that point, we have established a partnership with OHSU and we’ll be providing opportunities for medical and dental residents interested in serving rural communities to do a rotation through our health center. That’s going to really provide additional support for the community and providers.
Miller: Marc, the only reason you’ve been able to do these three projects – this new health center, the housing for employees and the renovation of the skilled nursing facility that’s underway – is that voters said “yes” to a bond measure ask back in May of 2023. Why do you think they said “yes?”
Johnson: Well, I think they said yes by almost 70% support because they really agreed with the vision that we had tried to articulate of better local health care close to home, so that people don’t have to travel, oftentimes great distances, to get the care that they need and frankly are entitled to; better opportunities to take care of the aging population that we’ve been talking about; and then the third piece is the understanding that we need to seize what opportunities do exist to try to address workforce housing.
One of the things that is a little hard to wrap your head around at times is spots where you can develop a housing component that might include 25 or 35 units, it takes a piece of property and the district does have that property. Ironically, it’s actually zoned for residential use. The old hospital was built under a conditional use back in the ‘50s, so we have all the elements there. We have the infrastructure in place. We have the property that’s owned by the health district. We have a willing community that’s willing to entertain this idea. And we just need some development partnership in order to try to pull it off in the short term.
So, the community really, really bought into the vision and I think there’s a genuine level of excitement about the fact that this new facility is coming online and there’s a prospect for even more improvements going forward.
Miller: Gail, am I right that the bond was just for capital costs, not for your ongoing operating expenses?
Nelson: Yes, Dave, that is correct. As the CEO, my challenge then became how are we going to furnish this new facility? And we were successful and approached a number of foundations for support. We are very thankful for that. Also, this grant funding allows us to … when the doors open, everything is going to be new. And that’s going to also be important for the community to experience it.
Miller: But where will your ongoing operational funding come from?
Nelson: We, as a federally-qualified health center, receive funding from HRSA, Health Resources and Services Administration. We also, of course, accept patients with insurance. And also, our revenue is generated through our pharmacy.
Miller: How much of your money comes from Medicaid reimbursement?
Nelson: Seventeen percent and I can tell where you’re going with that question.
Miller: Really, is it that transparent?[Laughter] Well, obviously this is a huge question for the entire country, but in a lot of ways, more dire for smaller or rural hospitals. So just to put some of the statewide numbers on it so that the question is not implied but explicit. There is a state analysis that some of our listeners may be aware of that Oregon could lose $11 billion in federal Medicaid funding over the next five years; 200,000 Oregonians could lose eligibility. How are you preparing for that?
Nelson: Very carefully. We were looking at other sources of revenue. And we’re also keeping a close eye on the impact. There’s some scenario planning that we’re doing. I think what’s most important is to continue to focus on our mission and look for opportunities to work within this new environment that we are in. I remain confident that our team here at the health center is going to rally and to make adjustments as we need to, without compromising quality of care to the community.
Miller: Really, one of the most basic questions, not from the perspective of a health care provider but from just Oregonians, is what happens if they become uninsured? Can you still see them?
Nelson: Yes.
Miller: How? And how do you not then just go out of business?
Nelson: Well, that’s what our mission is. We have to determine a way through this environment. It’s not the first time in the history of health centers that we’ve faced these challenges. What we do is we work together. There are 34 other health centers in Oregon, and with the support of the Primary Care Association in Oregon and also the National Association of Community Health Centers, they provide additional guidance to us and advocacy work with the legislators to push things through and make changes.
Miller: Gail Nelson and Marc Johnson, thanks very much.
Nelson: Thank you.
Johnson: Thank you, Dave. I appreciate the opportunity.
Miller: Gail Nelson is the CEO of the expanded and soon-to-open Nehalem Bay Health Center. Marc Johnson is the president of the Nehalem Bay Health District.
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