mnt ue [ il wi Contents 14 MOBILIZING HEALTH CARE Introduction County Map THE ALLEGANY COUNTY MOBILE HEALTH UNIT A Profile Unit Stations REACHING THE PEOPLE Health Assessment Referral Follow-up Weil Child EXTENDING EDUCATION A Two-way Exchange Future Mobility PROGRAM PEOPLE Project Directors Unit Staff Executive Committee Medical Advisory Committee Mobile Health Unit Advisory Committee Lakes Area Regional Medica! Program, 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 Allegany County is one of the rural counties com- prising the Lakes Area Regional Medical Program service area. One of the larger counties in this region, Allegany encompasses 75,000 acres and has a population of 46,458, with no large areas of con- centration. Area health professionals have cited four basic impediments to the adequate delivery of com- prehensive health care to these scattered pop- ulations: O geographic isolation O economic hardship (] a health manpower shortage C limited extended health care facilities Access to medical care has always been a major problem for most rural areas. In Allegany County, the lack of public transportation, the rugged Appalachian terrain, and the highly dispersed small community populations result in the immobility of both the health provider communities and the health consumers. In 1965, approximately 42.5% of the population was either under 15 or over 64 years of age. For many people within these age brackets, inadequate transportation and reduced incomes work a direct 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 total number of 194 hospital beds to the county's 46,- 458 residents, a rate of 4.7 beds per 1,000 people. This can be compared to the national norm of 8 beds The health professionals of Allegany County have assessed the needs of the rural citizens they serve and have determined that an alternate method to ex- tend the delivery of health care must be developed and that this alternative must effectively: O mobilize already existent facilities and health care providers ( aid in the development and utilization of any additional health services C and generate a countywide system of health screening and health education Based upon the health needs demonstrated in Allegany County, the faculty of the Alfred University School of Nursing and Health Care and the County Public Health Nursing Service of the Allegany County Board of Legislators proposed to the Lakes Area Regional Medical Program the establishment of a Mobile Health Unit. On July 6, 1972, the Lakes Area Regional Medical Program, Inc. presented Allegany County with a fully equipped $52,000 traveling unit in response to the county’s documented health needs and to the in- itiative of the people prepared to help meet those needs. Ratio of Physicians to Population in Allegany County for the years 1962, 1967, 1971, and 1973. Number of Rate per Loss/Gain over Year Physicians 1,000population previous period per 1,000 people, as presented by the U.S. Depart- 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) 1973 26 0.57 +2 8.3 (gain) sing, physical therapy, speech therapy, and home 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 1-2000 Z 2-3000 243 | | | | | | | | | | | | | | | | | | | CATTARAUGUS COUNTY CUBA | 305 WYOMING COUNTY 305 LIVINGSTON COUNTY PENNSYLVANIA ;O””~ ST TTA WV — 7 / / 19A N LT — Ny — oi One Physician LY FILLMORE One Physician PTs WN IN One Physician Lr Vii N ALMOND LL N mK Two Physicians 19 One Physician ca _- Hospital - Seven Physicians ALFRED BELMONT County Public Heaith One Physician Nursing Service oY FRIENDSHIP ANDOVER | TN Two Nursing Homes Ten Physicians | WELLSVILLE | Hospital | 17 248 | One Physician BOLIVAR | 19 | 248A | | | | | | | STUEBEN COUNTY | | | | | | | | | | | The Allegany County Mobile Health Unit A Profile Operational since October, 1972, the primary goal of the Mobile Health Unit is to facilitate access to health care in rural Allegany County. Utilizing the resources of the Alfred University School of Nursing and Health Care, the Allegany County Public Health Nursing Service, Jones Memorial Hospital, Cuba Memorial Hospital, and the Lakes Area Regional Medical Program, the Unit will primarily serve to: O make health education available to the residents of Allegany County. O provide a health assessment program to county residents with limited access to health care, establishing appropriate methods of referral and follow-up. Referred to as the “Challenger,” the Mobile Health Unit is a fully equipped, bus-type vehicle which travels throughout Allegany County providing preven- tive health services such as maternal and child health care programs, community action programs, family planning counseling, and Public Health Services. It can be driven to community centers for scheduled programs or used for disaster emergency service. Measuring 35 feet long, 8 feet wide, and 11 feet - 7 inches high, the Unit has a reception area, dressing room, two fully equipped examining rooms, and a telephone communication system. It is built to over- come challenges to health care delivery, especially that of geographic isolation. Allegany County Mobile Health Unit Stations* Rushford . ® Caneadea » Angelica = Belmont = Bolivar ae aula ROG! Bese eee Station At present, the Mobile Health Unit spends one to two days each month at seven rural locations in the county: Alfred Station, Angelica, Belmont, Bolivar, Caneadea, Rushford, and Whitesville. These locations are subject to change depending upon the needs of the communities throughout the county. Public Health Nurses who have undergone special training in health assessment and have been assign- ed to specific areas in the county serve on the Unit when it is in their locale. Senior and sophomore nur- sing students from Alfred University are assigned to the Unit for participation in a vitally important lear- ning experience in which they assist in heatth counseling and provide health education on a one-to- one basis with each patient. in its one year of operation, the Allegany County Mobile Health Unit has established an identity as a source of help. Originally scheduled to cover four communities, it has expanded to seven in response to public request as well as crucial need. For the nurses who staff the Unit, for the people they are reaching, and for those they have yet to reach, the Allegany Mobile Health Unit is providing a mutually productive relationship and a workable way of health. Alfred § ; Reaching The People Entry is a key word when considering the problem of rural health care delivery. Facilities and personnel may be scarce, but an effective method of entry into the health delivery system can insure their maximal utilization and improve health services for rural citizens in need of care. The Allegany County Mobile Health Unit offers the opportunity for entry into the health care system, free of charge, to every individual in the area. Special emphasis is placed upon reaching children under six years of age and adults eighteen and over, those not receiving schoo! health services. These are the in- dividuals experiencing the needs for entry, assess- ment, and education; and these are the people being reached by the Mobile Health Unit. Health Assessment The Allegany County Public Health Nursing Ser- vices has the responsibility of assigning Public Health Nurses to the Unit which functions under an Operating Certificate issued by the New York State Department of Health. These Public Health Nurses conduct ihe health assessments, provide for referral and actively conduct a program for follow-up care. Together with nursing students from the Alfred University School of Nursing and Health Care, they literally ‘start the wheels rolling” toward a com- prehensive system of health care delivery in Allegany County. The Mobile Health Unit is equipped for complete health assessments which include vision and hearing tests, blood sugar screening, urinalysis, blood pressure, height, weight, electrocardiogram, and 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. Referral Patients with apparent health problems are counseled by the Public Healtn 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- pie unable to make connections with a physician ora 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 Subject to this method of referral, a person can easily enter into the Allegany County health delivery system. In the Unit's first complete year of operation, the staff examined 329 adults, 62% of whom were referred to a private physician for diagnosis. That is six out of ten people who received medical attention they might not otherwise had been able to attain. Eight of those referred were subsequently hospitaliz- ed and two have undergone major surgery. Forty of the people examined at the Unit had no family physi- cian and had not even seen a physician for over a decade. If numbers can represent anything, these represent lives that are being reached and are receiving care. Follow-Up Within a few weeks of referral, or sooner depen- ding upon the nature and severity of the apparent problem, a Public Health Nurse will provide the patient with follow-up care at home. If the individual has met with a physician, the nurse will assist the patient in understanding and carrying out the medical instructions for continued care. If any individual fails to make or keep an appointment, the nurse will try to determine the reasons why, and attempt to resoive the problems. So far, the Unit has seen 10 people for a second time as part of the annual follow-up procedure. Two of these were referred to a physician for care. Patient follow-up is essential for continued good health. It is a way of reaching the people before old problems reoccur, before new problems develop, and while both maybe solved, A Well Child 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 Western 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 ‘weli 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 similar to that 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. Extending Education A Two-way Exchange Community Health Education refers to the need and the right of individuals to understand the actual and potential health hazards which determine their life productivity and expectancy, in order that they might successfully combat or cope with these problems. To be effective, educators must have con- tact with the community and an undertstanding of what is right with the region as well as what its problems may be. The Allegany County Mobile Health Unit began with the concept that education is a two- way informational exchange and that the community and the nurse-educator have something to offer each other. Individual health counseling and formal health 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 Heaith 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 Future Mobility Mobilizing health care education requires a flex- ibility that can move with a community as needs are met and others are confronted. The educational ser- vices offered through the Mobile Health Unit will ex- pand to include multiple aspects of heaith care. Bas- ed upon input from the communities and the county health professionals, three specific areas have been identified and are currently being developed into community-oriented courses: C1 Economica! Nutrition for All Ages C] Normal Child Growth and Development CO Diabetic Teaching 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., 8.S., Director of Patient Service, Allegany County Public Health Nursing Service; and Virginia Barker, R.N., Ed.D., Dean, Alfred University, School of Nursing and Health Care. Dr. Barker qc Mrs. Connelly Sag Ste e Et Unit Staff Public Health Nurses who have had special train- ing in health assessment and have been assigned to 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 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 Elizabeth Norod, R.N., B.S., M.S., Ed.D., Chairman, Rural Division, Alfred University School of Nursing and Health Care 11 Extending Education A Two-way Exchange ane ding Ed 1) Medical Adwy‘isory Board A Medical f Advisory Board was established to ap- prove operati: onal procedures regarding medicine which are or (,™ay be carried out by the staff of the Mobile Healthy Unit. jude: 4 Members inc Virginia 7/Barker, Ed.D. Margare#? Connelly, R.N., B.S. irwin Fefisen, M.D. F. Cliftor? Miter, Jr., M.D. Daniel Tartaglia, M.D. George “Taylor, Jr., M.D. t ‘ Mobile Health Unit Advisory Committee The Mobi’é Health Unit Advisory Committee is composed ef community members, business ex- ecutives, nirsing students, physicians, hospital ad- ministrators, Public Health Nurses, and Alfred University feculty members. This committee meets bi-annually 2nd has the responsibility of relating the acuity of the Mobile Health Unit to the needs of Allegany County and to the program priorities of the Lakes Area Regional Medical Program Inc. Members include: Susan Aspinwall (Senior Nursing Student) Alfred University School of Nursing and Health Care Bartlett Dorm Rm. 315 Alfred, New York 14802 Virginia Barker, R.N., Ed.D., Dean Alfred University School of Nursing and Health Care Alfred, New York 14802 Henry E. Black, M.D. 100 High Street Buffalo, New York 14203 Mr. Robert Clinger, B.S. (Volunteer Ambulance Corps - Consumer) Alfred University Alfred, New York 14802 Mr. Gerald Cole, B.S., M.S. Administrator Cuba Memorial Hospital Cuba, New York 14727 Mrs, Margaret D. Connelly, R.N., B.S. Director of Patient Services Bert Cunin, Ph.D. (Psychologist) Alfred University Alfred, New York 14802 Irwin Felsen, M.D. (Physician) 243 Maple Avenue ' Wellsville, New York 14895 Mrs. Mary Giles, R.N. Chairman, Allegany County Mental Health Board 5405 Cook Road Alfred, New York 14802 Mrs. Beverly Harding, R.N. (School Nurse Teacher) Cuba Central School Cuba, New York 14727 Mrs. Edith Johannes, R.N.,B.S., M.S. Associate Professor Alfred University School of Nursing and Health Care Alfred, New York 14802 Mrs. Bernice Lackey 1 East Main Street Cuba, new York 14727 Reynard Meacham R.D. 1 Alfred Station, New York 14803 Mrs. Dorothy ©. Nielson, R.N., B.S. Director of Nursing Cuba Memorial Hospital Cuba, New York 14727 Mrs. Marilyn Palmer, R.N., B.S. (School Nurse Teacher) Wellsville Central School Wellsville, New York 14895 Edward Schwert, D.D.S. (Dentist) 19 Genesee Street Belmont, New York 14813 George Taylor, M.D. (Physician) 130 West Main Street Cuba, New York 14727 Mr. Joseph Waitkus 25 Chestnut Street 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: [1 To promote consumer education regarding availability and utilization of existing ser- vices. Cl 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.