With space restrictions at its current location and an increasing patient need, Eastport Health Care (EHC) is planning to relocate to a new facility not far from its current Boynton Street location. The parcel for the new health center, which is estimated will cost between $5 and $6 million to build, was acquired late last month.
      The 2.8-acre lot at the corner of Key Street and County Road, which adjoins the R&M IGA parking lot, was purchased from M & L Realty Inc., co-owned by Merilyn Mills, with the closing on January 19, according to Ellen Krajewski, CEO of Eastport Health Care. While no detailed planning has yet been done, she estimates that the new building, which will have its entrance on Key Street, may be more than double the size of the present health center, possibly up to 15,000 square feet, and while the initial drawing is for one story it could be two stories. She notes that Eastport patients who walk to the current facility will still be able to walk to the new site.
      Krajewski says the design phase will start as soon as grant funds are secured, and she hopes construction will begin this summer. The new health center may be completed in 2025, depending in part on funding. Prior to the purchase, the seller completed an extensive environmental assessment of the former railroad yard site, and "we got a clean bill of health" from the Maine Department of Environmental Protection, she says.
      The new, larger facility, which will still be named the Rowland B. French Medical Center, will allow for expanded offerings of services, more staff and the ability to see more patients and reduce wait times for becoming a registered patient. "It's an ideal location for us," she says. "It's a huge win for EHC. We have to be sustainable and keep the doors open for the future. The patients and the staff need a good space. This is essential."
      Krajewski says that the health center has been looking to expand since she was hired in 2019. "When I came there was a long trend of patients leaving. We need new space. There are congested halls, the patient rooms are small, and there are patient flow constraints."
      Following the closure of the Eastport Memorial Hospital, the current health center had opened across Boynton Street in 1981, with a 1,980-square-foot expansion in 1987 and a current size of 6,558 square feet. She points out that the current location in a residential area is congested with the traffic, which she says is not safe, and is limited for parking. "We looked extensively at renovating here," she says, noting that a second story could be added just to the back of the building, but for about a $2 million cost only about 100 square feet of primary care space would be gained. "It was not a doable scenario," she says, noting that the building's footprint and the parking area cannot be expanded at the current location.

Expansion of services outlined
      The new facility will have a larger dental center, Krajewski notes. The dental team headed up by Dr. Abhay Ektare is in demand, with a one- to two-year waiting period for those who would like to become established dental patients. However, Krajewski points out that same-day dental appointments are provided for emergency care, and children can always get in for care. At the new building, the health center will add a second full-time dentist, and at least a dental assistant will be trained for the position of expanded function dental assistant to handle more tasks.
      The new health center will include a community room open to the public, expanded lab capacity and a diabetes center that offers education, patient care and training. The center's current diabetes program is very successful and takes referrals from other sites. "We're the only health center in the state with a certified diabetes program," Krajewski observes.
      With a great demand for behavioral health services, particularly since the pandemic, and substance use disorder services, and with the closure last year of EHC's Calais facility, which offered podiatry and behavioral health services, she says that the health center wants to expand both direct and remote access behavioral health services in Eastport.
      The new facility also will provide space for public health clinics, and Krajewski notes that the health center provided a great many COVID vaccinations and treatment for area residents, with some of the vaccination clinics held off-site. Also, there could be a triage area with shower capacity in case of a public health emergency, she says.
      To assist residents in accessing its many services, the Eastport health center has a community health worker who help patients in finding resources and also look at barriers to obtaining quality healthcare, such as transportation and housing issues. In addition, EHC provides insurance assistance and a sliding fee scale, which is unique to community health centers. "Patients, particularly the elderly, face many barriers for access to care," Krajewski says. The health center assists with transportation, insurance and the acquisition of durable medical goods. She notes that in Eastport many struggle with obtaining affordable medications, and she says the new building potentially may include a pharmacy.
      The health center also provides food distribution, working with the Good Shepherd Food Bank and the Labor of Love Food Pantry, and the new building will provide more capacity for food storage.

Increased patient need
      EHC has three primary care providers, including a new medical director, Dr. Robert Phares, and a total staff of 44 in Eastport and four primary care providers and a total staff of 27 at the health center in Machias that EHC opened last July. As for its economic impact, direct spending by the health center totalled $6.4 million in 2022, with an additional $7.2 million in community spending.
      As a nonprofit, federally qualified health center (FQHC), EHC serves over 5,350 patients each year at its Eastport facility. Services are available regardless of a patient's ability to pay. FQHCs are the largest primary care network in the country, with decisions made locally but while being part of a network of health centers that receive federal funding and have to meet strict requirements. They receive bipartisan support in Congress, Krajewski observes, pointing out, "It is a clinical model for quality and access and a financial model that is sustainable."
      Of how that model works at the local level in Eastport, she states, "The [EHC] board is so supportive of our work. They see the need for quality primary care and understand the importance of investing in infrastructure, not only physical but also staff, and of the health center's vision. The board members are huge advocates of our mission." EHC's vision "is to meet a full spectrum of health needs in rural Maine with innovative, affordable treatment," and Krajewski adds, "We can only be successful if we have good partners, which includes other healthcare entities, the City of Eastport and nonprofits."
      According to a market assessment by Capital Link, a national nonprofit, 23% of EHC patients whose incomes were reported in 2022 were below 100% of the federal poverty level and 82% were below 200% of that level. Concerning the insurance status of patients, 19% were uninsured, 26% Medicaid, 28% Medicare and 27% private or other third-party.
      As for health indicators, Washington County ranked lowest in the state, with substantial concern around drug overdose deaths, sexually transmitted infections, teen births and the uninsured. "Although these rates are concerning," the market assessment states, the presence of the Eastport health center "plays a vital role in reducing health concerns and improving health factors and outcomes for the service area's community." The report also states that the county has a significant need for more physicians and dentists.
      Supporting that statement is the fact that the number of visits by established patients at the health center increased by 33% in 2022. Krajewski says, "There's enough need to justify adding positions. We have waiting lists and take new patients every day." She points out that there are between 50 and 100 new patients on the waiting list to be registered with a provider, although if someone has an emergency both the Eastport and Machias sites provide acute care appointments for primary and dental care. "You don't have to be a registered patient," she emphasizes.
      As for why there is greater patient need, she observes that some private practices in the county have closed and that in Washington County there are not "a lot of independent primary care providers." And she notes, "Our main mission is providing primary care and providing quality care that is accessible to everyone, regardless of how they pay."
      Concerning the recruitment and retention of staff to meet that need, Krajewski observes that is "a huge challenge," both post-COVID and as part of a traditional challenge in Downeast Maine. Noting that there are staffing problems at healthcare facilities across the country for positions from entry level through physicians, she says that the remoteness of Downeast Maine is a particular issue, as the area is far from specialty services and metropolitan areas.

Funding and future plans
      As for funding for the project, EHC received a $500,000 Maine Thrive Grant that is a forgivable loan to purchase the property. The health center will also be receiving $5,061,000 in congressionally directed spending through Senator Susan Collins' office for building the facility. While those funds have been awarded, they still need to be appropriated in the federal budget. Some additional funding still needs to be raised.
      In addition, EHC received $284,000 from USDA Rural Development for dental equipment two years ago and $80,000 from the Downeast Public Health Council and the Maine Center for Disease Control for a generator and smaller temporary back-up generators for both sites, with Krajewski noting that vaccines can be at risk if power is lost. "And we want to be able to provide care in extreme weather," she adds.
      As for what will happen with the current building at 30 Boynton Street, that has not yet been determined. Back in 1977, for $1 the City of Eastport had given the land, the site of the former grammar school that had burned, for the construction of a healthcare facility. Krajewski observes that the EHC board believes it has a civic responsibility and wants to make sure that the future use of the site "will be to the benefit of the city."
      She notes, "This property is a key location for the city, and there's a terrific opportunity to do more good for the community." Among the ideas that have been floated are for a community facility with a pool and educational areas, a childcare center, assisted living or an expansion of the nursing home that is across the street. The health center will need to be in the new facility before the current building is vacated and the property is sold.