Winter Quarterly Newsletter
CONTENTS:
Director's
Column
Partner
Focus
Program
Focus
Special
Feature
RHAC
Member
Profile
WINTER
2012
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DIRECTOR'S COLUMN
IT WAS 20 YEARS AGO
In 1992, the Minnesota Legislature considered major health reform legislation
that would create the MinnesotaCare coverage program when passed. Among
the concerns voiced during that session were doubts there would be an
adequate health care workforce and misgivings that a wave of anticipated
consolidations would harm rural communities’ access to care. Worried the law
would end the ability of rural health leaders to have a say in these major
changes, rural legislators insisted that to earn their support, the law must be
responsive to rural needs and characteristics.
Mark Schoenbaum
On a parallel track, both state and federal leaders were recognizing that state
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leadership was needed to improve primary care services for underserved urban
communities.
The intersection of these trends created the Office of Rural Health and Primary
Care in 1992. Its mission: to promote access to quality healthcare for rural and
underserved urban Minnesotans.
At the time, a wave of hospital closures threatened access in large parts of the
state. Pioneering country docs were nearing the end of their careers, with
replacements uncertain. The rural ambulance system relied mainly on
volunteers. Statewide, the uninsured and low-income workers relied on a limited
health care safety net.
Since 1992, the Office has worked to be the voice of Minnesota’s health care
safety net in state government. It has been fortunate to be able to direct grants
and other financial resources to support the safety net workforce, rural hospitals
and safety net clinics. It’s been able to enlist great technical experts to help
improve clinic finances and build a state trauma system. The Office has also
become recognized for its ongoing analysis of Minnesota's health care
workforce.
Guided by the Rural Health Advisory Committee, along with the State Trauma
Advisory Council and the Rural Flex Program Committee, the office has
contributed to a variety of health policy and reform discussions. It published a
report that paved the way for establishing Critical Access Hospitals in
Minnesota, and put issues like the aging population, mental health needs, and
more on policymakers’ radar.
The Office has helped stabilize essential facilities, maintain access and
contribute to an ever- growing focus on quality. New Federally Qualified Health
Centers (FQHCs) have formed to serve unmet primary care needs, largely in the
Twin Cities but also in Mankato. Dental safety net providers have established
several beachheads throughout the state, though unmet dental needs still
swamp those clinics.
Through forums like the annual rural health conference, there’s a stronger
sense of community and connectedness among safety net leaders than 20
years ago. Many policymakers have a growing understanding that smaller rural
facilities and urban FQHCs are often the first to innovate, despite daunting
challenges.
Today’s environment has a lot in common with 1992’s, doesn’t it? Health reform
is again front and center, and the role of Minnesota's health care safety net -both rural and urban -- will change.
The safety net faces new questions and challenges: Is Minnesota ready for the
newly covered population that will seek care at community health centers? Will
rural clinics, hospitals and nursing homes play a role in new models like
Accountable Care Organizations? How will communities respond to rapid growth
in an already older and increasingly diverse population? Will local leaders set
the direction for health improvement, or will decisions be made in regional
headquarters? And who will staff those rural ambulances as the supply of
traditional volunteers dries up?
This year marks the twentieth anniversary of the Office of Rural Health and
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Primary Care, and in many ways it’s also the anniversary of a statewide
partnership dedicated to improving the health of Minnesotans regardless of their
address or their income. There’s been great progress since 1992, and the only
certainty is there will be great challenge ahead. Thanks as always for your
commitment to those served by Minnesota’s health care safety net. Here’s to
many more years of collaboration!
Mark Schoenbaum is director of the Office of Rural Health and Primary Care and can be
reached at [email protected] or 651-201-3859.
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PARTNER FOCUS
MINNESOTA'S FIRST SENIOR-FOCUSED COMMUNITY HEALTH CENTER
Tucked away in a corner of north Minneapolis is a kind of oasis for seniors.
Surrounded by landscaped green space, the new Heritage Park Senior Campus
offers assisted living, memory care and an elegant community center that brings
together a range of elder-tailored health and wellness services, including a
“boutique” YMCA open only to those 55 years and older, an indoor walking path
and one of the state’s few therapy pools.
This summer, a Community Health Center (CHC) joined the mix, with the new
Heritage Seniors Clinic. Operated by Neighborhood HealthSource, the clinic is
unique among Minnesota CHCs in its focus on eldercare. CHCs, also known as
Federally Qualified Health Centers (FQHCs), generally tend to serve much
younger populations -- only 7 percent of the patients served by such clinics
statewide are over the age of 65, though rural FQHCs tend to see far more. In
northeastern Minnesota, for example, seniors represent nearly a quarter of the
patients seen by Scenic Rivers Health Services. But no other CHC in the state
has a seniors-only clinic.
A collaboration that began with a housing agency
The idea came from an unlikely source: the Minneapolis Public Housing
Authority (MPHA). In planning the nation’s first public housing facility with
assisted living and memory care, the MPHA envisioned a senior services center
that could support the full well-being -- physical, emotional and social -- of its
residents. It saw a medical clinic as essential and invited Neighborhood
HealthSource to provide primary care services there.
Formerly known as Fremont Community Clinics, Neighborhood HealthSource
has served north and northeast Minneapolis for over 40 years, so it was familiar
with the neighborhood and had a track record of providing affordable, accessible
health care. It also had experience co-locating clinics with other agencies and
programs. Its Sheridan Clinic is located in the Northeast Neighborhood Early
Learning Center, which houses a number of agencies focused on supporting
families with young children.
The MPHA and its four partners -- Neighborhood HealthSource, the YMCA,
Courage Center and Augustana Senior Services -- met for over a year to plan
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the multi-faceted center. It’s been a challenging but exciting venture, according
to Neighborhood HealthSource Executive Director Steve Knutson. “One of the
great lessons learned has been the power of collaboration -- the power of
getting like-minded community service providers together and the possibilities
that can come from that,” he said. “Hopefully places like this can be a test tube
for learning what can be developed for our seniors.”
Tailoring CHC services to seniors
So far, the Heritage Seniors Clinic operates like many other community health
center sites: it provides a full spectrum of primary care along with supportive
services such as transportation and interpretation, and does so equally for both
insured and uninsured patients, turning no one away for lack of ability to pay.
Over time, however, it intends to adapt and expand its services to meet the
unique needs of its 55+ patients. It is currently expanding its diabetes program,
for example, and will be launching a nutrition program tailored to seniors.
Thanks to being co-located with partner organizations, providers can ensure that
patients follow up on exercise or therapy referrals, which are scheduled directly
on site. Clinic leadership also hopes to add podiatry services -- a “huge need,”
according to Mr. Knutson -- and to augment its mental health program, which
currently stretches one provider across three sites. The new site is physically
equipped to add dental services as well, but there are no immediate plans to
build out that portion of the clinic.
In its six months of operation, the clinic has seen a steady increase in the
number of patients. Initially, most patients came from the adjacent assisted-living
campus, but more seniors from the surrounding community are hearing about
the clinic and finding it a welcome option. Part of the draw seems to be its main
provider, a board-certified family medicine physician with a public health degree,
Dr. Frances Truitt, whom Mr. Knutson calls “perfect” for this new site. But he
also credits the senior center itself and the environment it has created for
connection and health. “North Minneapolis has a vibrant, engaged senior
population,” Knutson said. “This center gives a place for those seniors to flourish
and to connect with each other.”
For more information about the Heritage Seniors Clinic, contact Neighborhood HealthSource at
612-588-9411 or visit their website.
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PROGRAM FOCUS
BRINGING PEDIATRIC EMERGENCY TRAINING TO RURAL MINNESOTA
Trauma cases involving children are infrequent -- in 2009, they accounted for
less than 6 percent of all ambulance runs statewide, according to Minnesota
State Ambulance Reporting (MNSTAR) data. Yet when they do occur, the
results are often tragic. Trauma is the leading cause of death among pediatric
patients in the state.
Children’s cases are often stressful and challenging for emergency medical
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services (EMS) personnel. Not only is it difficult to see a child suffer, but such
cases call for unique skills and techniques specific to children -- knowledge that
can be difficult to retain when it is put to use so infrequently. In rural areas,
where low-population density often means low-volume EMS calls, providers can
go for months or even years without seeing pediatric trauma incidents. Yet
when those traumas do occur, the children are at increased risk of disability and
death compared to their urban counterparts, largely because of longer transport
times.
Last year, the Emergency Medical Services for Children Resource Center
(EMSRC) stepped up to address this challenge in rural Minnesota. After
surveying EMS providers across the state and finding that just over half cited a
“lack of confidence in treating pediatric patients” as their biggest concern when
responding to pediatric calls, and 75 percent indicated difficulty accessing
pediatric education, EMSRC applied for a grant from the Office of Rural Health
and Primary Care’s Flex program. The project’s goal: to use simulation training
as a way of equipping rural providers with the skills and confidence needed to
respond to pediatric trauma effectively.
Creating a new kind of pediatric emergency training
The EMSRC -- a collaboration of the Emergency Medical Services Regulatory
Board (EMSRB), Children’s Hospitals and Clinics of Minnesota and the
University of Minnesota -- has worked for over 15 years to improve the quality of
emergency care for children in Minnesota. It is part of the federal Emergency
Medical Services for Children Program, which works to ensure that all children
and adolescents, no matter where they live, attend school or travel, receive
appropriate care in a health emergency.
EMSRC used part of their Flex grant to design a training curriculum that would
be especially valuable in rural settings. Past EMSRC trainings had focused
solely on “pre-hospital” providers such as EMS personnel and paramedics. Here
they tried a new approach: training both pre-hospital and Emergency
Department providers together, in part to strengthen communication and
relationships across the two settings.
Making the training hands-on was also key. EMSRC contracted with Hennepin
Technical College (HTC) to bring its 45-foot mobile simulation trailer to rural
training locations throughout the state. Participants used mannequins and actual
equipment to treat four “on-the-job” trauma scenarios. Some of the equipment
was specialized and provided by EMSRC, but the educators also showed how
to adapt local equipment for use with children. Having these multiple, hands-on
opportunities to practice what was being taught was crucial to building
confidence among participants, according to Kjelsey Kluge of EMSRC. “We
wanted everybody to be able to say, ‘I did that.’”
A group effort and success in the field
Overall, 240 pre-hospital and hospital-based providers attended the free
simulation trainings in rural locations including Eveleth, Owatonna, Marshall,
Bemidji, Thief River Falls and Two Harbors. EMSRC worked with each of the
state’s five Regional Trauma Advisory Committees (RTACs) and the seven
regional EMS programs in greater Minnesota to organize the 11 sessions. In
addition to its trailer, Hennepin Technical College also provided the lead
educator, and many local educators donated their time as well.
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EMSRC hopes to build on the project’s success by making the curriculum
available for groups to use on their own and, if resources allow, to organize
more in-person sessions with the mobile simulation trailer. The need for such
training continues.
“No matter how many years an EMT has worked, they always tell me their
hearts race when they see a child,” says Kluge. She knew their trainings had
succeeded when one participant later thanked her and mentioned a child she
had treated a week after the training. “She said she had been able to apply the
information and felt she had done the right things,” she said. “That’s so key for
people working in EMS.”
For more information about Emergency Medical Services for Children, call 800-660-7022 or
visit their website.
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SPECIAL FEATURE
SHIP logo
TAKING A STEP TOWARD BETTER HEALTH
by Amber Dallman and Chera L. Sevcik
A hot, 95-degree day did not stop 25 citizens and community leaders from
attending a walkability and bikeability workshop in St. James on Tuesday,
September 11. The workshop, facilitated by the Minnesota Department of
Health, provided communities in Watonwan County with information on how
street and community design is essential to increasing physical activity levels
and improving the health of their community.
Participants spent an hour learning how to increase safety and support people
who want to walk and bike more through the “5 E” approach. The "5 Es"
include: evaluation, engineering, education, enforcement and encouragement.
The group then put on their walking shoes and went for a mile walk around St.
James to practice completing a "walkability audit." Upon returning, participants
broke into smaller groups based on the communities they were from. The
groups brainstormed ideas and strategies they could apply back home.
Next, Active Living Coalitions in St. James, Madelia and Butterfield will begin
the work of mapping out specific areas in their communities to complete a
walkability assessment. Upon completion, groups will work with Region 9
Development Commission to develop an action plan as well as multimodal
transportation plans. Groups will also look at upcoming street, highway and
land use renovation projects to ensure plans contain facilities for walking and
biking.
The local Statewide Health Improvement Program (SHIP) grantee,
Cottonwood-Jackson-Faribault-Martin-Watonwan (CJ-FMW), hosted the
September workshop. The group is no stranger to discussing how to increase
walking and biking in rural Minnesota communities. Back in 2010, similar
workshops were held in Faribault and Martin Counties. The City of Wells took
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the information about increasing walking and biking and ran with it, working
with Region 9 to develop an action plan for walking and biking. They also
increased the shoulder width and placed rumble stripes on a highway project
connecting their community to Winnebago.
Engaging Active Living Coalitions in road projects is just one way to support
more walking and biking. These groups are also addressing systems and
policies that make it easier for people to choose the healthy choice. Through
the work of SHIP, communities throughout the state are realizing the
opportunities to increase Active Transportation beyond urban centers. The
Rails-to-Trails Conservancy recent report, Active Transportation Beyond
Urban Centers: Walking and Bicycling in Small Towns and Rural America,
notes that “many rural small towns are choosing to invest more in promoting
active transportation, and making it safe and convenient, because of
economic, health and demographic benefits these modes return.”
The benefits of Bicycle and Walk Friendly Communities include:
Improving the health of people.
Reducing traffic demands.
Improving the quality of life.
Increasing economic development opportunities.
Increasing local tourism.
Providing transportation choice and equity for people.
What can you do to reap the benefits of more walking and bicycling
opportunities in your rural community? Here are a few things to check out:
Find an existing active living coalition. The Statewide Health
Improvement Program (SHIP) facilitates many throughout the state.
Check out what your Regional Planning Organization is doing -- regional
planners are aware of upcoming projects and can advise local residents
on how to support safe walking and biking facilities.
Ask if your community has a master plan to support walking and
bicycling facilities.
Go for a walk and report back to your decision-makers about what you
find. Use the Let’s Go For A Walk handout from MDH to help.
For more information about what MDH is doing to promote physical activity in
communities throughout the state, contact Amber Dallman at
[email protected] or 651-785-8463.
Amber Dallman is physical activity coordinator with the Minnesota Department of Health.
Chera Sevcik is Statewide Health Improvement Program (SHIP) supervisor for Cottonwood,
Jackson, Faribault, Martin and Watonwan Counties.
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RHAC MEMBER PROFILE
ORHPC TALKS WITH RURAL HEALTH ADVISORY COMMITTEE (RHAC)
MEMBER NANCY STRATMAN
Please explain your professional work to us . . .
I’m a licensed nursing home administrator working as the CEO/Administrator at
the senior campus of Cokato Charitable Trust in Cokato, which is about an hour
west of the Twin Cities. The campus consists of a 56-bed skilled facility, 46 units
of assisted living, a 10-bed dementia unit, a Medicare-certified Home Health
agency, home-delivered meals, child day care and adult day care. We serve a
total of about 225 people in the community and employ about 180 staff.
I am also a board member for Aging Services of MN and the Aging Services
Group, a member of the state’s Diabetes Steering Committee and chair-elect of
Care Ventures Cooperative. On RHAC, I am the Long-Term Care
Representative.
And your life away from work?
Six years ago I was widowed and since then have had many life-changing
events...I’ve remarried, changed jobs, moved. Both of my children have married
and I have three grandchildren. So, now life finally seems to be settling into a
“new normal.”
My husband and I have a cabin in the Aitkin area that is about 80 percent
complete, so weekends are often spent there making dust in preparation for
having it finished in time to enjoy before and during retirement, when we’ll move
there.
Visiting the North Shore and enjoying the outdoors are renewal for me. When I
find the time to read, I curl up with a book about self-improvement or
management. I love visiting my children and grandchildren in San Diego and
San Francisco. I was recently reminded of the blessings of rural life when my
18-month-old granddaughter visited “Grandma-in-the-Woods” and was so
excited about all the “tars” in the night sky, saying “Woooooow!” You don’t get
that kind of viewing in San Diego!
What do you think are the most important issues facing rural health?
I grew up in a community of about 500 people in central North Dakota, where
my parents still live. The county’s population is approximately 4,000. Their
issues of accessing healthcare are a personal reminder of the challenges and
concerns of elders in rural areas. My mother comments that in rural areas it
takes a village to support elders, a reminder of the campaign, “It Takes a Village
to Raise a Child,” spearheaded by former First Lady Hillary Clinton.
Our challenge is to create and to help facilitate the “village” of support, both
formal and informal, for elders in rural areas through technology and education,
building networks where neighbors check on neighbors, etc. to avert the
episode that will be catastrophic both in terms of health and costs. There is
strength and synergy that is unique to rural in bringing the community into
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health care.
Statisticians show that the number and needs of the elderly are on the rise,
while the workforce is dwindling. This phenomenon will be a force to contend
with for many years to come and has already had an impact in rural areas
where the elderly dependent ratio is highest. Our challenge is to train and retain
the talent of rural folks.
What do you think would make the most difference for rural health?
Engagement in healthy living! This is not true only in rural Minnesota, but also
for all of Minnesota and the country in general. According to the CDC:
Chronic diseases, such as heart disease, stroke, cancer, diabetes and
arthritis, are the most common and costly of all health problems, but they
are also the most preventable.
Four modifiable health risk behaviors -- lack of physical activity, poor
nutrition, tobacco use and excessive alcohol consumption -- are
responsible for much of the illness, suffering and early death related to
chronic diseases.
Reaching out and engaging people to take command of balanced living and
general wellness would make a big difference. Our challenge is to prevent,
delay, detect and control.
The Rural Health Advisory Committee advises the commissioner of the Minnesota Department
of Health and other state agencies on rural issues; provides a systematic and cohesive
approach toward rural health issues; and encourages cooperation among rural communities
and providers. Meeting information is online.
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VIEW ONLINE ALL PREVIOUS ISSUES OF THE OFFICE OF RURAL HEALTH AND PRIMARY CARE PUBLICATIONS.
Minnesota Office of Rural Health and Primary Care
P. O. Box 64882
St. Paul, Minnesota 55164-0882
Phone 651-201-3838
Toll free in Minnesota 800-366-5424
Fax: 651-201-3830
TDD: 651-201-5797
www.health.state.mn.us/divs/orhpc
MISSION: To promote access to quality health care for rural and underserved urban
Minnesotans. From our unique position within state government, we work as partners with
communities, providers, policymakers and other organizations. Together, we develop
innovative approaches and tailor our tools and resources to the diverse populations we serve.
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