Sister Marguerite McCarthy discusses funding challenges that the Little Sisters of the Poor encounter in maintaining healthcare services for the elderly in need. Watching with concern are colleagues Mark Litzler (left), Terry Snapp, Davoren Tempel and Jay Manitove.

The H&R Block Foundation's David Miles made a comparable point. An increase in health care demand and costs, when coupled with decreased levels of earned revenue, was leading to a shift in funding to direct patient care and away from the program enhancements and systemic improvements that have historically been the work of foundations.

As Dietrich Willke of the City of Kansas City, MO succinctly noted, “There is a shortage of money and an increase in service requirement,” and that inevitably spells, if not trouble, at least challenge with a capital C.

For the service providers, that challenge comes in a variety of forms and with varying degrees of stress. Benjamin Pettus, Jr. of the Samuel U. Rodgers Community Health Center has found a new stress point with the growth in the non-English speaking community. Now, 46% of the center's patients require interpretive services, a huge increase in just the last decade. That change may add to the operational costs, but the need for new equipment and enhanced facilities continues unabated. For Pettus, the access to capital for facilities like his is critical if the patients are going to continue to have access to resources.

“What we find,” said Susan McLoughlin of the Maternal & Child Health Coalition, “is that everything centers around access to care.” She sees more and more barriers to the working poor, including transportation and childcare issues as well as a basic lack of information. For Lesa Mitchell, the reduction of barriers was a critical first step in providing care.

Patricia Wyatt of Swope Ridge Geriatric Center addresses the challenges her organization faces in delivering services to the elderly indigent. She is accompanied by Denny Barnett of Kansas Citys Promise, Becky Schaid and Sister Helen Bristow.

The increase in the Hispanic population, Liz Levin noted, is also putting stress on the Cabot Westside Clinic. A seeming increase in the uninsured is also adding to the difficulty of securing adequate funding, observed Sr. Helen Bristow of the Duchesne Clinic. The greatest difficulty, as she saw it, was providing health care for those who are working. For Becky Schaid of the Baptist-Trinity Lutheran Legacy Foundation, the challenge is to assess these “huge needs” and dispense resources appropriately.

Jeff Simon, an attorney with Husch & Eppenberger and also the chairman for the Little Sisters of the Poor Development Committee, identified another systemic stress as the aging of the population. “The elderly poor tend to be invisible,” said Simon, “I don't know where they would turn without the Sisters.” With charitable giving flat and more of the state's discretionary funding going to transportation, Simon is unsure of where the funding will come from.

Sr. Marguerite McCarthy observed that the Little Sisters of the Poor have been serving elderly poor for 120 years in the Kansas City area. Still, finding the means to give high quality health care and “humble loving service” in a social atmosphere remains as much or more of a challenge as it was a century ago.

“A big scary issue” is how Patricia Wyatt of Swope Ridge Geriatric Center Care described the impending move of baby boomers to senior citizen status. Centers like hers face not only an increased need for capital but also, and perhaps even more problematically, a need for licensed nurses. Without changes to the systems in place for reimbursement, this challenge could soon become a crisis.