Access to Care in Oregon Isn't Equal - And We All Know It

by Jamie Daugherty, Executive Director

We talk a lot about access to care.

But in Oregon, access isn’t consistent, and for those of you running agencies, that’s not a policy discussion. It’s a daily operational reality.

Where a patient lives often determines what care they can receive, how quickly they can receive it, and whether services are available at all.

That’s not a new issue. But it is becoming more pronounced.

Geography Is a Clinical and Operational Factor
In home-based care, geography matters in a way that it doesn’t in most other parts of healthcare.

Distance between patients.
Drive time between visits.
Weather.
Workforce availability in specific regions.

All of these factors directly impact:

• How many patients your team can safely see in a day 
• Whether you can accept a referral 
• How you structure your service area 

For agencies serving rural and frontier communities, these are not occasional challenges—they are constant constraints.

Workforce and Geography Are Interconnected
Workforce challenges do not exist in isolation from geography.

In many rural parts of Oregon:

• The available workforce is smaller 
• Recruitment is more difficult 
• Travel demands are higher 
• Retention becomes more challenging over time 

Even when agencies are fully committed to serving their communities, there are limits to what is sustainable.

And those limits are often invisible in broader policy conversations.

The Expectation Gap
There is a growing expectation across the healthcare system that care can—and should—be delivered in the home.

That expectation is not wrong.

But it often does not account for:

• Travel time that reduces clinical capacity 
• Staffing limitations in specific regions 
• The cost of delivering care across large geographic areas 

For agency leaders, this creates a gap between what is expected and what is operationally feasible.

Closing that gap requires more than internal adjustments. It requires alignment at the system level.

What This Means for Agency Leaders
Most of you are already making the necessary adjustments:

• Defining realistic service areas 
• Managing referral expectations with partners 
• Structuring teams to balance access and sustainability 
• Making difficult decisions about where and how care can be delivered 

These are not easy decisions, but they are responsible ones.

And they are essential to maintaining access in the long term.

Why This Conversation Matters Now
As home-based care continues to gain attention, there is an opportunity, and a responsibility, to ensure that rural and geographic realities are part of the conversation.

If they’re not, policies will continue to be developed based on assumptions that don’t reflect how care is actually delivered across Oregon.

Continuing the Conversation in Salem
These are exactly the kinds of issues that benefit from being discussed together as a provider community.

At the OAHC Annual Conference on April 16–17 at the Salem Convention Center, we’ll be bringing together agency leaders from across the state to talk through operational challenges, policy updates, and what’s ahead for home-based care.

Beyond the sessions, the value is in the conversations, how different agencies are navigating geography, workforce, and access in their own regions, and what we can learn from each other.

If you’re able to attend, it’s time well spent stepping out of day-to-day operations to focus on the bigger picture.

Moving Forward
Access to care in Oregon has never been one-size-fits-all.

And in home-based care, it never will be.

But ensuring that access remains possible, especially in rural and underserved communities, depends on aligning expectations with reality, supporting providers, and continuing to have honest conversations about what it takes to deliver care in the home.

Because where a patient lives should influence how care is delivered, but it shouldn’t determine whether they receive it at all.