Survey IDs top health needs
SHARON — The latest assessment of community health needs in Sharon Hospital’s service areas in Litchfield County and Dutchess County, N.Y., has identified chronic disease, mental health and substance use disorders as the top health issues affecting residents.
The Community Health Needs Assessment (CHNA), a triennial review by Nuvance Health, parent of Sharon Hospital, was conducted from January to September of 2022 and included a review of the most current health data available, demographics and input from numerous community representatives on both sides of the state line.
The process culminated in the development over the past several months of a Community Health Implementation Plan (CHIP) to address the needs identified through the CHNA.
Sharon Hospital will utilize this plan as a guide through 2025 to offer programs that support both the health of the community and the mission of the hospital, according to Nuvance officials.
Priorities mirror 2019 needs assessment
Sharon Hospital President Christina McCulloch said the key focus areas identified as priorities in its 2022-2025 implementation plan are the prevention of chronic diseases — such as diabetes, heart disease, Alzheimer’s, stroke, arthritis, and chronic lung disease — promotion of well-being and prevention of mental health and substance use disorders.
Not surprising, said McCulloch, is that the priorities presenting in the 2022 assessment mirror those identified in the hospital’s prior 2019 CHNA. The reason, she said, is tied to the timing of the COVID-19 pandemic.
“We did fall behind in the pandemic,” as people avoided going to the doctor for preventive care, and if they were sick, many did not seek treatment at the doctor’s office or hospital out of fear of contracting COVID-19, she noted.
Plus, during the early days of the pandemic, for hospital officials and staff, it was all hands on deck as priorities shifted to responding to COVID-19.
Even though, the priority areas are a reflection of what is happening in the communities.
“Chronic disease management is always needed and mental health is always present,” said Ildie Rabinowitz, assistant vice president of health equity, diversity and inclusion for Nuvance Health.
Hypertension, for example, is a major concern, she noted. COVID-19, Rabinowitz explained, “threw a wrench into a lot of initiatives and the ability to expand them when we were forced to go into survival mode. COVID had a huge emotional and mental impact on people” as reflected in overdose deaths.
“Substance use really increased during the pandemic and after the pandemic,” said Rabinowitz.
The current challenge, noted McCulloch, is “How to, as a hospital, get back out into the community and promote wellness. It really comes down to partnering with all the stakeholders in the community and having representatives out there,” offering wellness classes, mental health first-aid, smoking cessation classes, substance abuse and use counseling and sessions on how to take blood pressure readings, among other outreach efforts.
“Yes, the hospital is here 24/7, but for the families when they aren’t able to get services, it’s a key part of the CHIP [Community Health Improvement Plan],” said McCulloch.
‘Very divergent level’ of household income
Sharon Hospital is located along the and Dutchess County, N.Y., border, and for purposes of the CHNA and partnering with state-based initiatives, Sharon Hospital focused on its Litchfield and Dutchess County service areas and conducted research for these communities separately.
Kathryn Palmer-House, who chairs the Sharon Hospital Community Health Committee, is a member of the hospital board and is the town clerk in Dover, N.Y., said her group “did see some commonalities” between the communities serves by Sharon Hospital in Connecticut and those in New York, but also many differences.
“There are about 58,000 people in the entire Sharon Hospital Health Service Area (HSA), representing a very divergent level of household income,” noted Palmer-House.
Income and work impact health outcomes, according to the report. For example, many people access health insurance through their job, although not all types of work provide access to health insurance.
Beyond health insurance, making healthy choices, such as purchasing lean meats and fresh produce, or joining a gym, all cost money.
The medium household income in the Connecticut HSA is $80,000, compared to $77, 696 statewide, and fewer residents live in poverty compared to the state overall, the report pointed out. However, this positive experience is not shared by all residents.
“Within the HSA, median household incomes by town range from $62,432 in North Canaan to $109,886 in Goshen. North Canaan also has higher poverty levels affecting approximately 14% of all residents,” according to the report.
In addition, within the Connecticut hospital service area, one in three households are considered “housing cost burdened,” according to the report.
Residents of neighboring Dutchess County also have historically higher household incomes and lower poverty compared to New York overall.
“However, it is worth noting that across the county, more than one in 10 (14.1%) households have an annual income of less than $25,000,” the CHNA reports.
“Having Sharon Hospital connect with our community is going to make such an impact,” noted Palmer-House. The overall Nuvance system, she said, has the ability to address specific concerns, including persistence substance abuse disorders.
“It’s system-level prowess on a local level.”
Report points to states that are aging
The 2022 report also revealed that Connecticut and New York overall are aging states.
According to Rabinowitz, all signs point to an increase in the older population.
“We do know that we need to really increase services that are focusing on the aging population through our community care team, by connecting the hospital to the community to make sure patients have the services in the home environment.”
“Between 2022 and 2027, the population aged 65 or older is projected to increase 14.2% and 16.9%, respectively, the largest increase of any reported age group,” according to the CHNA. The total population for both states is projected to increase 2% and 4.9% respectively.
The Sharon Hospital service area population is projected to increase by 1,549 people, or 2.7%, from 2022 to 2027, although consistent with an aging demographic, this growth will occur exclusively among adult populations.
The population aged 65 or older will increase by 1,904 people, or 12.8% from 2022 to 2027, while the child population under age 18 will decline by 297 people or minus 3.1%, according to the report.
“We definitely saw across both states an increase in the older population,” noted Palmer-House.
Findings point to a need for care focusing on older adults, including having services in the hospital promoting healthy aging and aging in place.
“We do see that in the E.R. mental health is a struggle for the elderly,” said McCulloch, who noted that Sharon Hospital has an award-winning senior behavioral unit which treats seniors in distress.
Health care access and quality
Having health insurance does not ensure access to health care when it is needed.
According to the 2022 report, “Litchfield County has lower provider availability than Connecticut and/or the nation, and all of the county is a Health Professional Shortage Area (HSPA) for mental health care.”
Dutchess County also has lower provider availability when compared to state benchmarks, and lower primary care provider availability when compared to the nation. While none of the county is HPSA, migrant and seasonal farm workers are identified as a medically underserved population within the eastern portion of the county, including the counties of Amenia, Wassaic and Dover Plains.Among New York respondents, 51% said it was “not very true” or “not at all true” that there are sufficient, quality mental health providers.
Approximately 17% of respondents said there was a time in the past 12 months when they or a member of their household were unable to get medication when they needed it, and 16% said there was a time when they couldn’t get health care, including dental or vision.
The report reveals that health care access disparities among New York residents may be exacerbated by language barriers and lack of bilingual providers or interpreter services.
Approximately 25% of the Litchfield County Asian residents and 23% of Latino residents were considered linguistically isolated, characterized as speaking English less than “very well.”
“Partnership is the most important piece of this,” said McCulloch. “If we work in silos, we are not going to be able to address the needs.”
According to Rabinowitz, plans are in the works to create individual focus groups “to make sure we are hearing from the community.
“We are looking at services and service gaps from many, many angles,” and focus groups will include representatives of food pantries, the medical community, churches, nonprofit agencies, health districts, the America Heart Association, behavioral health service providers and community members, among others, noted Rabinowitz.
Have action plan, time to act
The completion of the needs assessment and improvement plan is just the beginning of work that will progress over the next three years, said McCulloch.
“We are just getting started. We have a plan that was developed, but now is when we get to act, to take what we learned through our plan and put it into action, and that will really have an impact on the community.”
In announcing the release of the report, Dr. John M. Murphy, president and CEO of Nuvance Health, said staff are dedicated to the health and well-being of everyone in the health care system’s service region. “This is our promise to the more than 1.5 million children and adults we serve in western Connecticut and the Hudson Valley of New York.”