LEWISTON — Staff at Community Clinical Services are eagerly awaiting the expansion of their health center downtown as demand for affordable health and dental care reaches a record high.

CEO Coleen Elias said their health centers have seen a surge in new patient requests, particularly at their Birch Street location, B Street Health Center, and their dental clinic on Second Street in New Auburn.

“We’ve never seen (this) volume of need,” Elias said. “Folks just walking in looking for help. They truly have nowhere else to go.”

Based at 57 Birch St., Community Clinical Services served 13,000 patients last year across its nine locations in Lewiston and Auburn, four of which are school-based health centers. The federally qualified health center provides primary care, mental health, substance use disorder and pediatric dental care.

The center accepts patients regardless of their ability to pay and offers a sliding fee discount based on income. At most, qualifying patients pay $20 for care.

From January to June, B Street saw a 15% increase in new patients at its downtown Lewiston location compared to the same period in 2022.

In the past, the health center was able to schedule new patient appointments within two months, Elias said. Now, new patient appointments are being scheduled in January 2024.

Getting an appointment for mental health services takes even longer, she said. They have a waiting list because they are unable to provide services for everyone requesting it.

And as the only pediatric dental clinic in Androscoggin County that accepts MaineCare, Community Clinical Services has been overwhelmed by new patient requests. Its clinic on Second Street in New Auburn has a waiting list of more than 500 children.

Only a small percentage of dentists in the state accept MaineCare because the reimbursement is often not enough to cover the full cost of the care.

‘WHO DO WE PRIORITIZE?’

There are numerous factors contributing to the higher need, Elias said. Not only has there been an increase in New Mainers moving into the Lewiston area, but the number of vulnerable Mainers, broadly, has risen. She described them as those who have lost health insurance, lost housing, are not able to work, or have worsening health or mental health conditions.

Additionally, the pandemic has caused many people to delay health and dental care, leading to a backlog, she said.

“Their physical and mental and dental health are all deteriorated,” she said. “And so, not only is there an increase in demand for new patient care, but an increase in needs for the established patients to have care more often and more comprehensive care.”

Due to problems throughout the health care system, particularly with specialty care, primary doctors have taken on more patient care, she said.

Some staffing challenges have also made the rise in demand more difficult. Although Community Clinical Services offers on-the-job training for dental assistants, it hasn’t been able to fill a single position for more than a year, the result of a severe shortage of dental professionals in the state, Elias said.

Chief Medical Officer Megan Brewer said the health center has seen a near complete turnover of support staff in the past year, in part due to outbursts from scared, frustrated patients.

“Please, please be patient with your providers,” she said. “We’re really trying to provide a really high level of care, and that’s really challenging to do right now.”

Overall though, Elias said staffing has stabilized, adding that Community Clinical Services has been fortunate to retain its medical provider team.

With so much need in the community, determining which patients need care the most has been an ongoing challenge for the nonprofit, according to Brewer.

“We grapple with who do we prioritize, what is ethically correct to prioritize?” she said. “That’s not an easy decision to be made … We need to be able to take adequate care of the patients that we’re already committed to” while also being responsive to those with serious, immediate needs.

Because its health centers are increasingly providing care for patients without insurance, the nonprofit organization operates at a loss. Their partner, St. Mary’s Health System, provides the organization with a community grant each year to help offset this. Patients at B Street also qualify for free or reduced-cost care at St. Mary’s through their partnership.

But even with St. Mary’s financial support, Elias said Community Clinical Services will need more money. In May, she hired Regal Naseef as director of grants/development to help the organization bring in additional revenue.

Naseef said she was drawn to the organization for its growth potential and because it was led by a female veteran. Elias is a former member of the U.S. Coast Guard.

The expansion project at B Street is expected to begin in 2024, increasing the number of exam rooms from eight to 14. The project will also relocate Community Clinical Services’ pediatric dentistry services to downtown Lewiston and add long-awaited adult dentistry services.

The building, which is owned by Lewiston Housing Authority, is also set to be renovated to better utilize space.

“We’ve done a pretty extensive analysis of where to build, and it continues to come back to (B Street) because this is where people who need us most can access us,” Brewer said.

EXPANSION PROJECT

Nearly one in five households in Lewiston does not have a vehicle, according to a survey conducted during the Choice Neighborhood planning initiative’s application process prior to 2021. The rate is far higher in the Tree Street Neighborhood where B Street is located. There, 40% of households do not have a car.

Much of the funding necessary for the expansion has already been secured. Community Clinical Services was allocated $800,000 from the $30 million Choice Neighborhoods redevelopment grant and an additional $2.8 million in federal funding.

It aims to provide a single, accessible location that offers primary care, dental care and mental health services. The addition of dentistry at B Street means primary care providers can more easily refer patients for dental work, rather than trying to address problems on their own.

“It’s a truly integrated model,” Elias said.

The expansion project will not only add much-needed adult dental services to downtown Lewiston, but it will also result in a larger, more accessible pediatric dentistry program, Elias said. Community Dental on Main Street in Lewiston offers low-cost dental care, however, community need for dental care is high, she said.

Naseef said she is planning a capital campaign to raise money to purchase costly dental equipment for the new facility.

When the expansion project breaks ground, likely next summer or fall, Elias said, she expects it will take about six to nine months to complete. She expects it to have little impact on patient care.

Until the expansion is complete, administrators are trying to be creative to address the rising need for affordable and accessible health care downtown. In August, a new family nurse practitioner will join its team to help bridge the gap by helping those with the greatest needs and helping to stabilize people with emerging chronic illnesses such as diabetes. The practitioner will work in the clinic and out in the community.

Community Clinical Services also plans to partner with Recovery Solutions of Maine to increase access for people seeking help for substance abuse.

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