Volume 4 Number 3
PHOTO COURTESY OF MINNESOTA DEPARTMENT OF TRADE AND ECONOMIC DEVELOPMENT
Q U A R T E R LY
Fall 2002
The mission of the Office of Rural Health & Primary Care is 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, policy makers
and other organizations. Together, we develop innovative approaches and tailor our tools
and resources to the diverse populations we serve.
Rural Health Advisory Committee Member Profile:
ORHPC Talks with Maddy Forsberg
Home: Slayton
Family: 3 children, 6 grandchildren
Hobbies: Spending time with family and knitting
Maddy Forsberg is the Director of the Southwest Area Agency on Aging in Slayton and has been
with the agency since 1979. The goal of the Southwest Area Agency on Aging is to assist older
Minnesotans to live independent, meaningful, dignified lives in their communities. Maddy and her
staff work with a variety of resources to coordinate and advocate for services for older Minnesotans in
a nine county area of southwest Minnesota. She is very passionate about helping people and has
found her niche in helping seniors. Maddy is also the newly elected President-Elect of the Minnesota
Rural Health Association.
Maddy Forsberg, Rural Health
Advisory Committee Member.
Maddy has been involved in rural health care in one way or another most of her life. After years
of struggling with the health care system, both personally and professionally, she has concluded that
the health care system is in need of repair. Maddy is quick to credit the doctors, nurses and other
health professionals who are doing the best they can with the available resources. However, a multitude of factors are causing the health care system to interfere with a patient’s ability to access quality
health care. It is because of this fragmented system that she became involved in the Rural Health
Advisory Committee.
Maddy was appointed to the Rural Health Advisory Committee in 1999 and serves as a consumer
representative. She describes her role as an information liaison, providing information about rural
health issues to the Committee and taking information from the Committee back to her community.
And she adds, “I try to help however I can.”
What do you think are the most important issues facing rural health today?
MF: I feel there are three issues facing rural health today: Medicare disparities, rules and regulations, and skyrocketing health care costs. I am particularly concerned about how these issues affect
seniors. Due to lower Medicare reimbursement rates for rural areas and high prescription drug costs,
seniors are paying more out of pocket costs. For seniors on a fixed budget, this is an expense they can
ill afford, causing them to make choices between medications and groceries. Prescription drug programs for seniors are a good beginning but more needs to be done to control health care costs for
seniors.
What one or two changes do you think would make the most difference for rural health?
Estelle Brouwer, Director
Karen Welle, Assistant Director
Stefani Kloiber, Editor
MF: I would like to see an increase in funding for rural areas. Unfortunately, rural areas are receiving an unfairly small share of funding in comparison to urban areas. Rural areas have fewer resources
and therefore need more money to provide services. Additional funding is needed for everything from
health care to transportation to housing. An increase in funding to rural areas would be a good first
step in making a difference.
The Rural Health Advisory Committee advises the Commissioner of Health and other state agencies on rural health issues, provides a systematic and cohesive approach toward rural health issues,
and encourages cooperation among rural communities and providers. Meetings are regularly held at
the Snelling Office Park at the corner of Energy Park Drive and Snelling Avenue in St. Paul and are
2
open to the public. For dates, times, and directions, visit the Web site at
www.health.state.mn.us/divs/chs/rhac/meetings.htm or contact Tamie Rogers at (651)2823856/[email protected]
By Stefani Kloiber
Do you remember the pressure to choose a career path as a high school student? Imagine if you had had the opportunity to try on a career before committing to a career path. Wouldn’t it have been great to have your questions answered, see
the demands and rewards, and live a day, week, or month in the life of that career? The Summer Health Care Internship
Program gives students the chance to try on various health care careers and make informed decisions about their future.
What is the Summer Health Care Internship Program?
The Summer Health Care Internship program began in 1992 as an early effort to address health care workforce shortages. The program was created by the Minnesota Legislature and called for the establishment of a secondary and post secondary summer health care internship program. The purpose of the program is to expose students who are considering
pursuing a health care profession to various health care careers.
Initially, the program included only hospitals and clinics as eligible participating facilities, but in 2001 the program was
expanded. Representatives of eligible facilities provided input to the program redesign; the expanded program, which now
includes nursing homes and home care providers in addition to hospitals and clinics, was launched in 2002. According to
the Minnesota Hospital
and Healthcare
Partnership (MHHP),
which administers the
program, 1,327 students
have participated in the
program from its inception through the summer
of 2002. This includes
nearly 612 health care
facilities throughout
Minnesota.
The Summer Health
Care Internship Program
is mutually beneficial for
students and health care
Tri-County Hospital (Wadena) 2002 Summer Health Care Interns.
facilities. Students are
given the opportunity to
gain first-hand experience in the health care setting, allowing them to make more informed decisions about health care
careers. The health care facility and its employees also benefit from the program by having extra staff to assist with tasks,
financial assistance to pay the interns, and a method for future recruiting along with the opportunity to become more
involved in their community.
PHOTO COURTESY OF LORI GRESS, TRI-COUNTY HOSPITAL
PROGRAM FOCUS
Exploring Health Care Careers
Students are employed at the health care facilities anytime between May and September for six to twelve weeks and
are paid an hourly wage. Employers are reimbursed up to one-half the cost of employing interns. Students participate in the
program based on their career goals. The interns interact with both staff and patients and are involved in everything from
the hospital emergency room to clinic appointments to home health care visits. Interns may explore all areas of the facility
including radiology, laboratory, physical therapy, occupational and recreational therapy, nutrition services, business office,
See “Program Focus” (page 7)
3
COMMUNITY FOCUS
Health Care:
A Vital Element for the Survival of a Community
By Stefani Kloiber
Have you ever thought about what health care means to you and your community or what it would mean to lose it?
What would happen if the clinic or hospital in town closed? How far would you have to travel to see a doctor for yourself or
a family member? All of these are important questions to ask when discussing the impact of health care in a community.
Why does health care matter?
Accessible, quality health care in a community is important for individuals and families, but can also mean jobs, economic
growth, and retirement or relocation incentives. Health care is a vital element to the economic survival of a community.
Health care, however, is often an overlooked aspect of the local economy and as a result is disregarded by residents and local
leaders when making decisions and planning for their community’s development. According to Dr. Gerald Doeksen, an economist at Oklahoma State University and co-chair of the national Rural Health Works
Task Force, “On average, every dollar spent at home on health care re-circulates inside
According to
the community one and a half times. For every five jobs in the health sector, four jobs
Dr. Gerald Doeksen, an
are generated inside the community.” Consider these additional important facts about
economist at Oklahoma
rural health care and how it affects the local economy:
• Many rural counties are losing health dollars as residents go out-of-county for their
primary health care services.
• Changes are occurring in the health sector that threaten the existence of local rural
health care services.
• The health sector is often the largest rural county employer. In fact, it is often
directly responsible for 10 to 15 percent of jobs.
• Many rural hospitals are in financial trouble. Some depend on Medicare and
Medicaid payments for as much as 80 percent of their revenue.
• The average rural resident has little idea how important the health sector is to the
rural economy.
• The demographics of rural areas lead to higher health care costs. The rural population is older than the urban population, and therefore, tend to use more health care
services.
State University and
co-chair of the national
Rural Health Works Task
Force, “On average, every
dollar spent at home on
health care re-circulates
inside the community one
and a half times.
For every five jobs in the
health sector, four jobs
are generated inside the
community.”
With all of these factors affecting rural health care, what can be done to assure
communities that their local leaders are including the health care sector when it comes to making decisions for their community? One program, Operation Rural Health Works, is working on doing just that by helping communities understand the
economic importance of the health sector and arming them with the tools to strengthen their health care system.
What is Operation Rural Health Works?
Operation Rural Health Works is a program developed by a national task force of community, state, and federal leaders
concerned with keeping health care accessible to rural communities. It began in 1998 as a pilot project of five states:
Kentucky, Missouri, Nevada, Oklahoma, and Pennsylvania. The goal of the project was to expand public awareness of the
importance of the economic impact of the health care sector and stress its critical role in rural development through economic impact studies, community health planning, feasibility studies, and a public education campaign.
One objective of the pilot project was to develop a template for estimating the economic impact of the health sector on
each county in the five pilot states. The template uses a minimum of seven data sets, which includes local data on demo4
Community Focus
graphics, economic indicators, personal income, medical provider
information, health status, employment by sector, and health
impact. From this data, an economic impact analysis is generated
and presented to the community and/or local leaders. The local
leaders use the results to evaluate the need for the health care service in their community. Armed with this data, local leaders are better prepared to make decisions that will strengthen their health
care system by keeping the health care dollars local.
system’s role as a local employer. The health care sector includes
the hospital as well as offices of physicians, dentists, and other services; nursing homes; and pharmacies. The total employment impact
of the health sector in Renville County was estimated to be about
1,162 employees, with a total income impact of $20 million when
spinoff spending by employees’ households and input suppliers is
included. These jobs represent around 12 percent of the county
total employment, so any decline or expansion of the health sector
will affect the economic health of the community. The magnitude
Following the success of the pilot projects, Rural Health Works
of the impact underscores the need to be proactive in maintaining
has expanded. Through training workshops and technical assisand revitalizing their local health care services.
tance, the program is available to any state interested in measuring
The Health Services Foundation of
the economic impact of their
Renville County and the Minnesota
health sector. A “train the
Rural Health Association co-hosted a
trainer” workshop is designed
meeting to present the results of
to assist state agencies in
Renville County’s economic impact
developing teams to provide
study on October 24, 2002, in Olivia.
technical assistance to local
Following the presentation, the audicommunities on economic
ence discussed next steps for Renville
impact, community health
County. Please continue to watch the
planning, and feasibility studQuarterly for updates and information
ies. To date the program has
on the progress of Rural Health Works
been presented to 37 states
in Renville County and throughout
including Minnesota.
Bill Lazarus of the University of Minnesota’s Department of
Minnesota.
Applied Economics presents the results of Renville County’s
Representatives from the
economic impact study.
The national Rural Health Works
University of Minnesota
program is sponsored by the Rural Policy Research Institute, the
Extension Service and the Department of Applied Economics,
federal Office of Rural Health Policy and the U.S. Department of
Minnesota Hospital and Healthcare Partnership, Minnesota Center
Agriculture’s Cooperative State Research, Education, and Extension
for Rural Health, USDA Rural Development, Advocates for
Service. More information is available at the Rural Health Works
Marketplace Options for Mainstreet, Office of Rural Health and
Web site at http://rd.okstate.edu/health/ or contact Jill Zabel at
Primary Care, and local leaders from Renville, Pine and Cook
(651) 282-6304/[email protected] to learn more about the
Counties attended a training workshop sponsored by the Office of
program in Minnesota.
Rural Health and Primary Care in July 2002. Following the training, the University of Minnesota Extension Service, the Department
of Applied Economics, and the Office of Rural Health and Primary
Care collaborated on completing an economic impact study of
Renville County.
The health care sector affects rural development in at least three
ways. A strong health care system can help attract and maintain
business and industry growth, and attract and retain retirees. A
strong health care system can also create jobs in the local area. The
Renville County analysis looks at this third aspect - the health care
The Office of Rural Health and Primary Care is providing funding to help with the expansion of Rural Health Works in
Minnesota. During this first year of the program, a small number of
grants will be available to assist with the implementation and coordination of a Rural Health Works project. Application guidelines are
expected to be mailed to all eligible facilities in early 2003 and will
be available from the ORHPC Web site at
www.health.state.mn.us/divs/chs/grants.htm or by contacting Jill
Zabel.
5
After 10 Years, Focus on Rural Health Still Needed
By Estelle Brouwer
DIRECTOR’S CORNER
My siblings and our families traveled recently to our childhood home in rural Minnesota to
help our mom and dad celebrate their 55th wedding anniversary. My family always enjoys the
trip, partly because it’s an opportunity to “slow down”(albeit inside a rapidly moving vehicle!) and
enjoy one another’s company for a few hours. We also love, after the sun drops below the edge
of the prairie and the oranges and pinks fade into navy blue, watching the stars pop out. That’s a
kind of drama we just don’t get to see in St. Paul!
Of my three siblings, my brother and his family have moved furthest away. They now live in
northern Virginia, not far from Washington, DC, in a part of the country that is bustling with
activity and growth and opportunity. My brother told me during our weekend in Tyler that one
of the things he finds most disturbing about coming back to visit is the depopulation of the countryside. It’s true. In the case of southern and western Minnesota - prairie Minnesota - some
communities have been depopulating for almost as long as they’ve been populating. According to
State Demographer Tom Gillaspy, many counties in southern and western Minnesota and other
Great Plains states started losing population decades ago. Certainly the Internet and other
telecommunications technologies offer the potential of turning that trend around, but in many
places, there’s a lot of ground to make up before the trend lines start moving back up.
This year, the Office of Rural Health and Primary Care celebrates its tenth anniversary. Back in
1992, the Minnesota Legislature recognized that special efforts and programs were needed in
order to ensure that rural Minnesotans have access to quality health care. Much progress has
been made in that ten years toward stabilizing the rural health care system, recruiting and retaining health care professionals in rural communities, upgrading health care facilities and services,
and building networks that strengthen the fabric of the rural health care delivery system. The
Office itself, with the support of the Legislature and the federal government, has broadened its
scope to include programs benefiting not only rural hospitals and clinics, but also nursing homes
and other senior health services, ambulance services, young people exploring the possibility of
pursuing a health career, and a range of providers from physicians and dentists to nurses, nurse
practitioners, and physician assistants.
That broadened scope is a good thing for all of us. Here in the Office, our understanding of
how all the pieces of the rural health care system fit together grows every day. That understanding helps us do a better job of managing our programs and of anticipating what may be coming
around the curve next. And that’s good for rural Minnesota.
Perhaps it’s unfortunate that the services and assistance we provide are needed just as much
today as they were ten years ago. Be that as it may, however, I am grateful that our state and
national leaders value rural people and rural communities enough to continue to support them
through the kinds of programs our office delivers. We look forward to another ten years of working with you to strengthen rural Minnesota!
Estelle Brouwer is director of the Office of Rural Health and Primary Care. She can
be reached at (651) 282-6348/[email protected]
6
Program Focus (continued from page 3)
social service, pharmacy, emergency, inpatient care, and respiratory
therapy.
She further added that her greatest reward was helping the residents
and receiving smiles from them.
Tri-County Hospital in Wadena has participated in the program
since it began and has employed more than 100 students. When
asked about the program, Cindy Uselman, program coordinator, stated, “The program is great for both the staff and the students. The
staff have especially come to appreciate and look forward to the
summer interns.”
The MHHP conducts an annual survey of former interns five years
after their participation in the program. “Early results from the survey show
that the program is working,” said Mark Schoenbaum of the Office of
Rural Health and Primary Care. The data shows that more than 50 percent of the survey respondents were either currently employed in a
health care career or pursuing one following their internship.
PHOTO COURTESY OF DIVINE PROVIDENSE HEALTH CENTER
Tri-County Hospital recently completed a survey of
past program participants and found that of the 73 percent that replied, 98 percent felt the internship was helpful. In addition, 69 percent are currently working or
planning on working in the health care field. The survey
also asked interns if they felt that the internship was
helpful. Below are some of the responses.
“The program was a great summer job. I
left appreciating health care workers and their
relationships with patients...plus I gained an
appreciation for RURAL health care.”
“It (the program) emphasized the team
approach in health care. It also provided
knowledge, generally, of all members of the
health care treatment team. It allowed me to
decide whether physical therapy was the
career I wanted to pursue, or if I should think
of pursuing a different one.”
Divine Providence Health Center’s (Ivanhoe)
intern Amanda Bennett helping one of the residents play bingo.
Divine Providence Health Center, a long-term care facility in
Ivanhoe, is one of the new facilities recently added to the program.
Beth Daniels, program coordinator for the facility, was very thankful
for the program and hopes to participate again next year. She added,
“The program went very well. We were especially lucky because
our intern had established relationships with the residents as a certified nursing assistant prior to her internship.”
Divine Providence Health Center’s intern, Amanda Bennett of
Lake Benton, was able to see a different part of the Health Center
by spending some of her internship in the Activity Department. Ms.
Bennett learned about activities and techniques used to help meet
the physical, mental, and social needs and interests of the elderly.
She also helped with small group activities such as games, community outings, physical exercise classes, socialization, music exercises,
and other special events. Ms. Bennett said that she gained more
insight into the residents and the other departments in the facility.
To be eligible for the
internships, students
must be in their junior
or senior year of high
school, or must be a
post-secondary student
enrolled in a Minnesota
educational institution
or be a resident of
Minnesota. Post-secondary students must be
enrolled in a health
care training program
or a two or four year
health care degree program with the intention
of completing the program.
MHHP administers
the program in partnership with Care Providers of Minnesota,
Minnesota Health and Housing Alliance, and the Minnesota Home
Care Association, through a contract with the Office of Rural Health
and Primary Care.
For more information on the Summer Health Care
Internship Program, contact Elizabeth Biel at the Minnesota
Hospital and Healthcare Partnership at (651) 6033552/[email protected]
Stefani Kloiber is the editor of this
publication, and can be reached at
(651) 282-6338/[email protected]
7
To learn more about the
Office of Rural Health & Primary
Care programs, visit our Web site:
www.health.state.mn.us/divs/chs/
orh_home.htm
Two Rural Minnesota Physicians
Receive National Honors
The Office of Rural Health and Primary Care congratulates two outstanding Minnesota physicians. Drs. Darrell Carter and Dennis Peterson were recently honored with awards from the
American Academy of Family Physicians.
Darrell L. Carter, M.D., was selected by his peers to receive the 2003 Family Physician of the
Year Award. Dr. Carter is a practicing family physician from Granite Falls who has been delivering
quality and compassionate care to his community for more than 30 years. He serves as a role
model for the profession of family medicine and his community. Since 1996, Carter has assisted
in the development and teaching of Comprehensive Advanced Life Support courses (CALS). The
CALS program trains rural providers to manage crisis health situations with limited resources. His
program has been credited with improving rural health care delivery and saving countless lives.
In 2001, Carter was named the Minnesota Rural Health Hero for his innovative work, leadership skills and his efforts to establish Comprehensive Advanced Life Support programs in the state.
Dr. Carter was recently appointed to Minnesota’s state Rural Health Advisory Committee.
This information will be made
available in alternative format –
large print, Braille, or audio tape
– upon request.
Printed on recycled paper with a
minimum of 20% post-consumer waste.
Dennis L. Peterson, M.D., of Willmar was honored with a 2003 Exemplary Teaching Award
from the American Academy of Family Physicians. Dr. Peterson is a staff physician at Willmar
Family Practice Medical Center in Willmar. Since 1989 Peterson has been involved with the
Rural Physicians Associates program, where physicians spend a year training under other family
physicians in rural areas.
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