With shortages of medical professionals and an aging population, thousands of community healthcare workers prevent older adults from falling through the cracks.
With shortages of medical professionals and an aging population, thousands of community healthcare workers prevent older adults from falling through the cracks. Marsha, left, and Kirk Luce, both patients at New Hampshire's Ammonoosuc Community Health Services, eat dinner, Thursday, Oct. 23, 2025, at their home in Franconia, N.H.
Community health workers can provide patients with assistance between doctor visits. On a recent Monday, Sandy Guzman, a community health worker in rural Oregon, drove to visit a patient in her 60s in a small city called The Dalles. The patient lived alone, and “really struggles with social isolation,” Guzman said. After a serious fall and subsequent surgery, the woman was using a wheelchair.
She confided that she would like to attend services at a church down the road but had no way to get there and did not want to seem “a bother. ” “We called the pastor to see if there was someone who could pick her up” on Sundays, Guzman said. And there was. The next day, Guzman visited a woman with heart failure who required constant oxygen.
She lives in “less than ideal housing,” with no kitchen and only a plug-in heater for warmth.
“We were trying to figure out if she qualifies for HUD housing or assisted living,” Guzman said, referring to the federal Department of Housing and Urban Development. “We spent a lot of time talking about the options and came up with a game plan. ” Wednesday’s schedule included a 20-mile drive to Hood River to see an 81-year-old woman whose partner of nearly 40 years was contending with a serious cancer.
Guzman, who speaks to her in Spanish, found her distraught at the possibility of losing him. Guzman had arranged for the woman to begin seeing a therapist to help her through the crisis — no minor achievement. But on this visit, “I just handed her tissues and tried to give words of comfort,” she said.
“Honestly, sometimes just sitting and listening” is the best response. , is a “trusted member” of a local community or someone who has “an unusually close understanding” of it, enabling the worker to serve as intermediary between patients and the healthcare system. These workers have been on the job since the 1960s, particularly in rural and low-income areas. Today, their numbers are growing.
The Bureau of Labor StatisticsThat partly reflects the difficulty of counting workers who go by a variety of names — community health educators, outreach specialists, promotores de salud — and operate under different state regulations, sometimes with no licensure or certification required. What they have in common is that “they talk like the people they work with,” said Sam Cotton, who directs the curriculum for several such programs at the University of Louisville in Kentucky.
With shortages of healthcare professionals and an aging population, “there’s a lot of momentum for this,” she said. In Oregon, for example, five rural clinics employ community health workers, who become state-certified after completing 90 hours of online training, through a program called Connected Care for Older Adults. A sixth clinic employing a community health worker operates in neighboring Washington. Their frail patients are struggling.
“They can’t drive, so they can’t get to a grocery store and shop,” said Elizabeth Eckstrom, chief of geriatrics at Oregon Health & Science University, who helped oversee the program’s start in 2022. “They’re not taking their medications, either for cognitive reasons or because they can’t get to a pharmacy. ” Few have completed an advance directive, specifying the care they want — or don’t want — if they suffer a health crisis.
Connected Care’s community health workers tackle many of those not-exactly-medical problems — from installing wheelchair ramps to helping patients apply for food and housing benefits. They are allotted 90 days to work with each patient, usually during home visits. They help coordinate follow-up appointments. They administer cognitive and mental health screenings and watch for the use of too many medications, entering their observations into the patients’ electronic health records.
“It’s like being the eyes and ears for the doctors, to see what’s happening outside the 20 minutes they get to spend with patients,” said Guzman, whose work has ranged from ordering a bath mat to reporting suspected financial abuse. , a subsample found substantial decreases in emergency department visits and hospitalizations among those served by community health workers.
“ED visits cost thousands, and hospitalizations are tens of thousands,” she pointed out. The cost per patient for the 90-day program is $1,500. Its workers earn $25 an hour, a fairly typical wage, and receive full employee benefits.for older patients with advanced cancer in a clinical trial at the Department of Veterans Affairs’ Palo Alto Health Care System.
“Lots of people were passing away” in the intensive care unit, she recalled. “If we’d asked, they probably would have wanted to be at home. ” Oncologists, she added, are “notoriously bad at engaging in and documenting those conversations.
” But when a lay health worker made regular phone calls to help patients understand their options, discuss their preferences with their care team, and file advance directives, the results — published in JAMA Oncology in 2018 — were “very dramatic,” Patel said. More than 90% of the participating veterans had their goals documented in their records compared with fewer than 20% of the control group.
The lay worker’s patients had significantly fewer emergency room visits and hospitalizations and were more likely to enroll in hospice care. Patel and her co-authors have gone on to document the benefits of lay health workers, the term they used, in undertaking other tasks in other settings. Alerting healthcare teams to these patients’ problems substantially reduced their emergency department use and hospitalizations, and the cost savings averaged $12,000 a patient.
“Community health workers should be part of every healthcare team,” Eckstrom said. “They support the patient in ways the medical system just can’t, no matter how hard we try. ”In 2024, Medicare began covering some community health worker services, but not all. Medicaid coverage is piecemeal, reimbursing for some services in some states and not others.
“A lot of community health worker roles rely on short-term grants,” said Neena Schultz, a director of the National Association of Community Health Workers. “Sustainability is something we talk about every day. ”, which is distributing $10 billion a year, will include funding for community health worker programs, but cuts to state Medicaid budgets could more than offset those gains. The grants funding Connected Care for Older Adults continue, though.
Guzman, employed by the nonprofit clinic One Community Health, keeps making her rounds. One recent victory: A newly widowed patient in his 60s, struggling financially without his wife’s income, lost his housing and was sleeping in his truck. Through another patient, Guzman learned of an unused recreational vehicle whose owner was willing to donate it. When you’re in a patient’s home, “there’s a sense of ease,” Guzman said.
“They feel safer talking about things. They don’t feel rushed. You develop a relationship, and they feel they have someone to advocate for them. ”is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs 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SF's LGBTQ+ community organizes against proposed $17M in public health services cutsSan Francisco's LGBTQ+ community gathered to protest Mayor Daniel Lurie's proposed budget that would cut millions of dollars in funding for community-based organizations. In an effort to close a more than $870 million budget deficit, the mayor is slashing city spending by $400 million.
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Community members remember Kelly Hunt, call for bolstered Anchorage investigations involving Indigenous peopleHunt’s whereabouts were unknown for more than three months until Anchorage police found her remains on April 20. The circumstances of her disappearance and death remain unknown to the public.
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Habitat for Humanity uses volunteer effort driven by the Carters to develop a new Atlanta communityTwo years after his death, President Jimmy Carter is still inspiring Habitat for Humanity's efforts to build more affordable housing in the U.S. Over five days in May, nearly 1,000 volunteers with the international nonprofit will finish building 24 new housing units in Atlanta.
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Alaska Indigenous Community Walks for Justice, Honors Missing and MurderedA powerful 'Walk for Missing and Murdered Indigenous People' was held at the University of Alaska Anchorage, organized by the Alaska Native Science and Engineering Program. The event featured traditional drumming, a dance performance, and a moving speech by Tatiana Ticknor, a program coordinator for Data for Indigenous Justice. The walk highlighted the ongoing crisis of violence against Indigenous communities and called for systemic change.
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