The Recovery of Community Health Centers in Puerto Rico and the US Virgin Islands One Year after Hurricanes Maria and Irma

One year after hurricanes Maria and Irma struck Puerto Rico and the U.S. Virgin Islands (USVI), recovery has progressed but remains slow. This issue brief presents findings from the Geiger Gibson/Kaiser Family Foundation survey of community health centers in Puerto Rico and USVI one year after the hurricanes. It describes the current state of health center recovery and examines shifts in need and capacity, which have potential longer-term implications. Key findings include:

Health centers experienced an increase in the overall number of patients and an increase in patients with more complex mental and physical health needs in the year following the hurricanes. Nearly three-quarters of health centers reported an increase in the number of patients served, and some have experienced increases of 10% or more. Additionally, reflecting the lingering effects of the hurricanes, increasing numbers of health center patients are from suffering mental health problems, stress-related conditions, and poorly managed chronic health conditions. Health centers reported a substantial uptick in patients suffering from depression and anxiety, including post-traumatic stress disorder (PTSD), and said their patients are more likely to have suicidal thoughts and attempts than before the storms.

Many health centers expanded staff to meet patient needs, but some have experienced staffing losses over the past year. Most health centers have been able to retain or add key staff, including physicians and nurses as well as mental health staff. At the same time, losses of other professionals, including nurses, substance use disorder staff, and dental staff present challenges to service delivery for some health centers.

Health centers face increasing challenges referring patients with complex needs for more specialized care. While health centers have faced long-standing shortages when referring their patients for inpatient and specialty care, among health centers  that  refer patients, many said that these shortages have gotten worse since the hurricanes, likely due to outmigration of other community providers, and, in the USVI in particular, ongoing operational disruptions at hospitals. Provider shortages are particularly acute for mental health and other specialty care as well as substance use disorder treatment and dental care.

While most health centers reported that operations are back to normal at all sites, many continue to face critical infrastructure challenges. Over half of health centers reported that some or all sites still need repairs to their buildings and nearly 30% reported ongoing power grid and internet problems at some or all of their sites.

Meeting the increasing health needs of the community, and operating in a complex and insufficiently funded environment, emerged as top challenges. The most commonly cited challenges currently facing health centers were their patients’ growing health needs, broader health system changes, and infrastructure issues. Insurance revenue that is inadequate to cover the cost of care was reported as a top challenge by health centers in Puerto Rico, while health centers in USVI cited the loss of community providers and reduced capacity of the health system overall as a major concern.