One of the biggest barriers to good diabetes care in this country is... wait for it... just getting there.
Yep, nevermind having good insurance; for many across the country the biggest challenge is simply transportation to the healthcare they need and want. Luckily car services like Uber and Lyft are taking notice of this challenge, and now the American Association of Diabetes Educators (AADE) is also working to address this problem as part of its 2018 focus on poorer, underserved populations.
"There are so many disparities and gaps in healthcare,” says current AADE President Donna Ryan, a Certified Diabetes Educator who works for Ascension Health in Florida's Gulf Coast area. "It shouldn’t matter that you don’t have insurance. You shouldn’t be limited because you don’t have resources, or money for a bus. We have counties here that don’t have public transportation so they can’t get to their clinics or doctors’ offices. Pharmacies don’t deliver to their areas. That’s really the challenges of disparity, and something in diabetes that shouldn’t be as 'Third World' as it is in some areas."
Uber and Lyft Tackle Healthcare
This issue has been in the news recently, with ride-sharing companies Uber and Lyft announcing programs to address these healthcare transportation barriers through public-private partnership programs:
- UberHealth: announced in early March 2018, Uber is partnering with health organizations and clinics to get transportation to those who need it. They offer free rides to patients where clinics and other healthcare orgs agree to pick up the bills, and the service is event designed for those without smartphones. And the program is even HIPAA compliant, meaning it follows all the rules for protecting patient privacy.
- Lyft Rides: in May 2017 Lyft announced it would work with Blue Cross/Blue Shield to offer health-related rides in places with "transportation deserts." More recently, the company shared new plans to also work with CVS Health and Walgreens Boots Alliance to bringing more "no cost" options to underserved, lower-income populations in need of transportation to healthcare. The exact regions where this will roll out are yet to be announced.
But let's face it: the bigger issue is reaching all those in need who live outside of major urban areas, who have the most difficulty getting transportation to healthcare facilities.
For example, Susan Gannon, who lives in the little Gulf Coast community of Port St. Joe in northwest Florida, not too far from Panama City. They don't have Uber there, and there's only one taxi. The local community transportation requires three days' notice to use. With only a few scattered hours of Internet access each week that she shares with others in her apartment building, even telehealth isn't a viable option for her.
Gannon has been living with type 2 diabetes for almost two decades now, along with a variety of other health conditions that make even walking around her apartment building difficult. She has no car and her daughters live in other states, meaning Gannon had no way of getting to doctor's appointments.
"As much as those of us who are under-abled have available to us here in Port St. Joe, it is not enough," Gannon tells us. "We need transportation. We need companionship, help in our homes, and help with personal care. We sometimes need food."
A Scooter-Sharing Solution
Everything changed a couple years ago, when Gannon moved about three-quarters of a mile from the local federal healthcare clinic and her daughters bought her a mobilized scooter to get there for her medical appointments.
Since then, she's even been letting others in her apartment building use the scooter. And now, Gannon and a few others in the same building are planning to start a "buddy system," where they trade chores and neighborly assistance in exchange for using the scooter to go out grocery shopping or to their own healthcare appointments nearby.
Diabetes and Poverty on the Gulf Coast
When she returned in 2010 to northwest Florida where she grew up, the AADE's Ryan took on the task of running the diabetes programs for four hospitals along a 350-mile stretch. A good amount of that area is poor and rural – in stark contrast to what she'd grown accustomed to while working in Los Angeles. She now covers two rural counties that don’t have public transportation, and are 200% or more below poverty level with high incidence of diabetes.
“I was very humbled by the level of poverty here, which was more rural poverty than urban poverty. I’ve traveled to people’s houses to help them with insulin pumps, or whatever diabetes case management they needed. I’m humbled by the lack of resources and overall knowledge and understanding about diabetes, from their blood sugars or general health.”
MyGulfCare is a program in Gulf County, FL, and surrounding areas that provides home visits, transportation to appointments and assists with other aspects of D-management and care. Its influence reaches all the way 350 miles to the east to Bayou La Batre in Alabama, a small fishing community in south Mobile County that has similar transportation barriers. There are no buses, rampant poverty, high rate of diabetes, and major language barriers, Ryan tells us.
"These are real people who are on the margins,” she says.
She recalls traveling to the home of one type 1 woman on dialysis, trying to train her on a new insulin pump while sitting in the woman’s mobile home trailer with holes in the floor.
"The good part of that is that it greatly helped her with blood sugars, but addressing it in that environment required a different application of my skillset," Ryan said.
One of the educators in the MyGulfCare program in Port St. Joe is Debbie Maulding, who works with the scooter-using Susan Gannon living with T2D. Often, Maulding says she has patients who are interested in learning more about diabetes and caring for their health, yet have no way to get to her and the clinic. Home visits seemed like the immediate fix, but soon issues became apparent.
Even though the local transportation there provided rides for those with Medicaid, it didn't offer service to patients who were uninsured. Finally, the local healthcare community was able to get a system in place for the uninsured to schedule trips -- for a $4 fee. That may not seem like much to many, but that cost can be limiting to people on fixed incomes.
Maulding says she's had to frequently reschedule appointments because of rain or 100-degree-hot, humid days where patients just couldn't walk to the clinic.
That's where Gannon comes into the story, as she lives in the nearby income-adjusted apartment complex. Several other patients with diabetes live there too, and Susan's scooter has been a helpful resource. Some of the local churches also offer rides to members if they know in advance. Maulding says the churches are considering a plan to use their vans to help on the broader healthcare transportation front.
'Double the Motivation' Necessary
"I know from working with the underserved in the community that the amount of motivation it takes to care for yourself is immediately doubled when your resources are half of what they need to be," Maulding says. "It's difficult to engage a client who can't easily participate, no matter how important the appointment is, or how much they need the service."
That's certainly true for Gannon, who not only navigates T2D but a plethora of other health conditions -- impaired balanced and coordination due to brain damage (known as ataxia), intracranial hypertension that causes pressure inside the skull, sleep apnea and lung problems.
She tells us she has good days and bad days, when she's not able to move around much and even trying to focus on something for too long can be challenging. But living in the federally-subsidized 40-unit apartment complex within a mile of the clinic -- a place that she and residents have dubbed "The Manor" -- certainly helps ease some of the burdens at times.
"I'm from Houston, a city big enough where one would assume all things are possible and available, however, not so," Gannon wrote in an email. "I am much better off here in a small town in a rural setting where needs are recognized and where the community at least tries to help out. Debbie (Ryan) and her organization are case in point."
Gannon says when it comes to her diabetes control, she can't overemphasize the importance of being able to get to her appointments. Her A1C has dropped from double-digits to more "reasonable" levels as a result of having the scooter that makes it possible to access the clinic, and she describes having a better life that means being healthier overall.
Getting There = Life Changing
In talking about what a life-changer this transportation to healthcare can be, Gannon shared her excitement about being able to take on an Easter project last year that had her decorating 80 eggs all on her own.
"I would never have attempted this six months before," Gannon wrote to her CDE Maulding just after Easter 2017. "You have taught me that I am not dead. I am a whole human being and a vital part of this community. I am Susan Ruth Ebdon Gannon. I am an intelligent and confident woman, even when my body is not behaving. And on days that my body is not behaving, I just have to wait it out and the day will come soon when it is behaving and I can do the things that I couldn't do the day before. And I can ask for backup. I am not an island!!"
"I can't imagine a more perfect gift...," she added. "Just like you give every time you leave your house and change a bandage, take someone's blood sugar, or teach them how to be a healthier, more productive person."
Wow, what a difference rides can make! We applaud all of the efforts to help people get to the care they need.