Community Health Workers Make a Difference in Rural Oregon
On a recent Monday, Sandy Guzman, a dedicated community health worker in rural Oregon, visited a patient in her 60s living in the small city of The Dalles. The patient, who lived alone, felt very isolated and had recently experienced a serious fall that left her using a wheelchair. She shared her wish to attend services at a nearby church but felt hesitant to ask for help with transportation.
“We called the pastor to see if someone could pick her up on Sundays,” Guzman said. Luckily, there was someone ready to help.
The next day, Guzman met another woman with heart failure who relied on constant oxygen. This woman lived in difficult conditions, with no kitchen and only a plug-in heater for warmth. Guzman worked with her to explore options for better housing through the federal Department of Housing and Urban Development (HUD), and they came up with a plan to improve her situation.
On Wednesday, a 20-mile drive took Guzman to meet an 81-year-old woman whose partner was battling serious cancer. Speaking to her in Spanish, she found the woman deeply distressed about the possibility of losing him. While Guzman had already arranged therapy for her, she felt that sometimes, “just sitting and listening” was the best way to provide support.
Community health workers, as defined by the American Public Health Association, serve as trusted resources within their local communities, helping bridge the gap between patients and the healthcare system. Since the 1960s, particularly in rural and low-income areas, these workers have been growing in number. Currently, the Bureau of Labor Statistics reports about 65,000 community health workers, though this may be an underestimate due to varying titles and regulations.
Sam Cotton, who oversees community health programs at the University of Louisville, noted that these workers often have a unique understanding of the people they serve. “They talk like the people they work with,” she explained, highlighting the connection they build.
In Oregon, several rural clinics employ community health workers who undergo 90 hours of online training through a program called Connected Care for Older Adults. Their patients often struggle with daily challenges, such as getting to grocery stores or pharmacies for medications.
Workers like Guzman assist with many non-medical issues, including installing wheelchair ramps and helping patients access food and housing benefits. They typically have 90 days to work with each patient, maximizing impact through home visits.
By observing daily life and patient needs, community health workers provide valuable insights for doctors, often addressing issues that go beyond what can be covered in a typical appointment. This approach has led to decreased emergency room visits and hospitalizations among those they serve, according to a study of the Connected Care program.
The cost of the 90-day program is about $1,500, with workers earning $25 an hour along with benefits. Research has shown that engaging community health workers can lead to significant cost savings in healthcare.
For instance, a study at the Department of Veterans Affairs found that a lay health worker’s regular contact with patients resulted in better communication about their wishes and led to fewer hospital visits. Similar successful initiatives have been documented in oncology clinics, where health workers monitored patients’ symptoms and reported concerns to healthcare teams, which also reduced hospitalizations.
However, funding continues to be a significant challenge. Although Medicare began covering some community health worker services in 2024, reimbursement remains inconsistent, especially for services in rural areas.
Despite these hurdles, Guzman and others continue their vital work. In one recent case, she helped a recently widowed patient who had lost his housing find a donated recreational vehicle to live in.
“When you’re in a patient’s home, there’s a sense of ease,” Guzman noted. “They feel safer talking about things and develop a relationship with someone who advocates for them.”
The work of community health workers is crucial, providing support that the medical system often cannot deliver alone.
