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When ‘safety nets’ close, people fall through cracks

Safety-net agencies, such as food banks and nonprofit organizations, connect vulnerable people who may be uninsured or underinsured with services, such as health care, legal aid, and housing.

But, when they close, the people most in need may get lost in the system.

A new study, published in the journal World Medical & Health Policy, shows that when a large, safety-net agency suddenly closed, many clients receiving services from smaller HIV service organizations got “lost in the system,” or were disconnected from services.

Additionally, clients experienced delays in care and lost a resource where they could be connected to multiple services. Similarly, service agencies reported suffering from the closure because they had relied on the larger agency for case management.

Emotional sustenance

“Safety-net agencies serve as starting points to connect clients with resources and help coordinate services for clients,” says Nidhi Khosla, assistant professor of health sciences at University of Missouri. “The services that the agencies provide are interconnected, and when one agency closes, all have to adjust.

“Agency leaders need to acknowledge that their organizations often provide intangible services for clients,” she says. “Leaders need to understand that these agencies and their programs serve vulnerable populations, and once individuals have established a relationship with an agency, it means much more to them than simply health care; it’s a source of emotional sustenance for them.”

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Agencies should have plans in place so that services for their clients would not dissolve should the agencies close suddenly. Policymakers also should implement changes to agencies incrementally and in a planned manner to ensure individuals are not lost in the system, Khosla says.

Needs of the clients

“Ideally, agencies that close would be able to transfer their clients to other agencies that can fill those needs. Policymakers should consider how difficult it’s going to be for a person who’s already vulnerable to transfer to a new agency, because it takes time to make appointments, to figure out how a new agency works, and how to get there. These are all small factors that sometimes escape policymakers’ consideration.”

Many agencies constantly face a shortage of time and money, and it may be difficult for leaders to find time to think about larger issues, such as long-term sustainability, when they’re confronted with operational challenges on a daily basis, Khosla says.

But, agency leaders should engage in constant review to adapt to the needs of those they serve.

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“Agencies begin with a mission, and over time, the environment changes. It’s important for agency leaders to step back and review their missions to make sure they’re still relevant to the needs of their clients.

Additionally, even though non-profits operate with altruistic motives, they still need to function as agencies that are dependent on funding.”

Source: University of Missouri

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