As voters get their ballots in the mail and contemplate whether or not they want to form a public hospital district, many locals have voiced an obvious question: If the vote fails, what will change for islanders — particularly those who are elderly — who currently rely on local primary care?

Chris Jovanovich, who runs the Vashon Care Network — a nonprofit that offers referrals for islanders looking for nursing homes and caregivers and helps coordinate a network of independent caregivers on Vashon — said that families will need to get creative if access to primary care is diminished on Vashon.

“If we do see reduced or no access to our current clinic, I could see how family members may need to rely more on a caregiver, volunteer or friend to help take their loved one to an off-island doctor’s appointment, especially if that family member is in the workforce and it is difficult for them to take time off of work,” Jovanovich said, adding that the time spent transporting elders to appointments will increase dramatically.

“If the person is alone, and in a more fragile state, instead of a 15-minute drive to the island clinic, they will be looking at at least a three- to four-hour round trip to the doctor’s office over town, which will be exhausting no matter how they get there,” she said.

Jovanovich also detailed additional resources, such as home health care provider programs and sources for off-island transportation that islanders may need to familiarize themselves with in the event of the closure of Vashon’s primary health care clinic.

One of those sources of transportation is Bluebird Medical Transportation, run by the Vashon Senior Center. According to a fundraising appeal that arrived in islanders’ mailboxes on Oct. 22, Bluebird has transported 372 seniors to medical appointments in the past year — a 40% increase in ridership. Each trip costs the Senior Center $120 — roughly $850 each week.

Vashon Youth & Family Services also provides help, though a voucher program, for those who cannot afford the cost of going back and forth to the mainland for medical treatments. Last year, the program provided ferry vouchers to 1,437 islanders. Much of the need for these vouchers came from seniors and families, said Deborah Rieschl, a counselor and case manager with VYFS. The program is currently partially funded by a single fundraising event, Home2Vashon, which last year provided the money to pay for more than 600 of the users of the program.

“Without Home2Vashon, we would run out of ferry support for the island’s most vulnerable neighbors,” said Rieschl.

Will the clinic close? If so, how many seniors will be affected?

Candidates running to serve as commissioners of the board of the new hospital district have posited that without the revenue provided by a property tax levy included in the ballot measure, the island’s current primary care provider, Neighborcare Health, will close, and an alternative provider will be difficult if not impossible to attract.

Mary Schilder, director of communications for Neighborcare Health, told The Beachcomber in an email that Neighborcare has “not created any plans or made decisions for what to do after the vote.”

She did acknowledge funding challenges not only for Neighborcare but also Vashon’s previous primary health providers in the same email.

“A sustainable, predictable funding source is likely the only way to ensure primary care services can remain on Vashon into the future,” she wrote. “That said, we are not planning, participating, or leading the campaign in any way. It is up to the residents of Vashon to decide on the public hospital district by voting in November.”

Likewise, Tim Marsh, vice president of operations with the Franciscan Medical Group, which operated the clinic prior to Neighborcare, predicted that support from a public hospital district would be essential to have any primary care provider at that clinic. Marsh made the comment to The Beachcomber in May of 2016 when he announced that CHI Franciscan was terminating its operations at the clinic because of financial losses of as much as $500,000 per year.

At a recent forum, most candidates for the board of commissioners of Vashon’s hospital district agreed that keeping Neighborcare was not their primary goal, but rather, to find a good fit for primary care that could be filled by other possible providers.

The number of seniors affected by a disruption of Vashon’s current health care services is sizeable.

According to the 2010 census data, Vashon has one of the highest concentrations of adults age 60 and older in King County.

Neighborcare officials have said the Vashon clinic served 1,612 islanders age 65 and older from June of 2018 to June of 2019. Of those, slightly more than 700 were insured by traditional Medicare.

Vashon Natural Medicine, which is owned by Kelly Wright, also provides primary care for patients of all ages. As per the clinic’s website, the providers there are not contracted with traditional Medicare and cannot bill Medicare or Medicare Supplemental insurance for visits. VNM does accept some Medicare Advantage plans, such as Aetna, Regence and United.

Wright — who co-authored the opposing statement for the hospital district measure in the election guide — said that her clinic has five primary care providers who are currently accepting new patients.

“I am not sure exactly how many new patients we can take, but we currently have over 5,000 and are not at capacity,” she said.

Hilary Emmer, who co-authored the “no” response with Wright, declined email requests to be interviewed for this article.

Another resource islanders have, regardless of whether or not residents vote to have a hospital district, is the “care closet,” located at the Lutheran Church off Vashon highway. The closet — two of them, in fact — are full of items ranging from walkers to foot braces. The closet has been particularly helpful to the island’s aging population and youth, members of the Vashon Care Network said. On Monday, physical therapist Kim Eckhardt came by to grab items from the closet for her patients.

What islanders are saying

Some locals have stated that islanders will simply need to get used to a new reality of traveling off-island for routine medical care.

Steven Nourse, a wheelchair-bound islander, attended the recent forum for the commissioner candidates and told The Beachcomber after the meeting that he had mixed feelings about voting for the proposed hospital district. By last week, however, Nourse’s positions had hardened into opposition for the measure, which he explained in a lengthy and much-commented-upon post on the Vashonites Facebook page.

Regarding the issue of the need to travel off-island for primary care, Nourse wrote that “going off-island for anything is an inconvenience.” Nourse also added, “if a friend of mine needed a ride to a medical appointment off-island, I would take them. Isn’t that the Vashon solution?”

Another islander, George Wright — who is the mother of Kelly Wright — pointed out in a letter to the editor of The Beachcomber that there are almost 20 facilities that provide either urgent care or primary care within seven miles of ferry docks in Seattle, Tacoma and Southworth.

Some islanders have speculated that the loss of the current health clinic might result in more calls to Vashon’s fire department. However, Charlie Krimmert, Vashon’s fire chief, said that call volume for emergency services did not increase in any significant way during the weeks-long duration of time between the closure of the Franciscan clinic and the opening of Neighborcare in 2016.

But others have pointed to the problems that might result from a long-term diminishment of primary care on Vashon.

Throughout his campaign to become a hospital district commissioner, islander Eric Pryne has pointed to three major studies that show a rise in preventable hospitalizations as well as a decline in glycemic control in diabetes and early diagnosis of breast cancer in communities that lack access to primary health care.

For some, the problem is personal.

Mary Tuel, a 71-year-old woman who moved to the island 47 years ago, said that it will pose a physical and financial hardship for her and others facing similar challenges to have to travel off-island for basic health care needs, even though care is available at clinics relatively close to the mainland ferry docks.

“There are people on the island who can’t get there, and if they get there, they can’t get back,” she said, explaining that she walks with a cane and lives on a fixed income.

Bill Wood, an 88-year-old islander who visits the Neighborcare clinic on a monthly basis for routine blood draws, said that having to travel to Seattle for routine care would be a significant disruption to his life.

“It would be a whole day’s trip,” he said, adding that he is no longer comfortable with driving himself to the city. “You need a doctor on the island — people my age have regular appointments they need to keep.”

John Lucas, an islander who works as a caregiver and also has a 93-year-old mother who lives on the island, cited one recent instance when his mother was diagnosed quickly at Vashon’s clinic with a urinary tract infection.

“To go off-island for a urine sample or a blood draw — I mean, c’mon. … I think the lab up there is a big deal,” Lucas said, adding that ferry travel is especially difficult for some elderly people who, like his mother, suffer from incontinence.

Jessica Wesch, the medical director of Vashon’s Neighborcare Health clinic, told The Beachcomber in an email earlier this month that one of the reasons she is a supporter of a hospital district is because, without it, she fears there will not be a medical safety net for the island’s elderly population.

“We must protect Vashon Island as a safe place to grow up and grow old,” Wesch said. “Our hospital district can help support a model of care delivery that meets the needs of our aging population so that no one is left out and all can thrive.”

Need a ride, or other healthcare resources?

Chris Jovanovich, of Vashon Care Network, suggests that islanders become familiar with the following services, many of which are detailed in a gold brochure, printed by the Vashon Social Service Network, that is available at the Vashon Pharmacy. The brochure includes additional resources for those seeking hospice and palliative care.

Jovanovich said her organization is planning an upcoming fair next spring, where islanders can find out more about these entities and others that serve the needs of islanders. She also mentioned a new group, Isolated Adults, comprised of representatives from on- and off-island organizations, which aims to coordinate efforts to serve vulnerable islanders including seniors.

Transportation

• Details about King County’s Metro Access Program can be found online.
• The Vashon Community Van is a rideshare pilot program provided by King County and the Department of Local Services to provide islanders ways to share rides. Find out more online.
• For information about Vashon Senior Center’s Bluebird Transportation program and Neighbor to Neighbor programs, which provide transportation to medical appointments for seniors, call 206-463-5173.
• Vashon Youth & Family Services (206 463-5511) has a ferry ticket voucher program for those in need who must travel off-island for medical programs. The program is subsidized in part through an annual fundraiser, the Home 2 Vashon benefit.

Home Health Care

• Providence Home Services of King County (425-525-6800) provides home health care visits by RNs, PTs and OTs for housebound patients living with acute or chronic illnesses or recovering from surgery.
• The Vashon Care Network (206-604-3253 or vashonhomecare@gmail.com) provides referrals for independent caregivers, most of whom charge $30 an hour for their services. VCN also operates the Care Closet (206-473-8715 or vashoncarecloset@gmail.com) where islanders can borrow medical necessities ranging from wheelchairs to incontinence supplies.