I in 11 I I Hill l@itil ILIII Hill I I l@ Contents 1 MOBI[-IZING @iEAL.-['F-I CARE ntroductiort County Map 3 TI-IE ALLEGAN'( COUNTY MOBILE HEALTH UNIT A Profile Unit Stations 6 REACHING 1-@IE PEOPLE i-lealt@i Assessment Referra Follow-Lip VVell Child '10 EXTENDING EDUCATION A Two-way Exchange FLituire Mobility 11 PROGRAM PEOPLE Project Directors Unil@ Staff Executive Cornniittee Medical Advisory Committee Mobile Health Unit Advisory ComrT)jttee Lakes Area Regional Medical Prograrn, Inc. Acknowledgements Editorial Janet Gelsinger Anthony Zerbo, Jr. Design Richard Macakanja Photography International Trail, Truck Publication of International Harvester Co, July, 1974 Mobilizing Health Care Introduction Located in the Southern Tier of Western New York The health professionals of Allegany County have Allegany County is one of the rural counties com- assessed the needs of the rural citizens they serve prising the Lakes Area Regional Medical Program and have determined that an alternate method to ex- service area. One of the larger counties in this tend the delivery of health care must be developed region, Allegany encompasses 75,000 acres and has and that this alternative must effectively: a population of 46,458, with no large areas of con- n mobilize already existent facilities and centration. Area health professionals have cited four health care providers basic impediments to the adequate delivery of com- n aid in the development and utilization of any prehensive health care to these scattered pop- additional health services ulations: Fl geographic isolation r7 and generate a countywide system of health screening and health education El economic hardship Based upon the health needs demonstrated in El a health manpower shortage Allegany County, the faculty of the Alfred University n limited extended health care facilities School of Nursing and Health Care and the County Access to medical care has always been a major Public Health Nursing Service of the Allegany County problem for most rural areas. In Allegany County, the Board of Legislators proposed to the Lakes Area lack of public transportation, the rugged Appalachian Regional Medical Program the establishment of a terrain, and the highly dispersed small community Mobile Health Unit. populations result in the immobility of both the health On July 6, 1972, the Lakes Area Regional Medical provider communities and the health consumers. In Program, Inc. presented Allegany County with a fully 1965, approximately 42.5% of the population was equipped $52,000 traveling unit in response to the either under 15 or over 64 years of age. For many county's documented health needs and to the in- people within these age brackets, inadequate itiative of the people prepared to help meet those transportation and reduced incomes work a direct needs. hardship upon their entry into the county health care system. Manpower and facility shortages and/or maldistributions directly affect the patterns of delivery in any system of health care. In Allegany County, there are two general hospitals offering a Ratio of Physicians to Population in Allegany County total number of 194 hospital beds to the county's 46,- for the years 1962, 1967, 1971, and 1973. 458 residents, a rate of 4.1 beds per 1,000 peop/e. This can be compared to the national norm of 8 beds Number of Rate per Loss/Gain over per 1,000 people, as presented by the U.S. Depart- Year Physicians 1,000population previous period ment of Commerce, Statistical Abstract of the United No. % States, 1971. The county has two nursing homes, 1962 37 0.84 ? ? both located in the same town, and one Home Health 1967 30 0.68 -7 18.9 (loss) Agency providing such home care services as nur- 1971 24 0.52 -6 20.0 (loss) sing, physical therapy, speech therapy, and home 1 1973 26 0.57 +2 8.3 (gain) health aid services. There are 26 physicians serving the entire population, a rate of approximately .57 physicians per 1,000 people. This can be compared with the national norm of 1.6 physicians per 1,000 people (U.S. Department of Commerce, 1970 Cen- sus) or the New York State average of 2.6 physicians per 1,000 people, (New York State 1971 Statistical Yearbook). Population Pattern and Location of Health Care Agencies and Physicians in Allegany County 0-1000 El 1-2000 2-3000 WYOMING COUNTY LIVINGSTON COUNTY One Physician ILLMORE -One Physician 08 One Physician z ALMOND D 0 Two Physicians 244 z < Hospital Physician :D er 10 < Seven Physicians z < MONT LLJ County Public Health ysi( i Nursing Service Hi CD ANDOVER 75 Two Nursing Homes 305 Ten Physicians E 7 One Physician BO AR 9 248A PENNSYLVANIA 2 TheAlleganyCountyMobileHealthUnit A Profile Operational since October, 1972, the primary goal At present, the Mobile Health Unit spends one to of the Mobile Health Unit is to facilitate access to two days each month at seven rural locations in the health care in rural Allegany County. Utilizing the county: Alfred Station, Angelica, Belmont, Bolivar, resources of the Alfred University School of Nursing Caneadea, Rushford, and Whitesville. These and Health Care, the Allegany County Public Health locations are subject to change depending upon the Nursing Service, Jones Memorial Hospital, Cuba needs of the communities throughout the county. Memorial Hospital, and the Lakes Area Regional Medical Program, the Unit will primarily serve to: Public Health Nurses who have undergone special 11 make health education available to the training in health assessment and have been assign- residents of Allegany County. ed to specific areas in the county serve on the Unit El provide a health assessment program to when it is in their locale. Senior and sophomore nur- county residents with limited access to sing students from Alfred University are assigned to health care, establishing appropriate the Unit for participation in a vitally important lear- methods of referral and follow-up. ning experience in which they assist in health Referred to as the "Challenger," the Mobile Health counseling and provide health education on a one-to- one basis with each patient. Unit is a fully equipped, bus-type vehicle which travels throughout Allegany County providing preven- In its one year of operation, the Allegany County tive health services such as maternal and child health care programs, community action programs, family Mobile Health Unit has established an identity as a planning counseling, and Public Health Services. it source of help. Originally scheduled to cover four can be driven to community centers for scheduled communities, it has expanded to seven in response to programs or used for disaster emergency service. public request as well as crucial need. For the nurses Measuring 35 feet long, 8 feet wide, and 1 1 feet - 7 who staff the Unit, for the people they are reaching, inches high, the Unit has a reception area, dressing and for those they have yet to reach, the Allegany room, two fully equipped examining rooms, and a Mobile Health Unit is providing a mutually productive telephone communication system. It is built to over- relationship and a workable way of health. come challenges to health care delivery, especially that of geographic isolation. Allegany County Mobile Health Unit Stations* Rushford Caneadea m Angelica Alf red Station Belmont m Bo livar n@l-=-ching The People Entry is a key word when considering the problem Subject to this method of referral, a person can of rural health care delivery. Facilities and personnel easily enter into the Allegany County health delivery may be scarce, but an effective method of entry into system. In the Unit's first complete year of operation, the health delivery system can insure their maximal the staff examined 329 adults, 62% of whom were utilization and improve health services for rural referred to a private physician for diagnosis. That is citizens in need of care. six out of ten people who received medical attention they might not otherwise had been able to attain. The Allegany County Mobile Health Unit offers the Eight of those referred were subsequently hospitaliz- opportunity for entry into the health care system, free ed and two have undergone major surgery. Forty of of charge, to every individual in the area. Special the people examined at the Unit had no family physi emphasis is placed upon reaching children under six cian and had not even seen a physician for over a years of age and adults eighteen and over, those not decade. If numbers can represent anything, these receiving school health services. These are the in- represent lives that are being reached and are dividuals experiencing the needs for entry, assess- receiving care. ment, and education; and these are the people being reached by the Mobile Health Unit. Follow-Up Health Assessment Within a few weeks of referral, or sooner epen- The Allegany County Public Health Nursing Ser- ding upon the nature and severity of the apparent vices has the responsibility of assigning Public Health problem, a Public Health Nurse will provide the Nurses to the Unit which functions under an patient with follow-up care at home. If the individual Operating Certificate issued by the New York State has met with a physician, the nurse will assist the Department of Health. These Public Health Nurses patient in understanding and carrying out the medical conduct the health assessments, provide for referral instructions for continued care. If any individual fails and actively conduct a program for follow-up care, to make or keep an appointment, the nurse will try to Together with nursing students from the Alfred determine the reasons why, and attempt to resolve University School of Nursing and Health Care, they the problems. So far, the Unit has seen 1 0 people for literally "start the wheels rolling" toward a corn a second time as part of the annual follow-up prehensive system of health care delivery in Allegany procedure. Two of these were referred to a physician County. for care. The Mobile Health Unit is equipped for complete Patient follow-up is essential for continued good health assessments which include vision and hearing health. It is a way of reaching the people before old tests, blood sugar screening, urinalysis, blood problems reoccur, before new problems develop, and pressure, height, weight, electrocardiogram, and while both maybe solved, vital capacity measurements. These assessments are essential for health maintenance and early iden- tification of health problems. Entry into the health care delivery system can be accomplished on a voluntary and preventive basis, rather than emergent. The difference between preventive medicine and actual care can often mean a life. 4 R Referral Patients with apparent health problems are counseled by the Public Health Nurses and referred to the individual's family physician for an appointment or to an area health facility for immediate care, Those with no personal physician are given a list of area physicians so that they may choose one for referral. Sometimes transportation is arranged for those peo- ple unable to make connections with a physician or a hospital. A letter is always sent to the physician, ex- plaining that the person was assessed and is being referred due to specific findings. 6 wwv g%w%l I Ch i Id A 1971 study indicated that Allegany County had the highest mortality rate among children under five years of age in five southern tier counties of estern New York. It lead the area as well as New York State in the highest percentage of fetal death rates. In view of these findings, the term 'well child' has a special meaning for the health professionals and residents of Allegany County. A monthly Well Child Conference was initiated by the Allegany County Public Health Nursing Service August 27, 1973, and conducted in part through the Mobile Health Unit. The staff consists of two Registered Nurses, one of whom is a Pediatric Nurse Practitioner. The conference is currently held at four sites: Angelica, Caneadea, Bolivar, and Whitesville. Each child receives a health assessment simi ar to t at given to an adult, Special attention is given to eye and ear testing and general health counseling. To date, 87 children have been assessed by the nursing staff of the unit, 18% of which were subse- quently referred to physicians for addition attention. This count does not include those children and in- fants assessed at other sites. These assessments, together with the Unit's educational program in Normal Child Growth and Development, are working to reach the children in need. 8 Extending Education A Two-way Exchange Community Health Education refers to the need Future Mobility and the right of individuals to understand the actual Mobilizing health care education requires a flex- and potential health hazards which determine their ibility that can move with a community as needs are life productivity and expectancy, in order that they met and others are confronted. The educational ser- might successfully combat or cope with these problems. To be effective, educators must have con vices offered through the Mobile Health Unit will ex- tact with the community and an undertstanding of pand to include multiple aspects of health care. Bas- what is right with the region as well as what its ed upon input from the communities and the county problems may be. The Allegany County Mobile Health health professionals, three specific areas have been Unit began with the concept that education is a two- identified and are currently being developed into way ihformational exchange and that the community community-oriented courses: and the nurse-educator have something to offer each @ Economical Nutrition for All Ages other, F7 Normal Child Growth and Development individual health counseling and formal health 7 Diabetic Teaching education classes are conducted on the Unit by both the Public Health Nurses and students from the Alfred University School of Nursing and Health Care, Senior and sophomore nursing students are required to participate in the Unit's educational activities for which they receive credit hours and invaluable first hand experience. The Unit offers a unique opportuni- ty for Public Health Nurses to extend the scope of their activities and to make preventive health counseling and education more readily available to more people. The educational services of the Unit are carried out in churches and community centers adjacent to the areas in which the Unit is located. Individual health counseling is conducted on a one-to-one basis. Each person is privately instructed on diet, nutrition, immunization, illness recognition, and health maintenance. The use of audio-visuals insure that the instruction can be understood by all age groups and educational backgrounds. The first formal class was conducted in 1970, prior to the initiation of the Mobile Health Unit. Under the direction of the School of Nursing and Health Care and the Allegany County Public Health Nursing Ser- vice, an Expectant Parents Class was developed and taught at Jones Memorial Hospital in Wellsville and Cuba Memorial Hospital in Cuba. Nine county villages were represented, as well as one town in Pennsylvania. The material offered was new to ap- proximately 75% of those who attended and their enthusiasm was the best indicator that the informa- tion was not only needed, it was wanted, With the use of the Allegany County Mobile Health Unit, Expectant Parents Classes continue to teach those within the reach of wheels. 10 Program People The Allegany County Mobile Health Unit is a go- between for people. It may be considered a vehicle giving people a chance to respond to human need. That response may be in the form of a patient helping a student to understand what health care is all about. Or it may be in the form of a qualified nurse bridging the gap between need and access to care. Whatever form of response, the result is a unity of concern and action, by many people for the sustained good health of many other people. Project Directors The Mobile Health Unit operates under the direc- tion of Mrs. Margaret Connelly, R.N., B.S., Director of Patient Service, Allegany County Public Health Unit Staff Nursing Service; and Virginia Barker, R.N., Ed.D., Public Health Nurses who have had special train- Dean, Alfred University, School of Nursing and ing in health assessment and have been assigned to Health Care. specific areas in the county will serve on the Unit when it is in their area. Nursing students from Alfred University will be assigned to the bus during the school year under Faculty supervision. A driver-secretary is responsible for the operation of the mobile unit, including such responsibilities as mapping the Unit's route, determining the most accessible sites, providing local newspapers or public agencies with updated time schedules, and maintaining all equipment and supplies. Executive Committee An Executive Committee meets monthly and is responsible for operational activities of the Mobile Dr, Barker Health Unit, Members include: Virginia Barker, Ed.D. Dean Alfred University School of Nursing and Health Care Margaret Connelly, R.N., B.S., Director of Patient Services Allegany County Public Health Nursing Service Edith Johannes, R.,N., B.S., M.S., Associate Professor Alfred University School of Nursing and Health Care Reynard Meacham, Driver-Secretary Allegany County Mobile Health Unit Mrs. Connelly Elizabeth Norod, R.N., B.S., M.S., Ed.D., Chairman, Rural Division, Alfred University School of Nursing and Health Care Extending Education ol (%r r, A Two-way Exchange A I I I I ,,ding Ed, Medical Ad@eisory Board Bert Cunin, Ph.D. A Medical l@Ndvisory Board was established to ap- (Psychologist) Alfred University prove operati,@l,,"'onal procedures regarding medicine Alfred, New York 14802 which are or @may be carried out by the staff of the Mobile Healt"@', Unit. Irwin Felsen, M.D. Members inc;9iude: (Physician) 243 Maple Avenue Virginia 7@Barker, Ed.D. Mar,aare#'t Connelly, R.N., B.S. Wellsville, New York 14895 Irwin Fe@ilsen, M.D. Mrs. Mary Giles, R.N. F. Clift0ill Miller, Jr., M.D. Chairman, Allegany County Mental Health Board Daniel T,)artaglia, M.D. 5405 Cook Road Alfred, New York 14802 George raylor, Jr., M.D. Mrs. Beverly Harding, R.N. (School Nurse Teacher) Cuba Central School Mobile Health Unit Advisory Committee Cuba, New York 14727 The Mobi!e Health Unit Advisory Committee is composed of community members, business ex- Mrs. Edith Johannes, R.N.,B.S., M.S. ecutives. n@irsing students, physicians, hospital ad- Associate Professor ministrators, Public Health Nurses, and Alfred Alfred University School of Nursing and Health Care University f,@cultY members. This committee meets Alfred, New York 14802 bi-annually-ind has the responsibility of relating the of the Mobile Health Unit to the needs of Mrs. Bernice Lackey Allegany County and to the program priorities of the 1 East Main Street Lakes Area Regional Medical Program Inc. Cuba, new York 14727 Members include: Reynard Meacham Susan Aspinwall R. D. 1 (Senior Nursing Student) Alfred Station, New York 14803 Alfred University School of Nursing and Health Care Mrs. Dorothy C. Nielson, R.N., B.S. Bartlett Dorm Rm. 315 Director of Nursing Alfred, New York 14802 Cuba Memorial Hospital Virginia Barker, R.N., Ed.D., Dean Cuba, New York 14727 Alfred University School of Nursing and Health Care Mrs. Marilyn Palmer, R.N., B.S. Alfred, New York 14802 (School Nurse Teacher) Henry E. Black, M.D. Wellsville Central School 100 High Street Wellsville, New York 14895 Buffalo, New York 14203 Edward Schwert, D.D.S. Mr. Robert Clinger, B.S. (Dentist) (Volunteer Ambulance Corps - Consumer) 19 Genesee Street Alfred University Belmont, New York 14813 Alfred, New York 14802 George Taylor, M.D. Mr. Gerald Cole, B.S., M.S. (Physician) Administrator 130 West Main Street Cuba Memorial Hospital Cuba, New York 14727 Cuba, New York 14727 Mr. Joseph Waitkus Mrs. Margaret D. Connelly, R.N., B.S. 25 Chestnut Street Director of Patient Services Wellsville, New York 14895 Lakes Area Regional Medical Program, Inc. John R.F. Ingall, M.D. Father Cosmas Girard, O.F.M., Ph.D. Executive Director Chairman, Regional Advisory Group The Allegany County Mobile Health Unit is a project of the Lakes Area Regional Medical Program, Inc. Its objectives correspond with the following LARMP ob- jectives: F] To promote consumer education regarding availability and utilization of existing ser- vices. Fl To seek feasible solutions to the problems of distance and lack of transportation as barriers to utilization of preventive, primary care and rehabilitative services. During the three year federal funding period, there will be no cost assessed to those who utilize the ser- vices of the Mobile Health Unit.