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PART IX - HEALTH AND WELLNESS.
The tri-county area of Northeastern Vermont is the most rural sector of the state with a population of 60,000 people, living for the most part in small communities and on rural farms. The overall population density is less than 6 people per square mile Isolation is exacerbated by long, severe winters, mountainous terrain and large areas of unpaved roads. Approximately 29% of residents receive some benefits through state and/or Medicaid health insurance programs and an additional 21% through Medicare. With these conditions in mind, the following summarizes both the assets and challenges to the Northeast Kingdom in assuring access to quality, affordable health care for all.
1. Hospitals.
The Northeast Kingdom supports two community hospitals, North Country Hospital
in Newport and Northeastern Vermont Regional Hospital in St. Johnsbury.
Each provides inpatient and emergency care as well as specialty clinics. Annual
discharges for each of the hospitals are approximately 1600 and 1700 respectively.
Tertiary hospitals in New Hampshire and Vermont are approximately one to two
hour drives away.
2. Primary Care.
There are a total of seventeen primary care practice sites throughout the region
as well as a Women's Wellness Clinic and a walk-in clinic at one hospital. The
two major towns of St. Johnsbury and Newport are home to 59% of the practices
although only 23% of the region's population reside in these communities. Of
the seventeen practices, nine are federally designated Rural Health Clinics.
In addition, Northern Counties Health Care operates four rural clinics
as part of a Federally Qualified Health Center network. There are also several
alternative medicine practitioners and chiropractors providing services in the
region.
3. Dental Care.
There are eighteen primary care dentists in the region with thirteen of them
located in Caledonia County. The only dental practice in Essex county is part
of the Federally Qualified Health Center Clinic in Island Pond.
4. Home Health.
Caledonia Home Health Care and Hospice and Orleans-Essex VNA and Hospice
provide home health services to home bound patients in the region. Approximately
2400 patients are served annually by these organizations.
5. Mental Health Services.
Northeast Kingdom Human Services (NKHS) is the non-profit community
mental health agency serving the region and having primary responsibility for
serving adults with severe and persistent mental illness, children who are seriously
emotionally disturbed and their families, and children and adults with developmental
delays or disabilities. The agency also provides alcohol and substance abuse
treatment. Through contracts with many schools in the Northeast Kingdom, the
agency provides case managers and counselors to address the mental health needs
of students. The NKHS has offices in St. Johnsbury, Newport and Hardwick and
provides services to approximately 3300 Northeast Kingdom residents. Mental
health services are extended to elders through the Area Agency on Aging network
for individuals 60 and over, including those with organic brain disorders.
6. Nursing Homes.
There are seven nursing homes and seventeen residential care homes in the region.
7. Public Health Agencies.
There are two district offices of the Vermont Department of Health in
the region. These offices provide maternal and child health services, operate
WIC clinics and participate in community health initiatives.
8. Health Education Resources.
Consumer health education programs are provided by the local Health Department
District Offices, by hospital and community-based wellness programs and annual
Wellness Fairs sponsored by community groups in St. Johnsbury and Newport. The
Northeastern Vermont Area Health Education Center works with local agencies
throughout the region to develop consumer health education programs and Health
Education and Resource Centers.
9. Community Resource Centers.
There is one community center in the region, the Hardwick Area PATCH,
that brings to one location multiple public and private agency services, provides
information and referral services, offers health education and information resources
and works with the community to develop its resources and support community-wide
problem solving. A second PATCH resource center is being considered for development
in the community of Wells River that would provide services and resources to
residents in Southern Caledonia county.
10. Services for the Elderly.
Northeastern Vermont Area Agency on Aging supports people sixty and older
in their efforts to remain active, healthy and in control of their lives. Services
include health benefits counseling, senior companions, case management for long
term care services, senior congregate and home delivered meals, transportation
and referrals to legal services.
11. Adult Day Services.
There are two adult day service programs in the region: The New Move Adult
Day Services in St. Johnsbury and Adult Day Services of Orleans County
in Newport. These programs provide medical, social and nutrition services for
elders and adults with disabilities.
12. Women's Services.
Umbrella in St. Johnsbury, Step One in Newport and Aware
in Hardwick provide services to women and children who have been victims of
domestic violence.
13. Family Planning.
Planned Parenthood for Vermont operates two sites in the tri-county area:
in St. Johnsbury and in Newport.
14. School Nurses.
There are 24 school nurses in elementary, middle and high schools throughout
the region who provide screenings and medical referral for students
15. Consortiums.
Northeast Kingdom Consortium of Health Care is an affiliation of non-profit
health care related organizations that seeks to improve health care services
for residents of the region by working together.
The Northeast Kingdom Vision for Health and Wellness is that all citizens in the region have access to high quality affordable physical and mental health care through local providers; that communities, employers and individuals support healthy lifestyles and environments, that the well-being of children is a central focus; that prevention, personal wellness and freedom from pain are strong areas of focus from birth to death; that domestic violence and substance abuse are rare and unacceptable in our families and communities and that our elderly and disabled citizens have adequate health and wellness supports to remain in their homes and remain integrated in their communities.
The rural isolation of Northeastern Vermont communities, the lack of public transportation systems and an economy that engenders the highest poverty rate in the state limit the strategies for improving access to health care. In addition, the publicly financed medical reimbursement systems (Medicaid and Medicare) continue to be inadequate and are eroding the ability of health care providers to meet the health care needs of the region or to recruit an adequate health care workforce.
1. Health Provider Shortages.
Significant parts of the region are designated as Medically Underserved Populations
(MUP), Medically Underserved Area (MUA) or a Health Professions Shortage Area
(HPSA) for primary care. All three counties have been federally designated as
a Mental Health HPSA In addition, only 5.2% of Vermont dentists practice in
the region even though the population is 10% of the state's. Accessing specialty
care often requires patients to travel to tertiary centers. Approximately 29%
of the population is enrolled in Medicaid or state supported health insurance
programs (including VHAP, Dr. Dynasaur and V-Script) and 21% in Medicare. Another
8.8% of the population remain uninsured. [1997 Survey of Uninsured (Vermont
Department of Banking, Insurance, Securities and Health Care Administration)
and 1998 Medicaid Database.] Attracting health, mental health and dental
providers to the region is therefore difficult.
2. Professional Development.
Developing a health care workforce locally is further challenged by the lack
of educational programs in the Northeast Kingdom that would enable young people
as well as working people to participate in career ladders leading to health
professions. For example, there are currently no nursing degree programs available
in the region although this is one of the greatest areas of workforce need.
3. Transportation Difficulties.
With limited public transportation systems reaching the outlying communities
beyond St. Johnsbury and Newport, people have great difficulty in accessing
their health care providers. A more critical problem is that of having to travel
to tertiary centers for treatments such as dialysis and chemotherapy and radiation.
In some cases, individuals must travel a minimum of 1 ½ hours one way
and as much as 3 hours to receive radiation, dialysis or chemotherapy treatments.
Often this involves daily trips. About 85% of the low income population surveyed
agreed there was a need for transportation services to medical services.
4. Health Improvement and Education.
There is limited access to health education in the communities of the Northeast
Kingdom. As important as promoting healthy lifestyles is to citizens in their
vision for the region, most programs and health information resources are centralized
in hospitals and to some extent in schools. Expanding access to health information
and education resources remains a challenge for our most isolated citizens.
5. Capital Improvements.
There is a continuing need to upgrade hospital, community health and mental
health facilities throughout the region. Existing commercial building stock
is old and generally inaccessible. Modernization costs are prohibitive. In addition,
there is limited access to financial capital and organizations in the region
have insufficient reserves to support major capital improvements. The region's
philanthropic wealth is very limited and in great demand.
6. Availability and Sustainability of Services.
Limitations of existing funding and medical reimbursement sources have severely
limited ability of our health providers to offer needed services. Inadequate
funding for mental health services is eroding community-based systems of care
and creating significant barriers to recruiting and retaining mental health
professionals. The challenges are to identify ways to maximize financial resources
and coordination to achieve greater efficiencies that will enable expansion
of needed services.
7. Technology and Telecommunications.
The provision of health care services and the delivery of the most current health
information to providers has undergone dramatic changes during the past decade
as the result of the availability of new technologies and telecommunication
systems. Increasingly, the quality and accessibility of health care in rural
areas will depend on efficient and effective use of new technologies and methods
for transmitting information. The limited telecommunication infrastructures
within the region to support these technologies, as well as the high acquisition
costs of the technologies, will limit the ability of health providers to provide
high quality health care in the future.
Increase the Numbers of Health Care Providers
Professional Development for Health Care Providers
Transportation Difficulties
Health Improvement and Education
Capital Improvements
Availability and Sustainability of Services
Technology and Telecommunications
Improve the Availability of Health Services