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When a hospital exits a low-income neighborhood, what happens to local residents?

August 15, 2012

This article was written by Lorena Aviles, Delia Beristain, Stephanie Frescas and Angela Kim, and reported by the staff of The Princeton Summer Journal.

Long before it opened this past May, the new campus of the University Medical Center of Princeton at Plainsboro was already turning heads. In 2009, a health care staffing company called Soliant Health ranked the hospital the 16th most beautiful in the United States—based only on the building’s architectural plans. 
 
Meanwhile, the building attracted rave reviews from the local press. The Trenton Times described the new facility as a place “that aims to promote healing through conscientious design.” The Star-Ledger headlined an article on the move: “A hotel-like hospital in Princeton health network brings comfort to its first patients.” 
 
Many local residents have been equally impressed. “This hospital is like a five-star hotel,” marveled Gloria Martinez, who was escorting her friend to the clinic on a recent weekday afternoon. 
 
And moving the hospital has had undeniable benefits. The state-of-the-art $447 million building—located along Route 1 in Plainsboro—is closer to 70 percent of its patients than the old facility in the Witherspoon neighborhood of Princeton. Visits to the outpatient clinic at the hospital—a facility on which many low-income patients rely for medical care—are up slightly since the hospital moved, according to Lillian Arriola, the clinic’s senior secretary.
 
But amidst all the plaudits and improvements, and even as the hospital serves more low-income patients overall, one question has gone largely unexamined: What about the mostly lowincome community the hospital left behind in the heart of Princeton?
 
When the hospital moved, it made several accommodations designed to ease the transition for the residents of the Witherspoon community, especially those for whom the hospital was a key source of primary care.
 
It left behind a community information center, and it agreed to pay for New Jersey Transit bus tickets so that residents could travel to the new hospital without having to pay the $1.50 fare. (The tickets are available at the information center.) The hospital also donated $200,000 toward the operation of the buses, according to Pam Hersh, vice president for government and community affairs at the company that owns the hospital.
 
Last week, The Princeton Summer Journal canvassed the Witherspoon neighborhood, speaking to 70 local residents to find out how the hospital’s move had affected them. More than half were not aware that the information center was available, and a significant majority did not know there was free transportation to the hospital. 
 
Hersh said the hospital has used various outreach measures to notify community members of both the transition and the transportation. “Advertising of the free bus tickets was extensive—in Spanish newspapers, at the churches, at the library, local newspapers, radio spots, Princeton Human Services Commission, presentations to community [groups] beginning one year before the move,” Hersh wrote in an e-mail, adding that letters went out twice to all patients who use the outpatient clinic. 
 
Maria Conde, an employee at the information center, estimated that about 100 people visit it per week, and six or seven free bus tickets are handed out. But of the 24 people in the Witherspoon neighborhood Princeton Summer Journal reporters  spoke to who had visited the new hospital, only 10 were aware of the  free transportation. 
 
When a group of Princeton Summer Journal reporters visited the hospital at 6:15 p.m. on a bus labeled  NJT 655, they recorded a travel time of 13 minutes and 24 seconds, with minimal traffic. It took about six  additional minutes to walk from the bus stop to the public entrance. 
 
Speaking about the residents of the Witherspoon community, Conde said, “A lot of them cannot transport  themselves, and they hate the bus because they have to carry their kids—it’s a hassle.” 
 
Residents of the community pointed to other problems related to the move. Vandyke Grant, a Witherspoon resident and former hospital employee, said, “Since the hospital moved, it changed the community. We’re hurting. The economy has suffered since the hospital left. People who are elders now have to catch the bus if they get sick.” 
 
Just a few doors down, Grover Tash, a 93-year-old man with a soft voice, hearing problems and critical heart conditions said, “I was not in favor of the move. I think it was a farce.” 
 
One possible solution would have been to leave a  small medical clinic at the old hospital site. Liz Lempert, deputy mayor of Princeton Township, said the local government is working to determine the percentage  of local residents who use the new hospital. She said that if there is a drop off in the percentage of people from the old outpatient clinic who now use the hospital they will consider proposing a clinic in the Witherspoon  area. 
 
Uwe Reinhardt, a professor of economics and public affairs at Princeton University and an expert on  healthcare economics, said, “I am disappointed that they didn’t leave a clinic. It would be nice to have ... just an outreach clinic with a nurse and doctor.”
 
One Witherspoon neighborhood resident said that “it seems like the dumbest thing in the world” to move the hospital “and not leave some kind of support here.” 
 
Another resident, a diabetic man who recently had a toe amputated, said he now has to walk to the bus  stop twice a week, then from the drop-off at the hospital to the clinic entrance. The relocation “hindered us, because it’s too far away,” he said in Spanish. 
 
“The idea of moving was good for the hospital,” said Juan Francisco, another  Witherspoon resident, “but bad for the community.”