Advancing Health Podcast

00:00:00:06 - 00:00:21:00
Tom Haederle
Welcome to Advancing Health. A child's ability to thrive starts long before the first day of school. Early literacy and language development have the power to shape their lifelong health and well-being. That's why the experts we hear from today are encouraging pediatricians to make literacy screening part of routine care.

00:00:21:02 - 00:00:49:18
Julia Resnick
Pediatric hospitals are increasingly looking beyond clinical care to support the longterm well-being of children, and literacy is emerging as a critical part of that work. I'm Julia Resnick, senior director of health outcomes and care transformation at the American Hospital Association, and this is the Advancing Health podcast. Today, I'm talking with Dr. Sara Bode, pediatrician and medical director of School Health, and Carneshia Edwards, lead of the Kindergarten Readiness program, both from Nationwide Children's Hospital in Columbus, Ohio.

00:00:49:25 - 00:01:09:18
Julia Resnick
They're working at the intersection of healthcare and education, helping children and families build the foundation for success through literacy and school readiness programs, that extend beyond the hospital and into the community. So to get started, why is early childhood literacy so important for children's health and long-term outcomes? Sara, we'll start with you.

00:01:09:24 - 00:01:31:15
Sara Bode, M.D.
Well, as pediatricians and working in the healthcare sector, we know that there are so many factors that affect whether kids thrive, grow up and are healthy, and their education is actually one of those most important determinants of if a child is going to thrive long term. And so we really care a lot about getting that start right off the bat.

00:01:31:15 - 00:01:50:15
Sara Bode, M.D.
So we know that if kids start kindergarten with the skills they need ready to learn, they're much more likely to succeed in school. And if they start behind it can be very hard to catch up. So those early years are critical to make sure that they're getting those early literacy skills and that when they start, they're ready to go.

00:01:50:21 - 00:01:56:10
Julia Resnick
Absolutely. And how did that connection lead Nationwide Children's to invest in literacy and kindergarten readiness?

00:01:56:15 - 00:02:18:28
Sara Bode, M.D.
Well, one of the things that we found is that when you are coming to Children's or any pediatric practice, you're getting checkups every couple months when you're first born, and actually you come to the doctor 15 times for checkups before you start kindergarten. So at a healthcare clinic, we have really like frequent repeated, you know, meetings with these families.

00:02:18:28 - 00:02:42:24
Sara Bode, M.D.
It's a trusted environment. And so we really want to make sure that we're addressing these early literacy skills as we have families come back. So it really is such a great place for us to address this, and traditionally, this has not been something that has been really looked at in the primary care clinic. We see if you walk on time, you talk on time, we check your development, but we've never really assessed reading skills.

00:02:42:24 - 00:02:47:28
Sara Bode, M.D.
And so this is a new idea and an addition to kind of help make sure families have what they need.

00:02:48:06 - 00:02:55:00
Julia Resnick
Yeah, this certainly is unique for children's hospitals, which is why we are so excited to talk to you. Carneshia, anything you want to add to that?

00:02:55:04 - 00:03:15:09
Carneshia Edwards
I think Dr. Bode hit it right on the nail. But just to add, like we recognize that healthy children need both medical care and developmental support. Our main goal is to really help families feel supported, empowered, equipped to really help get their child ready for kindergarten.

00:03:15:12 - 00:03:19:21
Julia Resnick
Amazing. And can you walk us through what those programs look like in practice?

00:03:19:27 - 00:03:45:19
Carneshia Edwards
Absolutely. So we go into the primary cares, and we see children preschool-aged between the ages of three and five, and we go in right before the physician goes in at their well-check visit. And so we'll go in and do a literacy screening on the kiddos. The screening looks at early literacy, language, fine motor, school readiness skills.

00:03:45:19 - 00:04:10:14
Carneshia Edwards
And so we use the book, The Reading House book to just really demonstrate for the families what they can do at home as well. And so after that screening is completed, we will connect the families to community resources. We're talking to them about their concerns. Every family receives a kit from us. And so we'll provide little things in the kits just to kind of help.

00:04:10:14 - 00:04:23:28
Carneshia Edwards
We put scissors in there, fine-motor skills that they can work on. Every child receives an individualized literacy plan as well, and so we walk the family through things that they can do to work with the child at home.

00:04:24:01 - 00:04:47:03
Sara Bode, M.D.
I mean this is really, it's a partnership. It's having this addressed in the primary care clinic really helps to show the importance of this, so those three components. It’s coming in doing the screener, and that screener's directly with the child. So it's an aha moment for the parents because our coordinators are specialists in early childhood development, and they're testing the children to see what they know.

00:04:47:03 - 00:05:09:09
Sara Bode, M.D.
And parents have one of two reactions. Either the child starts answering all the questions and the parents sometimes say, “I didn't even know my child knew that. And it's amazing,” or sometimes they're saying to us, “Wow, I didn't understand I was supposed to be teaching my child that. Isn't that something they learn in kindergarten?” And that opens up the conversation for us to say no,

00:05:09:09 - 00:05:30:26
Sara Bode, M.D.
there's a lot of early literacy skills you have prior to kindergarten. And so here's what those are. Once they finish that screening tool, then  just like Carneshia said, parents are their first teachers. So then they're giving them a bunch of materials, ideas, activities, kits, of what they can do at home, and then they're actually coordinating and connecting them to programs too.

00:05:30:27 - 00:05:39:04
Sara Bode, M.D.
So, they work really hard to get them into preschool and other library programs, different resources they need. So it's a really comprehensive program.

00:05:39:06 - 00:05:49:19
Julia Resnick
That's amazing. So when you detect that a kid is like a little far behind on their literacy, like what happens? How do you support them and their families so that they are ready for kindergarten?

00:05:49:21 - 00:06:18:00
Carneshia Edwards
I feel like everyone learns different at different paces, at different rates. And so it's not to really stress the families out about the child necessarily being behind, but more so what we can do to help support them to make sure when they get into kindergarten, they know all the things that they need to know. And so really just providing the materials that they can use to help get them there is huge for us, especially when we have major concerns.

00:06:18:01 - 00:06:40:13
Carneshia Edwards
I feel like we catch a lot of developmental delays when we're in the primary care setting too. And so really getting them connected to the resources is huge. So we make referrals for preschool. Special-needs preschool is a big one too. And just kind of going about those steps of making sure that they get enrolled into special-needs preschool.

00:06:40:16 - 00:06:59:01
Carneshia Edwards
We also refer to SPARK program. That's a huge one for us, because they actually go out to the family's home and work with the child one-on-one in the house, which is very helpful for families. And so I think the resources is really the huge piece of getting families the help and the support that they need.

00:06:59:04 - 00:07:24:24
Sara Bode, M.D.
And part of it is just working with the families to understand that, like, this is fun. Early learning is fun. So they're not sitting down completing hours of workbooks, right? So, you know, for example, we have these like, you know, magnetic letters that can go on the refrigerator. And so what are games they can play with their kid as they start to learn and understand, you know, letters, having that pencil with the grip they can use to start to think about how they doodle and trace things.

00:07:24:24 - 00:07:49:28
Sara Bode, M.D.
So it's really empowering families to understand, here’s some things you can do at home and engage and play with your child. Not only are they learning those skills, but that time in relational attention between the caregiver and the child is so important. Families are busy, competing priorities. You know, we have a lot of electronics available for kids, which are really not the greatest, you know, forum for this age to learn from.

00:07:49:28 - 00:07:59:19
Sara Bode, M.D.
So it's like turning that off, sitting down, playing together. And here's some ideas of how to do that, that’s going to support that home learning environment.

00:07:59:21 - 00:08:20:15
Julia Resnick
Incredible. And just so important for the long-term health and well-being of kids. I'm sure there are barriers that have made this program hard to start or been challenging for the families that you work with. Are there any things that other hospitals should anticipate when they're thinking about integrating childhood literacy programs into their clinics?

00:08:20:21 - 00:08:50:20
Sara Bode, M.D.
A couple things I'll say to start. One is that, you know, clinics and pediatricians have been doing developmental assessments and support for years. So sometimes people will say, well, we kind of already do this, right? We're checking on their development. We're talking to them about this. Why do we have to add an additional component? And one thing I will say is we did a lot of research before we started this, where we actually were assessing our own kids that were coming in and we were checking their developmental screening.

00:08:50:20 - 00:09:08:13
Sara Bode, M.D.
We were seeing all the advice we were giving in clinics, and we were doing great. We were checking their development and they were doing well. And then we said, okay, you're so healthy. We talked to the family, you're doing a great job. And then what happened is we had all of those kids take a kindergarten assessment when they started kindergarten in the state of Ohio.

00:09:08:13 - 00:09:31:07
Sara Bode, M.D.
And what we found is they were a majority of them failing the test. So to me, that was an aha for us that what we're currently doing isn't enough. We're not, we're making sure they're not behind, but we're not seeing if they're thriving. And that's a very big difference to be developmentally on track, but to be thriving, that's different with those early skills.

00:09:31:07 - 00:09:54:14
Sara Bode, M.D.
And so I think one is just an awareness that this is important. The second thing I'll say is that anytime you talk to anyone in the healthcare setting about adding in something, whether that's a screening tool or a new component to the well-check, there's concern because families know this too, right? You go in and you have like eight minutes for your well-check and there's so much going on.

00:09:54:14 - 00:10:25:26
Sara Bode, M.D.
But what we found, and the first thing we tested, was an ability to do this quickly with our coordinators. And so we did a feasibility study to say, can we do this at these checkups in the clinic without slowing things down? And we were able to find that, yes, we can when we're thoughtful about it. And so sharing that advice on how to incorporate it, how to get it done quickly so that it's not disrupting everything else you have to do, and then really the outcomes, it's just so worth the time and the investment for this.

00:10:26:01 - 00:10:57:06
Carneshia Edwards
I would also add partnerships are essential with developing a program within the primary care settings too, like schools, libraries, early childhood programs, community organizations, like really knowing what's in the community that can really help serve the families, and being able to share that with the physicians because everybody's working together to help serve the family. A story pops in my mind as I'm talking about this. Being in the clinic,

00:10:57:07 - 00:11:27:09
Carneshia Edwards
I had, shout out to Dr. Urs, he's a great physician. He's in the clinic, and a lot of times the physicians here, they actually have to really be sensitive to families because families are hearing for the very first time that their child may have a developmental delay, or there are some concerns. And a lot of times you might see families, especially moms, crying and very just devastated about the news.

00:11:27:09 - 00:11:52:18
Carneshia Edwards
And so Dr. Urs, I was in there one time and he was in there and mom's crying. She’s just received bad news. Not necessarily bad news, but just hearing this for the first time that there's developmental concerns. Immediately he got the social worker involved. He got me involved to help with getting the child connected to special-needs preschool.

00:11:52:22 - 00:12:17:03
Carneshia Edwards
And the social worker was also there to just kind of help with housing concerns because mom had like a lot of things on her plate, and he was just so sensitive to her. And just to see that, that does something for me because I think families need that support. And just to have everyone all together in the clinic working to help support that mom, she left, she actually left smiling.

00:12:17:03 - 00:12:32:27
Carneshia Edwards
So I think that's a huge win, and I think physicians just knowing that you're giving this kind of news to families, just being sensitive to that, I think that's helpful being in the primary care setting, doing this kind of work too.

00:12:33:01 - 00:12:35:28
Julia Resnick
Caring for kids just as much as you're caring for their parents.

00:12:36:00 - 00:12:36:28
Carneshia Edwards
Absolutely.

00:12:37:00 - 00:12:46:15
Julia Resnick
And giving the parents the tools to help their kids thrive. So how do you track the impact of these programs and like, what does that look like long term over a child's life?

00:12:46:19 - 00:13:08:20
Sara Bode, M.D.
We are tracking outcomes. When we are connecting these kids to resources and they're seeing the coordinator, we’re taking a look at these kids and their eventual scores when they take that kindergarten entrance assessment, when they start school in the state of Ohio. And so we're really excited as we continue to follow this, because we want to make sure we're moving the needle.

00:13:08:20 - 00:13:36:24
Sara Bode, M.D.
And we got our first set of results back last year. So kids last November took that assessment by their kindergarten teacher. And what we found is if they had gone through our program, where they actually had a 10 to 25% increase in their literacy score for kids, that didn't. And so we're just really excited to continue to pull in those results and track it and really understand how are we doing with moving the needle and getting these kids ready, so.

00:13:36:24 - 00:13:52:19
Julia Resnick
That's incredible. And is there any data? And I know this hasn't been going on for 18 years, so it's hard to tell. But like, how these early childhood literacy interventions impact health as they become adolescents and adults.

00:13:52:21 - 00:14:21:26
Sara Bode, M.D.
There's quite a bit of literature to show a couple of things. One is when you start kindergarten ready to learn, and specifically with literacy skills, you're much more likely to by third grade, be a fluent reader. And what we know for kids, you learn to read initially, but then after third grade you have to read to learn. So at some point, every subject that you're learning, whether that's math or science, you need to be a fluent reader in order to process that information.

00:14:21:26 - 00:14:46:08
Sara Bode, M.D.
And so what we know for kids and even teenagers, if we can get that early literacy going so that then their fluent readers later, they are so much more successful in all of their academic ventures throughout school. And kids that can like complete high school and graduate are actually less likely to have a host of health conditions. It's even associated with, like the rate of heart disease in adults.

00:14:46:09 - 00:15:18:27
Sara Bode, M.D.
So if you are healthy and graduate high school, you're much more likely to meet your potential and be a healthy adult. You have better health behaviors, health literacy, less likely to have any of those chronic diseases we talk about like diabetes or heart disease. So this is very much linked to ultimate adult health outcomes. And so, you know, it's interesting to think about this, but we tell this to parents, if you can sit with your child and do these fun activities now, they might be less likely to have a heart attack in their 50s.

00:15:18:28 - 00:15:21:22
Sara Bode, M.D.
I mean, it is totally linked.

00:15:21:25 - 00:15:26:25
Julia Resnick
Talk about return on investment. Read fun books with your kids. They don't have a heart attack.

00:15:27:01 - 00:15:42:28
Sara Bode, M.D.
Exactly. Keeping kids healthy and really meeting their potential learning. It just has huge ramifications for us. And that's what we're all about in pediatrics, it's all about prevention. And so this is what we want to kind of work on with our families when they're coming into the office.

00:15:43:01 - 00:15:59:01
Julia Resnick
That is the whole point. And Dr. Bode, Carneshia, thank you so much for sharing this and for all the work that you're doing to help parents and kids in your community thrive. It's just really incredible work that you're doing. I'm inspired. I'm sure our listeners will be inspired as well. So thank you both.

00:15:59:06 - 00:16:00:03
Carneshia Edwards
Absolutely.

00:16:00:06 - 00:16:02:04
Sara Bode, M.D.
Thanks for having us.

00:16:02:07 - 00:16:10:28
Tom Haederle
Thanks for listening to Advancing Health. Please subscribe and rate us five stars on Apple Podcasts, Spotify, or wherever you get your podcasts.

00;00;00;08 - 00;00;20;01
Tom Haederle
Welcome to Advancing Health. It's now been one year since Congress allocated $50 billion aimed at upgrading and expanding access to health care in America's rural communities. So, is the funding making a difference? What can rural residents expect? We explore these questions and more in today's podcast.

00;00;20;04 - 00;00;38;13
Shannon Wu
Hi everyone! My name is Shannon Wu. I am a director of payment policy here at the American Hospital Association. On this episode, we're going to talk about something very near and dear to my heart, the Rural Health Transformation Program Fund. As of this taping in June 2026, we are a little bit more than halfway through the first year,

00;00;38;18 - 00;01;02;25
Shannon Wu
where about $10 billion will be awarded to all 50 states. We thought it'd be a good time to talk about how the program is going, and what policymakers can do to further support rural communities. So with that, I'm really happy to introduce my fellow podcaster, Maya Sandalow from the Bipartisan Policy Center, joining me today to talk about everything Rural Health Transformation Fund related.

00;01;02;26 - 00;01;22;21
Shannon Wu
Maya is an associate director for BPC’s Health Program, where she leads work on health innovation policy. Her portfolio includes digital health, artificial intelligence, rural health, behavioral health, and nutrition. So with that, Maya, would you mind just describing a little bit more about the center and the work that you all do there?

00;01;22;23 - 00;01;44;24
Maya Sandalow
Thanks so much, Shannon. It's great to be with you today, and I'm so glad to be talking about the Rural Health Transformation Program. As you mentioned, I work at the Bipartisan Policy Center, and we're a nonprofit that's been around since the start of the 2000s, founded by former Senate majority leaders. And we work across the full political spectrum on domestic policy issues.

00;01;44;24 - 00;02;08;07
Maya Sandalow
So we aim to bring together diverse perspectives to craft solutions focused on lowering the everyday cost of living for families, expanding opportunities and strengthening the American economy. And we have a pretty robust health program that focuses on a range of topics, including rural health care, which is an area that we focused on for years, because one in five Americans live in rural areas.

00;02;08;07 - 00;02;12;27
Maya Sandalow
And so therefore, it's important to make sure that they can access the care that they need.

00;02;13;00 - 00;02;40;09
Shannon Wu
So we're really happy to have you here. Before I let you describe some of the key initiatives each of the 50 states are undertaking — I know you all have done a lot of work in that in the past couple of months — I'm just going to briefly describe the basic structure of the Fund for our listeners. So the basic structure of the Fund is that all 50 states had to apply for this funding, of which half of that $50 billion will be equally given to every state that applies.

00;02;40;09 - 00;03;02;24
Shannon Wu
And the other half is based on an application process the states went through at the end of last year in 2025. The program will run for five years, and the application process, as I mentioned, began at the end of last year. And the Centers for Medicare and Medicaid Services, which is the agency tasked for administering the fund, announced those awards the end of the year in 2025.

00;03;02;26 - 00;03;23;14
Shannon Wu
The Bipartisan Policy Center and the AHA have put out excellent primers on the notice of funding opportunity, if our listeners want to learn a little bit more about that application process, and you can find both of those primers on our websites. So, that's kind of the basic structure of the Fund. We’re into year one of the program now.

00;03;23;16 - 00;03;46;00
Shannon Wu
So Maya, I know the Center has done a lot of work in analyzing the applications, the key initiatives and projects that states have applied for. Do you want to talk a little bit more about, you know, kind of the broad programs each of the states have applied for, and then one or two key programs that you and the Center is focused on diving into a little bit further.

00;03;46;02 - 00;04;16;19
Maya Sandalow
Yeah, absolutely. And just to pick up on kind of the broad overview of the Fund, I think that it's important to note that CMS has a stated goal for the use of these funds to really transform healthcare delivery, right. So this $50 billion program was included in last year's reconciliation package, largely in response to concerns about federal Medicaid funding cuts in the years ahead and the impact on rural areas.

00;04;16;19 - 00;05;02;12
Maya Sandalow
But the Fund itself isn't necessarily intended or designed to directly replace those funding cuts to providers. Rather, it's focused on broader healthcare transformation. So CMS has a variety of strategic goals, including addressing the root causes of disease, investing in technology innovation, workforce development, value-based care. They really outline several strategic goals. And so what my organization BPC did was we reviewed all 50 state plans, state proposals, that they put together as part of their application process in the fall, to try to pull out some common themes and look at really across these strategic priorities that CMS has outlined.

00;05;02;14 - 00;05;32;15
Maya Sandalow
Where are states really committed to investments? The level of detail varied widely in their state applications. But that said, we were able to discern that every single state plans to invest in technology and workforce in some way. So those are really two of the biggest themes that we picked up on. And we outlined specific categories of how they plan to invest in technology and workforce in several publications.

00;05;32;15 - 00;05;35;16
Maya Sandalow
So I'm happy to walk through the details of those, if helpful.

00;05;35;19 - 00;06;05;16
Shannon Wu
That'd be great. I know on the topic of workforce, especially, for example, you know, the AHA believes that the needs of rural providers and rural communities and rural hospitals are really fundamental, and one key initiative and support that we're really looking for is a workforce development, both in recruitment and retention of current workforce, but also really building that pipeline out to make sure that access to care in rural communities is maintained and even expanded.

00;06;05;16 - 00;06;18;17
Shannon Wu
And so we really strongly believe that the funds should really prioritize these fundamental priorities in rural communities. So I would love to hear from you, the workforce type of initiatives that you are seeing in these state applications.

00;06;18;23 - 00;06;41;09
Maya Sandalow
Yeah, absolutely. Workforce is a central priority of the states, and to your point, it's no surprise, right? Because the rural areas have long suffered from workforce shortages and providers who are fantastic but really stretched thin. So we identified broadly three ways in which states are planning to invest in workforce development and workforce issues. The first is training and bringing along new providers.

00;06;41;09 - 00;07;13;26
Maya Sandalow
So the pipeline piece that you mentioned, and that's from a pretty young age, we see some states investing in healthcare training at the high school level. We see some states investing in medical school. So Delaware, for example, is proposing the state's first ever four-year medical program. Also, investments in new rural residency programs. And then many states focused on how can we retain those new providers through things like housing bonuses and incentive structures?

00;07;13;27 - 00;07;43;21
Maya Sandalow
That whole bucket a lot of that is subject to a five-year service requirement. So every investment that's tied to an individual and leads to a credential or a degree of some type, based on CMS's requirement, those individuals are required to stay in that rural area for a minimum of five years. The second category that we kind of pulled out is upskilling and building the infrastructure needed to sustain the existing workforce, right?

00;07;43;22 - 00;08;14;19
Maya Sandalow
So that's everything from training providers who are stretched thin. They may not have the time or the resources to really ensure that they're kind of practicing at the top of their license. So investing in training for those providers, things like how to use telehealth, or like robotics and surgery, right. So various types of training initiatives. Also, states focused on closing the data gap so that they have the information that they need to know where are their workforce shortages, so that they can kind of allocate resources efficiently.

00;08;14;19 - 00;08;43;12
Maya Sandalow
And then also lots of focus on non-clinician workers right. So community health workers, peer support specialists. These really important workers making sure that they're reimbursed adequately. And I'll just say the third theme that we pulled out relates to policy actions. So through the Rural Health Transformation Program, states received points in the potential for more funding if they commit to certain types of policy actions. Two with a lot of relevance for workforce are interstate licensure.

00;08;43;17 - 00;09;06;00
Maya Sandalow
By default, providers have to be licensed in the state that the patient is, in order to deliver care, but states can join what are called interstate licensure compacts, which makes it easier for providers to practice in other states. And so states are incentivized and some states are committing to joining interstate licensure compacts through the Rural Health Transformation Program.

00;09;06;01 - 00;09;25;15
Maya Sandalow
And then the second policy piece is scope of practice. right? So that relates to what healthcare workers are allowed to do based on their state medical licensing board requirements. So some states are proposing to, for example, expand what pharmacists or nurse practitioners or physician assistants can do with their funds.

00;09;25;15 - 00;09;51;21
Shannon Wu
And I know another piece of some key programs and initiatives that I think all 50 states applied for, as well is related to technology, whether it's AI, whether it's telehealth. I also know that the Center has put out some great primers on the projects and initiatives states have applied for in that regard. Do you want to talk a little bit about what you all are seeing across the states, in some key themes that are coming out from that bucket of funding?

00;09;51;27 - 00;10;26;00
Maya Sandalow
Yeah, technology investment is a really big focus across all 50 states. We identified four broad categories. So the first is states investing in the foundational health IT infrastructure that's needed as kind of a prerequisite for broader transformation. And that's really important, right? So modern healthcare really runs on data, but right now rural facilities might not necessarily have the resources that they need to make sure that the data of a patient is moving with them when they, for example, see a specialist in another town.

00;10;26;00 - 00;10;49;29
Maya Sandalow
And that can lead to duplicative tests and unnecessary care. So states are investing in that foundational infrastructure. Also in that category, cybersecurity readiness. We know that rural healthcare facilities have been subject to cyberattacks in recent years. So states are investing in kind of ensuring that healthcare facilities are prepared for potential cyber. That first bucket is really foundational.

00;10;49;29 - 00;11;11;26
Maya Sandalow
We also see states investing in expanding access to digital health, things like telehealth and remote patient monitoring. Patients in rural areas tend to live pretty far from providers, have to travel really long to get the care that they need. So you can imagine this telehealth and patient monitoring being really valuable for patients, but rural areas tend to have less access.

00;11;11;26 - 00;11;44;07
Maya Sandalow
So states are focused on closing that gap. One story that really illustrates the potential here. I talked to a patient named David last year, and he's in his mid-80s and he lives in rural North Carolina. And he really credits his remote patient monitoring program with keeping him out of the hospital consistently. Like every morning he checks his blood pressure, he uses a weight scale, and his data is automatically sent to a remote healthcare provider who, if there's something out of range, can call him, adjust his medications.

00;11;44;07 - 00;12;12;28
Maya Sandalow
So there's really a lot of potential here for it to help patients health and also save money. The third bucket is artificial intelligence, which everybody is talking about right now. Same story here. Rural areas tend to have less access to AI. You know, AI is long been used in areas like medical imaging. Increasingly it's used a ton in clinical documentation, which can help to reduce burnout and kind of administrative burden on rural areas.

00;12;13;04 - 00;12;39;07
Maya Sandalow
Then the fourth and final category that we pulled out are something called rural technology catalyst funds. And these are created by the Rural Health Transformation Program. States are allowed to invest up to 10% of their money into this. And it's really meant to be a catalyst for innovation. So states partner with external entities. So maybe a startup incubator to vet technology proposals.

00;12;39;07 - 00;12;51;25
Maya Sandalow
And then those external entities can also bring in outside capital, so it's a way to combine public investment with private investment. So that fourth bucket is definitely something to keep an eye out for.

00;12;51;27 - 00;13;16;06
Shannon Wu
That really runs the spectrum of kind of the core infrastructure needs of setting up health IT. You know, for us, we tend to think of kind of the broadband needs of rural communities, right, kind of having that initial infrastructure. But now you also describe the fourth bucket in terms of really innovative care using drones, etc. So this will be a really interesting, I think, bucket of funding to see what states do.

00;13;16;09 - 00;13;56;27
Shannon Wu
Well, I know that, you know, with this funding, as we said before it's a five-year program. The AHA and BPC have suggested to policymakers other initiatives and models of care for rural communities. You know, that this funding could use, but also beyond the scope of this Transformation Fund, right? So for us, for the AHA we publish our Rural Advocacy Agenda every year at the beginning of the year, which our listeners can find on our website. For this year, in addition to understanding and seeing where the progress of this Transformation Fund is going, one of our main focus is also holding commercial insurer actions accountable so that patients have timely access to care.

00;13;56;27 - 00;14;23;22
Shannon Wu
And these actions include prior authorization denials for patient care, delayed payments to providers, among other actions used by commercial insurers. I'm curious, does the BPC have any particular recommendations or policy that you are thinking about now or in the future, that's really aimed at ensuring that access to care in rural communities is maintained or expanded on? We would love to hear kind of what you all are thinking in this space as well.

00;14;23;25 - 00;14;51;20
Maya Sandalow
Yeah, absolutely critically important, and we are focused on a lot of the same areas that AHA is. We're coming out with an issue brief in the next month that will really elevate federal bipartisan policy priorities to bolster rural healthcare. And that will include really re-upping recommendations that have existed for a long time, as well as some new ones, to help to kind of sustain and maximize the investments of the Rural Health Transformation Program.

00;14;51;22 - 00;15;15;07
Maya Sandalow
There's going to be a lot of recommendations in that. I'll highlight two. Both relate to Medicare funding, because Medicare is really a primary payer for many rural hospitals and rural health care facilities. So the first one that I'll talk about is something called Medicare rural hospital designations. Those are extra funds that are given to hospitals with low volume in geographically-isolated areas.

00;15;15;07 - 00;15;40;25
Maya Sandalow
And there's a really strong track record for a lot of these programs and incentive designations. Yet, several of them lack permanent authorization. And so Congress has extended them year after year. And that makes it harder for providers to really have the security to be able to invest in kind of supports for their hospital and know that there's going to be financial stability over time,

00;15;40;25 - 00;16;11;09
Maya Sandalow
so we think that those should be made permanent. And then another thing that we think should be made permanent is access to telehealth and telehealth funding through Medicare, right? Telehealth is a fixture in the U.S. healthcare system at this point, yet Medicare payment for most of telehealth relies on temporary extensions. And we saw the repercussions of that this fall when there was a government shutdown, actually. Authority for Medicare financing for telehealth lapsed,

00;16;11;10 - 00;16;23;08
Maya Sandalow
right? And so this is a big barrier to long-term investment in the telehealth infrastructure is the need for these temporary extensions. So we call for permanency on that as well.

00;16;23;11 - 00;16;47;15
Shannon Wu
We really appreciate those recommendations. We support all that and especially on the Medicare-dependent designations and low volume, I think that's been a long -standing AHA policy as well, making those permanent, because we do hear from our members that having that security in payments, in these really geographically-isolated and Medicare-dependent hospitals, it really makes a big difference.

00;16;47;15 - 00;17;12;14
Shannon Wu
So we appreciate all the work that you all are doing to spearhead all that as well. Maya, we really appreciate you, appreciate your time and coming on to the podcast and of course, efforts from the Center and supporting rural communities. I know you all are hosting a virtual event coming up this month, right on the Transformation Fund? So do you want to give our listeners a little bit of detail on how to sign up for that, and what you guys will be talking about during that virtual event?

00;17;12;19 - 00;17;40;26
Maya Sandalow
Yeah, absolutely. Thank you for highlighting that. So BPC will be hosting a webinar on June 30th. You can go to our Events page at bipartisanpolicy.org to sign up. And we're going to bring in some experts that represent different state perspectives and can kind of speak to implementation, transparency, sustainability, some of the key questions that experts are raising when it comes to the Rural Health Transformation Program.

00;17;40;26 - 00;17;59;23
Maya Sandalow
And then we'll also outline some of the key themes that we've picked up as we reviewed all the state plans and give a preview to some of those federal policy recommendations, that are important for sustaining access to rural healthcare. So definitely tune in. We've got lots of great experts joining that event.

00;17;59;28 - 00;18;24;20
Shannon Wu
That's great. I'll definitely be tuning in. I know we're really looking forward into how that transparency piece is going to play out for the Fund and knowing where the funds are going, how they're being awarded, where they're being used. We really are looking into that as well. So, as the Fund continues into years two through three through four through five, we'd love to have you back on other episode of the podcast.

00;18;24;21 - 00;18;43;06
Shannon Wu
Just discuss how things are going, how progress is doing, what other programs and models of care that you all are suggesting to policymakers at the Bipartisan Policy Center as well. So again, we really appreciate you coming and joining us on this episode of this podcast, and we look forward to having you back. Thanks very much.

00;18;43;08 - 00;18;48;10
Maya Sandalow
Yeah, thank you so much for having me. Look forward to coming back in the years ahead.

00;18;48;13 - 00;18;57;03
Tom Haederle
Thanks for listening to Advancing Health. Please subscribe and rate us five stars on Apple Podcasts, Spotify, or wherever you get your podcasts.

00:00:00:02 - 00:00:19:08
Tom Haederle
Welcome to Advancing Health. Achieving good health is a balance of many factors beyond clinical care. In this Leadership Dialog podcast, we learn how Denver Health takes a holistic approach to wellness that even includes providing housing options for those who need it.

00:00:19:10 - 00:00:38:06
Marc Boom, M.D.
Greetings and thank you everyone for joining us today. I'm Marc Boom. I'm the president and CEO of Houston Methodist, and I'm the current board chair of the American Hospital Association. As we continue these discussions, we're going to focus today's conversation on the importance of community health and the innovative, impactful work that often takes place outside of the four walls of a hospital.

00:00:38:07 - 00:01:01:18
Marc Boom, M.D.
Because as hospitals and health systems, we work to improve the overall health and well-being of those we serve. And we know that clinical care accounts for only about 20% of an individual's health status, meaning that achieving good health involves so many factors, from housing and education to employment and access to nutritious food. So, to truly improve health, we know that we must care for our patients very holistically.

00:01:01:19 - 00:01:22:22
Marc Boom, M.D.
We need to address all factors that affect their health and well-being. So today, I'm pleased to be joined by Donna Lynne, the CEO of Denver Health. And in a moment, I'll ask her to tell us a bit about herself. But I want to share briefly that Denver Health is Colorado's primary safety net health system, and is very well known for providing a broad range of health services across the Denver community.

00:01:22:24 - 00:01:45:03
Marc Boom, M.D.
Denver Health is an academic medical center that also serves the community by providing care at ten family health and primary care centers and 19 school based health centers. So, without further ado, let's jump into our conversation. So, Donna, our viewers always like to know a little bit about our guests before we get started. So please tell us about your pathway and how it has influenced the work you're now championing at Denver Health.

00:01:45:09 - 00:02:08:00
Donna Lynne
It's great to see you again, and I'm happy to talk to you and to the viewers. I often say that careers only make sense looking backwards, and I'm certainly one of those people. So I'd say I have a non-linear career. I started off my first 20 years in the public sector, but that connection with the community really resonates with me in terms of the work that I did.

00:02:08:00 - 00:02:29:25
Donna Lynne
So I worked in New York City for four mayors and focused on a lot of issues. Whether it was the budget, it was human resources, and certainly as part of human resources, healthcare and trying to think about how do you make healthcare more affordable for some of those public servants? I spent time in two different health plan organizations.

00:02:29:26 - 00:02:52:27
Donna Lynne
I was the lieutenant governor for the state of Colorado and worked also at Columbia University Medical Center. So it's a 50 year career, so there's lots of pieces to it. And as you said, I'm now happily at Denver Health. But all of those organizations were large. They were complex and, you know, not real verticals, as I say, that were just focused on one thing.

00:02:52:27 - 00:03:20:09
Donna Lynne
And building that community is really important, and certainly here at Denver Health. We have a hospital, but we also have a lot of other arms to us. We run the ambulance system, for example, for the city and County of Denver. We provide health care in the jails. We're a $1.6 billion organization and about 9,000 employees. The majority of our patients actually are seen in those clinics that you describe.

00:03:20:09 - 00:03:33:18
Donna Lynne
The ten community clinics, soon to be 11, and our 19 public schools. And we touched so many of those social determinants of health and I'm sure we'll talk about as we go forward.

00:03:33:20 - 00:04:00:09
Marc Boom, M.D.
Well, fantastic. And four mayors, I bet you that I taught you to be nimble because I'm sure priorities moved and changed on you during that time. So I know that you're very intentional and strategic. So talk a little bit about how you think strategically about thinking in terms of the community as a whole. And you alluded to it, but how is that involved addressing those social drivers of health as core pillars in your health system?

00:04:00:12 - 00:04:28:15
Donna Lynne
Sure. And thank you for that. So I think first to start with a profile of what our patients look like. 47% of our patients are on Medicaid. About 15% are uninsured. And so that leaves a minority of those who might be on traditional commercial insurance, working. And hopefully, even though some of the folks who certainly are working in lower wage jobs might have some of the complicated issues that we deal with.

00:04:28:15 - 00:04:58:02
Donna Lynne
But the majority of our patients oftentimes have housing insecurity, food insecurity, challenges around transportation. And so we have to focus very much on what else do they bring to the table. I like to say - although our chair of orthopedics doesn't like it when I say this - anybody can fix a broken arm. But we fix a lot of other broken things, including some mental health and substance use issues.

00:04:58:02 - 00:05:33:25
Donna Lynne
About a third of our patients have mental health and substance use as part of their condition. And so it's not just fixing that broken arm, it is dealing with much more long term chronic conditions that are sometimes influenced by things, you know, outside of our four walls. So we do social needs screening for all of our patients. We routinely look at their income, household size, and also even in a place like dental, which we didn't talk about, we provide dental care in those high schools and in our community clinics.

00:05:33:27 - 00:05:59:08
Donna Lynne
Even our dentists are trained to ask questions about patients mental health. So it's so diverse to do both the economic and social screening that we not only provide a lot of those services ourselves, but we have a lot of partners in the community that we rely on, whether it's Food Bank for the Rockies or housing organizations that very much support what we do.

00:05:59:08 - 00:06:21:10
Donna Lynne
And then the last thing I'd add in this sphere is about two and a half years ago, we started providing housing for our patients because we recognized that many of them have no place to go once we're ready for discharge in the hospital. They don't have a guardian, they don't have family members. They were living on the street, or maybe they were just housing insecure.

00:06:21:12 - 00:06:33:13
Donna Lynne
So we now have 34 apartments that we provide to our patients. It avoids long stays, it avoids repeat admissions. And quite frankly, it's the right thing to do.

00:06:33:16 - 00:06:45:13
Marc Boom, M.D.
So 34 different apartments themselves. How do you figure out the prioritization of that? How do you how do you sort out who goes there and how long do people typically stay? Is it a bridge to others? How do you use that?

00:06:45:15 - 00:07:12:27
Donna Lynne
Yeah, that's a great question. So there's two types of housing that we provide. One is called recuperative care. And so those are patients for whom maybe wound care is still necessary. But that's not paid in our current healthcare system as an inpatient service. So we will discharge patients to a housing complex that we work on with the Colorado Coalition for the Homeless.

00:07:12:27 - 00:07:43:04
Donna Lynne
And they have a clinic inside that housing complex. So they're able to provide that kind of continuing care. And their average length of stay is only 2 to 3 days, so quick. But it discharges them. And as you know, we get paid on a DRG and we're done. And it provides them with a little bit of shelter. And that organization, the Colorado Coalition for the Homeless, also works with them on perhaps a move to something that is longer term.

00:07:43:04 - 00:08:12:10
Donna Lynne
So that's 20 of our 34 apartments. We also have 14 apartments that are much more for people who don't need recuperative care, but we know have no place to go. And perhaps more highly utilized in the cold months here in Colorado. And those patients can stay up to six months and they get moved into a housing authority, the Denver Housing Authority Service, which again, is an important partner for Denver Health.

00:08:12:10 - 00:08:35:15
Donna Lynne
And we both work during that time that they're in the apartment on there, perhaps their behavioral health needs and on certainly some more permanent type of housing. So it's really a great program. Our mayor loves it because we do have a homeless problem in the city, although 14 apartments isn't going to put much of a dent in it.

00:08:35:16 - 00:09:02:12
Donna Lynne
It is a way for us to collaborate both with the mayor and with the housing authority, and to provide some social support to those patients. They don't need an inpatient admission into our psychiatric unit, and they might not be willing or able to pursue outpatient care in one of our clinics. So we bring some of those services directly to them while we're working on longer term housing.

00:09:02:14 - 00:09:09:18
Marc Boom, M.D.
What a great program. Now, y'all recently won the AHA Nova Award. Tell us a little bit more about that.

00:09:09:19 - 00:09:38:01
Donna Lynne
Sure. Thank you. And it was such an honor to get that award, which is very competitive. And in fact, it was for this program that we call Hope, which is housing, outreach, partnership and engagements. And last year we saw at Denver Health, 14,000 patients who were housing insecure or experiencing homelessness. And, you know, in the past, we would sometimes hold on to them in our inpatient units, which was unnecessary.

00:09:38:01 - 00:10:06:00
Donna Lynne
And as I said, we weren't seeing reimbursement for that and we weren't getting paid. And that increased our uncompensated care. And while as a safety net, we take all patients regardless of their ability to pay, we still at the end of the day, we have to make a little bit of margin to be able to continue. So having a place for patients to transition, to safely recover is critically important to improving our length of stay,

00:10:06:00 - 00:10:34:12
Donna Lynne
and just from a humane perspective. So our hospitalists, who really are the core of this program. Also, we're experiencing some what we call in healthcare, as you know, a little moral distress. Those 34 apartments that we have can't solve the problem. But partnerships with other housing organizations is also an important part of this program. So we're looking to sustain the program, to scale it.

00:10:34:19 - 00:10:59:16
Donna Lynne
Having the recognition from AHA is important because what I'll do is I'll go to funders and say, the American Hospital Association recognize how innovative and how essential this program is. And we're really excited because I think it gives us a great opportunity. As you know, we have some storm clouds on the horizon with HR One. And even in the impact that HR One has on our own state budget.

00:10:59:18 - 00:11:12:13
Donna Lynne
So bringing together all those other resources coupled with this recognition, I think, is going to give us an opportunity to seek additional funding from foundations and maybe even from our legislature.

00:11:12:20 - 00:11:29:24
Marc Boom, M.D.
I love the fact that the award, hopefully, is a little bit of a catalyst even to grow the program further and help more humans. So, you know, that's a great example of innovation. You all are really a designated safety net is what you do. And we have, of course, some wonderful institution in Houston that does it.

00:11:29:24 - 00:11:45:01
Marc Boom, M.D.
But we're all safety nets, every hospital, we care for our community. So what would you be your advice to other hospital leaders about how they tackle innovation in delivering care and innovation in functioning to improve that community health?

00:11:45:03 - 00:12:07:01
Donna Lynne
Sure. And I think in addition to, as I said, it being the humane thing to do, and as you said, every hospital, I mean, we could talk a lot about rural hospitals who are the lifeblood of their communities. Any hospital, as a large employer, is providing a vital economic function in their communities. And you're absolutely right. We all take Medicaid for the most part.

00:12:07:02 - 00:12:36:10
Donna Lynne
We all struggle with how do we make this complex financial formula work? We approach this not just though from the humane perspective. We said, is there a business case that we can prove that this investment - because nobody paid for it - makes sense. And the investment is not just in the people, our hospitalists who do the work, but we pay the rent for these two facilities that are mentioned.

00:12:36:10 - 00:13:01:00
Donna Lynne
So what we started looking at was how long do homeless patients or housing insecure patients stay in the hospital? And we know that they stay, on average, about two and a half times longer than other patients. We also know that they are a source of readmissions and they're coming back. And again, some of them have Medicaid, but many of them are not insured.

00:13:01:00 - 00:13:31:01
Donna Lynne
And so we thought, let's figure out how this strategy of renting apartments could decrease the length of stay, could reduce readmissions, as well as create a more moral environment for these patients. So we literally just did a business analysis. I would point out too, I know I just read in Health Affairs, Massachusetts has a housing program similar to ours, much bigger in scale, and they published an article that was very rigorous.

00:13:31:01 - 00:13:56:07
Donna Lynne
It was part of a 1115 waiver from Medicaid. But while I'm proud of what we do, we're not the only health care system doing this. I know University Hospital System in Missouri is doing a similar program. So I think, what are the economics? What challenges do we all have, and how can we make a dent in what's going on in our society?

00:13:56:07 - 00:14:10:02
Donna Lynne
As we know, homelessness is not a problem that is just restricted to certain states or certain urban areas. It's a major problem. So we did the financial analysis and we said, this really makes sense from an economic point of view.

00:14:10:09 - 00:14:26:01
Marc Boom, M.D.
And you bring up one of the things I always say to my team is, look, when others are doing similar work, go cheat off their paper because we're all we're all in it together. We're all there to help humanity, right? Last thing I want to ask you about, and you've talked about this a couple of times. Community partners in all of this work are critically important.

00:14:26:02 - 00:14:32:21
Marc Boom, M.D.
Hospitals can't do it alone. Sometimes we may be the anchor to that, but we can't do it alone. So talk a little more about the partners you're working with.

00:14:32:28 - 00:15:05:08
Donna Lynne
Absolutely. And as you said, many of us, whether it's hospitals, health care systems or some of the other community organizations, we all have the same goal. We want to improve the health of our community so that we see young people graduating from school, either moving on to higher ed or perhaps moving right into jobs. I look at our investment in the community also as a job strategy, as we're perceived of as a good employer, and one that's looking at the whole patient.

00:15:05:14 - 00:15:37:03
Donna Lynne
Our partners oftentimes provide us with patients, with employees, and so we have partnerships with a number of food bank organizations. And we actually raised money to provide 250 of our patients with food, continuous food over a nine month period. We have another organization called revision that provides food boxes to patients when they're discharged. And one thing I didn't talk about was our mobile health care.

00:15:37:03 - 00:16:01:18
Donna Lynne
And that is really important because as I said, transportation can be a challenge. We do provide some free transportation where we can through Medicaid, but we also take our mobile health units out into the community. And in some cases, those mobile health units are parked at a school, for example, where we may not have a health clinic. We don't have a health clinic in all of our Denver public schools.

00:16:01:20 - 00:16:28:19
Donna Lynne
The partnership that we have with the public school system is tremendously important. Principals refer patients to us, the superintendent of the school system and I are friends and work together. And so our vans will move around to other schools as well. I think all those social determinants of health that we've talked about beg that we use partnerships because we can't go out and buy the food ourselves.

00:16:28:19 - 00:16:52:07
Donna Lynne
And as I said, transportation to a certain extent is provided under Medicaid. But having a different kind of strategy, including a telehealth strategy, just help us get to patients where they are. And I think that's so important. We don't believe everybody should drive to one place to get health care. When we can bring it to the community, that's a much better strategy.

00:16:52:12 - 00:17:09:03
Marc Boom, M.D.
Well, you all are doing amazing work. So Donna, thank you so much for your time today. I'm sure this has been an inspiration to many people. I'm already filing away some ideas of things we need to look at and how we serve our community even better. And just really appreciate all of your insight. To all of our viewers,

00:17:09:03 - 00:17:16:02
Marc Boom, M.D.
thank you for finding the time to listen today. I'll be back next month for another Leadership Dialog conversation.

00:17:16:04 - 00:17:24:24
Tom Haederle
Thanks for listening to Advancing Health. Please subscribe and rate us five stars on Apple Podcasts, Spotify, or wherever you get your podcasts.

00:00:00:06 - 00:00:18:22
Tom Haederle
Welcome to Advancing Health. The recent outbreak of the dangerous hantavirus infection on a cruise ship sent countries around the world, including the US, scrambling to bring their citizens home for quarantine and treatment. We learn more about America's ongoing response to the threat in today's podcast.

00:00:18:25 - 00:00:47:24
Chris DeReinzo, M.D.
Hi everyone! This is Dr. Chris DeRienzo, Thank you so much for joining us again on the Advancing Health podcast. I am incredibly excited to welcome to the podcast this week, Dr. Angela Hewlett. She is a professor of infectious diseases at the University of Nebraska's Medical Center, also called UNCW and the medical director of Nebraska's Biocontainment unit, which is not a thing that I imagine many of you know exists, and something that we're going to talk a little bit about over the course of our conversation today.

00:00:47:25 - 00:00:51:00
Chris DeReinzo, M.D.
Dr. Hewlett, thank you so much. Welcome to the podcast.

00:00:51:01 - 00:00:52:09
Angela Hewlett, M.D.
Oh, thanks for having me.

00:00:52:10 - 00:00:58:14
Chris DeReinzo, M.D.
Before we jump in, if you would tell us just a little bit about yourself and what brings you to the conversation today?

00:00:58:15 - 00:01:34:09
Angela Hewlett, M.D.
Well, I'm an infectious diseases specialist by training, and so I, I am originally hail from Houston, Texas, and did all of my training at University of Texas Medical Branch in Galveston, Texas, including an infectious diseases fellowship. And then I transitioned to Nebraska for my first so-called real job in 2009. And part of that package actually did involve the need for an associate medical director of the Nebraska Biocontainment Unit, which at the time I didn't really know existed, and like many people, but I was absolutely just floored by this facility when I visited this university.

00:01:34:09 - 00:01:54:12
Angela Hewlett, M.D.
And it really was part of the reason that I landed here in Nebraska in 2009. So I became associate director of the Nebraska Biocontainment Unit, at that time under the direction of Dr. Phil Smith, who was my mentor and the founder of the Nebraska Biocontainment Unit. And he was the director of the unit until 2016, when he retired.

00:01:54:12 - 00:01:59:00
Angela Hewlett, M.D.
And then I've been the director of the biocontainment unit since 2016.

00:01:59:06 - 00:02:23:08
Chris DeReinzo, M.D.
Wow. We've seen a lot in those ten years. But perhaps let's start the conversation with a little bit more about the role that that UNMC plays in the nation's critical medical infrastructure. Because truth be told, before I joined AHA three and a half years ago, I really had no concept of just how deeply integrated you are into how America manages emerging infectious diseases.

00:02:23:08 - 00:02:27:03
Chris DeReinzo, M.D.
So really, what is the biocontainment unit and what kind of work do you all do?

00:02:27:08 - 00:02:53:06
Angela Hewlett, M.D.
Well, here in Nebraska, we actually have two facilities that are designed for the care and monitoring of both patients and individuals who have either exposures to high consequence infectious diseases or are infected with high consequence infectious diseases. And we're part of a network called the National Emerging Special Pathogens Training and Education Center - NETEC. And this network was actually built after the 2014 Ebola experience.

00:02:53:06 - 00:03:18:01
Angela Hewlett, M.D.
And there are 13 regional emerging special pathogen treatment centers, or the RESPCs in the United States currently, as well as multiple level two facilities which are also designed for the care of high consequence pathogens. So those 13 facilities serve as the leads within their regions within the United States and here at UNMC Nebraska Medicine we are one of the originators, the founders of NITEC.

00:03:18:01 - 00:03:46:04
Angela Hewlett, M.D.
So one of the three facilities alongside Emory and Bellevue, New York City as well. And so we brought this network up, actually to enhance preparedness throughout the United States. But our facilities have actually are - the Nebraska biocontainment is actually been here since 2005. So this unit was dedicated in 2005. And our first official activation was actually in 2014, when we did care for three patients infected with Ebola virus disease.

00:03:46:04 - 00:04:07:27
Angela Hewlett, M.D.
But we do have two facilities here at UNMC that are designed strictly for this purpose. And the first facility is a national quarantine unit, which is actually the only quarantine unit of its kind in the United States. And it's a federally funded facility. It has 20 beds in the unit, and it's designed to monitor individuals that have exposures to high consequence infectious diseases.

00:04:07:27 - 00:04:32:11
Angela Hewlett, M.D.
So this is not a patient care facility per se. It's more like more designed like a hotel. Because we know that our guests can potentially be with us for a prolonged period of time. And so we have things in the rooms like, you know, refrigerator and a TV with streaming capabilities and exercise equipment in every room just to try to make this kind of difficult quarantine as comfortable as we can be.

00:04:32:16 - 00:05:01:06
Angela Hewlett, M.D.
Our guests have access to, you know, in person and virtual behavioral health support, which is, I think, critically important. And a mission like this, where we have individuals who do stay with us for a prolonged period of time. We host a daily town hall meeting where our guests can communicate with our team and with each other, just to kind of interact and discuss the different scenarios and things like everything from testing plan to food to, you know, really anything else that they would like to discuss throughout the day.

00:05:01:10 - 00:05:22:04
Angela Hewlett, M.D.
Although that facility is designed sort of like a hotel, it also does have some interesting capabilities in that it is all negative pressure. We are monitoring these individuals, which should they become ill, we have negative pressure throughout our unit, as well as an autoclave that we could potentially use for waste disposal if necessary. So there are some more unusual aspects.

00:05:22:04 - 00:05:28:20
Angela Hewlett, M.D.
So it's not your typical hotel, but it was really designed to monitor individuals with those types of exposures.

00:05:28:21 - 00:05:48:28
Chris DeReinzo, M.D.
That is the understatement of the century. Not your typical hotel. Well, before we go one level deeper, you've used the term high consequence pathogen or high consequence infectious disease a couple of times. For a non ID doc, for our general listener population, what is a high consequence pathogen and what are the kinds of potential infectious diseases that folks would be exposed to

00:05:49:00 - 00:05:53:22
Chris DeReinzo, M.D.
where this would be a unit that we might send them to for the kind of monitoring you're describing?

00:05:53:24 - 00:06:33:22
Angela Hewlett, M.D.
So a high consequence infectious disease. And I will say there's been a lot of work on this because the terminology has changed quite a bit over the years. You may have heard highly infectious disease or highly hazardous communicable disease or a special pathogen. Those terms are all essentially interchangeable to really mean the same thing. And that is a disease for which there is a chance for transmissibility between humans, a disease that has potentially a high mortality rate or for which there are minimal or none as far as therapeutic agents or vaccines, and so typical diseases that fall in that category of high consequence infectious diseases include things like viral hemorrhagic fever.

00:06:33:22 - 00:07:05:25
Angela Hewlett, M.D.
So things like Ebola virus disease, Lassa fever, Marburg,  smallpox is in that category. Certain types of mpox potentially, depending on the facility, could be classified as that. So there are multiple types of diseases that could fall in that category. The most recent that we've been dealing with is the Andes virus, which is a hantavirus. But it's the only hantavirus known to be transmissible person to person and has all of the things that I mentioned as far as limited therapeutic options and no vaccine.

00:07:05:25 - 00:07:09:28
Angela Hewlett, M.D.
So we would classify that as a high consequence infectious disease as well.

00:07:10:01 - 00:07:30:25
Chris DeReinzo, M.D.
Well, let's spend a minute then on the subtype of the hantavirus, the Andes virus, it sounds like what it is called by those in the know. We know that that hit the news in a substantial way earlier this year. Help us understand the role that y'all played in Nebraska in the nation's response. And you know, where are we in the arc of that response right now?

00:07:30:27 - 00:08:06:02
Angela Hewlett, M.D.
Well, so the initial cases of Andes virus were actually reported off of the MV Hondius cruise ship. That was an expedition ship that was started in Argentina and made its way across the Atlantic to some very remote areas around the world, mostly territories, actually. So again, an expedition ship with a lot of very active outdoor exposures and other things that that occurred while unfortunately an individual on that on that ship became ill very quickly after boarding the ship in in early April and succumbed to his illness on board.

00:08:06:04 - 00:08:30:12
Angela Hewlett, M.D.
Subsequently, his wife became ill, as did another passenger. And so then there started to be some concern for is this disease that's transmissible human to human, what could this possibly be? And as more people got sick, eventually those individuals, when they were transferred off of the ship for medical care, eventually the diagnosis was made of a hantavirus and then eventually the Andes strain of hantavirus.

00:08:30:12 - 00:08:55:23
Angela Hewlett, M.D.
And so that occurred in all throughout April, essentially. In early May, you know, many of these people were still on the ship, and they had individuals who had become ill, who had been transported off of the ship, but also a fair number of people who had had various exposures during the cruise. And if you think about a cruise ship, there are potentials for lots of in-person contact with each other, lots of close contact potentially.

00:08:55:23 - 00:09:18:13
Angela Hewlett, M.D.
And this was a special voyage. It wasn't your typical kind of large cruise line. This was very much an expedition where they had a lot of close contact with each other. It was a small ship, but still a lot of prolonged contact with other people on the on the boat. And so because of that, that introduced the possibility of transmission of Andes hantavirus, which is what was occurring on the ship.

00:09:18:13 - 00:09:44:03
Angela Hewlett, M.D.
So when the ship eventually docked, all of the individuals on the ship had potential for having exposure just due to the number of cases of hantavirus that individuals that became ill on the on the ship, including the ship's physician, actually. And so after that happened, then each individual country flew a plane essentially to, to the area and actually which was the Canary Islands at the time and actually then took their citizens back to their home country.

00:09:44:03 - 00:10:05:27
Angela Hewlett, M.D.
So this happened all over the world. This was a cruise that had many countries involved from all over the world. And those countries actually were came back and essentially, you know, picked up their exposed individuals and took them back home for quarantine. And so here in the United States, because we have the national quarantine unit here on our campus, that was our job is to monitor those individuals.

00:10:05:27 - 00:10:28:10
Angela Hewlett, M.D.
And, you know, should they become ill, then we have the possibility of transferring them into the Nebraska Biocontainment Unit, which is our patient care unit. We originally accepted 16 individuals that had exposure to Andes hantavirus on the cruise ship. Later we received an additional two individuals and so we had a total of 18 when we started this on May the 11th.

00:10:28:10 - 00:10:54:28
Angela Hewlett, M.D.
And so we're still currently monitoring eight individuals. We since that time, some of our individuals have actually been transferred home for home quarantine. So they're still they're still under quarantine for 42 days total, which is the maximum incubation period of Andes hantavirus. The average incubation period is around 18 days. And we have definitely surpassed that. And so we are definitely past the average incubation period, but not completely out of the woods with our individuals yet.

00:10:54:28 - 00:11:01:03
Angela Hewlett, M.D.
We're very fortunate to have PCR testing capability here on campus, which is a very unusual entity.

00:11:01:08 - 00:11:19:04
Chris DeReinzo, M.D.
Especially for such a for such a rare virus. In order to be able to test for it, you truly have to be in, in like the top leading center in the country, which what you all are. And it really sounds like the connection there between the quarantine unit and the bio containment unit make it a potentially seamless experience.

00:11:19:04 - 00:11:31:12
Chris DeReinzo, M.D.
So it sounds like I think I heard you say we're not out of the woods yet, but in terms of timing here, we're on hopefully the back end of what could have been much more significant kinds of exposures.

00:11:31:16 - 00:11:57:25
Angela Hewlett, M.D.
Yeah, absolutely. And I think just to highlight the reason that the national quarantine Unit is here on our campus is because of the Nebraska Biocontainment Unit, which is our patient care facility. So that is where as in all ages, all hazards unit, we can provide a full spectrum of clinical care in the Nebraska Biocontainment Unit, everything from typical supportive care to critical care modalities like mechanical ventilation, dialysis, ECMO, really the full spectrum of clinical care.

00:11:57:25 - 00:12:20:21
Angela Hewlett, M.D.
And that unit is also negative pressure throughout with the gradient. It has HEPA filtration of all of our exhausted air. We have dual autoclaves for waste management. We have an in-house laboratory as well as laboratorians who train with us on our team and come in and process specimens for us right inside the unit. We have a large trained team of healthcare workers that includes physicians from multiple different specialties.

00:12:20:21 - 00:12:44:21
Angela Hewlett, M.D.
And I mentioned all ages unit. We have pediatricians. We have pediatric infectious diseases specialist, peds critical care docs, neonatologist. We have a cadre of surgeons actually on our team as well. We have a CT surgeon who's actually part of our team as well as obstetricians. You know, there's a chance that we could need you need to care for a pregnant individual and potentially a neonate as well.

00:12:44:21 - 00:13:03:09
Angela Hewlett, M.D.
So all of our team members, including the physician groups as well as the nursing team, which comprises a variety of different specialties of nurses. We have respiratory therapists on our team. We're an all volunteer team, actually, so none of our health care workers are compelled to do this type of work. We have a lot of team maintenance activities.

00:13:03:09 - 00:13:24:01
Angela Hewlett, M.D.
We have ongoing training that we're required to participate in, as well as drills and exercises and team building events and things like that that really enhance our teams. So, you know, again, these two facilities are an unusual entity. And the fact that they're co-located on our campus makes us sort of the spot to be, if you will, for individuals who require quarantine.

00:13:24:02 - 00:13:33:06
Angela Hewlett, M.D.
Also keeping in mind that that's the reason that these facilities are here is so that should we need to care for someone with an infection, we're able to do that readily.

00:13:33:10 - 00:13:57:03
Chris DeReinzo, M.D.
Well, they truly sound like a one of the kind duo. And you know, you mentioned back in the 2014-15 Ebola virus disease response, the unit was active. I got to be honest, in 2026, the recurrence of Ebola virus in the conversation globally was not on my dance card. But we know that there's one of the most significant Ebola virus disease outbreaks going on in history right now.

00:13:57:07 - 00:14:12:01
Chris DeReinzo, M.D.
What are you all seeing again? We know you are as plugged in as any unit could possibly be in the global conversation. Where are you seeing that outbreak trending at the moment? And what, if anything, should hospitals be doing in preparedness?

00:14:12:03 - 00:14:36:10
Angela Hewlett, M.D.
I'm really concerned about what's going on in the Democratic Republic of the Congo and Uganda. You know, there have been a large number of cases and deaths associated with this outbreak, which actually is reminiscent of the earlier days of the 2014 outbreak, which occurred in a different part of Africa. So in West Africa, but still just the large number of cases and the ongoing increase in case counts that we're seeing on a daily basis.

00:14:36:13 - 00:14:56:21
Angela Hewlett, M.D.
The 2014 outbreak resulted in around 28,000 cases and about 11,000 deaths. And I'm really hopeful that we won't see that number of cases with this outbreak. But I'm very nervous about that, just given the kind of volatile situation that's occurring, particularly in this area of the Democratic Republic of the Congo, which has a history of outbreaks in the past.

00:14:56:21 - 00:15:17:15
Angela Hewlett, M.D.
So this is not the first time that they have seen Ebola virus disease, but they also have a very mobile population in that area, limited access to health care, which subsequently results in limited access to testing, as well as a history of conflict in the area, which really makes this scenario very difficult. And so I'm definitely concerned about what is going on overseas.

00:15:17:19 - 00:15:41:03
Angela Hewlett, M.D.
You know, as far as preparedness locally, we should all be aware of what's going on throughout the world because these outbreaks are occurring regularly, and they're also something that we need to take note of because, you know, there could always be imported cases of any infectious disease with travelers who either are from the United States and go travel abroad and return, or travelers from other countries who are coming to the United States.

00:15:41:03 - 00:16:01:28
Angela Hewlett, M.D.
And a great example that is occurring right now is the World Cup. Just in the fact that there are a lot of people who a lot of fans who are coming to the United States and traveling to other parts of the world for these games. And so facility preparedness is, is incredibly important. And I think infectious diseases, we use a mantra that we call identify, isolate and inform. Facilities -

00:16:02:00 - 00:16:22:22
Angela Hewlett, M.D.
regardless of the size of your facility - it could be the smallest kind of critical access hospital or a clinic or the emergency department or a large academic center. People can present to any of these settings, and so even the smallest hospital needs to be ready to at least identify, isolate and then inform appropriate authorities should there be concern for high consequence infectious diseases.

00:16:22:22 - 00:16:53:26
Angela Hewlett, M.D.
And the way to do that is to make sure that you have protocols in place that can identify symptoms that are appropriate and concerning, as well as a history of travel, which we actually have frontline in our facility. We utilize our electronic medical record, and we ask patients a set of questions on intake, whether they're coming into our emergency department or to any clinic setting, and then that the answers to those questions sometimes lead to the isolation of that individual or further questioning or, you know, the activation of some of our protocols.

00:16:53:26 - 00:17:04:13
Angela Hewlett, M.D.
So I would just emphasize that it's really important that every facility is prepared, and it doesn't matter the size of your facility, because people definitely will present. And so we need to be ready for that.

00:17:04:14 - 00:17:25:12
Chris DeReinzo, M.D.
Dr. Hewlett, that is the perfect note to end today's conversation on. You hit the nail on the head. I've been to every conceivable kind of hospital in America, and none of them, except UNMC, have your unique combination of the national quarantine unit in a biocontainment unit. But every hospital can follow those kinds of steps in every clinic and every outpatient center.

00:17:25:14 - 00:17:40:27
Chris DeReinzo, M.D.
Those steps really are sort of the foundational baseline of us being prepared. And that's what today's conversation has been all about. Thank you so much for joining the podcast. This has been a fascinating conversation, and I certainly wish you all the best as the summer goes on.

00:17:41:02 - 00:17:43:18
Angela Hewlett, M.D.
Thank you so much. I appreciate you having me.

00:17:43:20 - 00:17:52:13
Tom Haederle
Thanks for listening to Advancing Health. Please subscribe and rate us five stars on Apple Podcasts, Spotify, or wherever you get your podcasts.

00;00;00;08 - 00;00;18;01
Tom Haederle
Welcome to Advancing Health. Today we learn about geriatric psychiatric programs offered by two rural New England hospitals, and how both organizations are leaning in to meet the mental health needs of older adults in their communities.

00;00;18;04 - 00;00;43;10
Rebecca Chickey
My name is Rebecca, and I'm the vice president of the Health and Trustee services for the American Hospital Association. And it's my honor today to be joined by three leaders at rural hospitals who are improving access to mental health services in their rural communities. I am joined by Holly McCormack, who is president and chief executive officer of Cottage Hospital.

00;00;43;13 - 00;01;24;09
Rebecca Chickey
I'm also joined by Doctor who is a consultant psychiatrist and medical director at senior Behavioral Health unit at Sharon Hospital, which is part of Northwell Health, and as well the CEO and president of Sharon Hospital, part of Northwell Health. Christina McCullough rounds out this wonderful panel discussion today. So I'm going to jump right in. And Holly, I'm going to start with you, if I may share with the listeners a little bit about Cottage Hospital and why you decided to open your unit for older adult behavioral health care called the Ray of Hope.

00;01;24;15 - 00;01;49;05
Holly McCormack, DNP, RN
Sure. Happy to. So Cottage Hospital is an independent critical access hospital located in Woodsville, New Hampshire. We were founded in 1903, and at the time, the community built this hospital to respond to a lot of surgical type needs that were happening, from injuries related to working in logging and other industry in the area. And so we have been here supporting our community for over 123 years now.

00;01;49;10 - 00;02;20;06
Holly McCormack, DNP, RN
We are a 35 bed critical access hospital, and that's because we have our 25 bed hospital with our med surge unit and our ICU beds, but we also have a ten bed distinct part unit that is focused on geriatric behavioral health. And so we call that unit the Ray of Hope unit. We also have multi-specialty rural health clinic across the street from a hospital campus which has internal medicine, podiatry, endocrinology and behavioral health integrated into the care there as well.

00;02;20;14 - 00;02;44;16
Holly McCormack, DNP, RN
So the Ray of Hope unit was opened in 2016 as a response to the behavioral health crisis that was happening in New Hampshire. We found that a lot of hospitals were boarding behavioral health patients in the emergency department, and we decided to do something to become part of the solution. The demographic of Woodsville, New Hampshire, tends to be older, and we have a lot of older adults in our community and in communities that we serve.

00;02;44;17 - 00;03;05;10
Holly McCormack, DNP, RN
So this made a lot of sense for us. So early in 2016, we had a unit that we were using for physical therapy. We moved them to a different part of the building, and we were able to redesign this unit to safely house acute beds for ten Jerry psych patients. And so on October 1st of 2016, the unit opened.

00;03;05;16 - 00;03;15;16
Rebecca Chickey
What is the unit look like for the listeners? If you can paint a picture of what it looks like and also how it's staffed, because with only ten beds, I know that can be a challenge.

00;03;15;23 - 00;03;53;28
Holly McCormack, DNP, RN
Yeah. So the unit has ten private bedrooms. The unit is painted in calming colors that you would see in nature. So sage green, a lovely cream yellow color that we find to be very soothing. The artwork on the walls is inspired from local landmarks, but also things that might inspire. Reminiscing when patients are to tour the unit. One of the pictures is very popular is we have a photo of older trucks that look like they're rusting in a field, but you wouldn't believe how many patients actually gather on the picture and talk about having had a truck like that in their younger years, or knowing what kind of truck that was, or knowing somebody that

00;03;53;28 - 00;04;16;01
Holly McCormack, DNP, RN
had that truck. So it's very interesting. We have an activities room. We have a quiet room so that we can separate patients if they need a space that's quieter while we're doing group therapies. And then we also have an outside area with a patio where patients can go and be in a covered space outdoors. And we have raised garden beds so that they can work in the garden beds.

00;04;16;01 - 00;04;51;11
Holly McCormack, DNP, RN
Or sometimes we'll just do our morning activities and our morning stretch out there. The unit is staffed with registered nurses, lens nursing assistants. We have a recreational therapist, a licensed clinical social worker, and we have a psychiatrist that is affiliated with the local academic medical center that oversees the aprons, who are on site seven days a week, and that relationship with the local academic medical center, providing the expertise has been a way for us to have this specialized care locally, where we don't have to transfer people to a higher level of care.

00;04;51;13 - 00;05;14;24
Rebecca Chickey
I think that is great. I grew up in rural Alabama, and so I know how important it is for individuals to be able to stay close to their community, to stay close to their homes. And that provides a healing element that I think is hard to measure. But when you talk to the patients, equally important. And so that's my next question to you.

00;05;15;00 - 00;05;26;00
Rebecca Chickey
What type of patients do you treat in terms of diagnoses, and what impact have you seen? What's been the response from the community and from the families that you've helped as well of those you treat?

00;05;26;06 - 00;05;42;03
Holly McCormack, DNP, RN
The patients and families that we treat are very thankful to be able to have a place in the state of New Hampshire where we can care and provide the specialty care for them. But we've not only cared for patients in the state of New Hampshire, we provide care to patients in the state of Vermont and also Maine and Massachusetts as well.

00;05;42;10 - 00;06;10;21
Holly McCormack, DNP, RN
These specialty units are very hard to come by, and typically we'll have a waiting list for patients to get into the beds on our unit. In the state of New Hampshire, there are 221 towns, and we have represented patients from 110 of those towns so far. And we typically see diagnosis such as depression, bipolar or dementia schizophrenia. But the providers on the unit describe Jerry psych as complex and involving overlaps of psychiatry and neurology, internal medicine and palliative care.

00;06;10;27 - 00;06;14;12
Holly McCormack, DNP, RN
Those are the types of things when you see patients in this particular age group.

00;06;14;17 - 00;06;42;09
Rebecca Chickey
It's interesting. There's been a lot of discussion over the last couple of decades around med psych units. And I think that geriatric psychiatric units by default are medical psychiatry units, because by the time you're over 65, more than likely you have more than one comorbid physical condition, much less a mental illness or addiction. So such an important aspect of care to bring to a critical access hospital, to any rural hospital itself.

00;06;42;16 - 00;06;58;24
Rebecca Chickey
So thank you so, so much. It is my honor now to transition to Sharon Hospital. So doctor, tell us a little about Sharon Hospital and why the organization decided to open your senior behavioral health unit.

00;06;58;27 - 00;07;30;06
Sabooh Mubbashar, M.D.
It was established more than 20 years ago, and this was in response to a growing recognition that the rural communities, they really lacked adequate resources for older adults suffering from severe psychiatric and neurobehavioral illnesses. And as Holly mentioned, this is truly an area of great need. Just given the statistics of geriatric psychiatric problems that we are dealing with, which are actually expected to double in the coming decade.

00;07;30;08 - 00;07;59;24
Sabooh Mubbashar, M.D.
I personally have been involved in this role as the medical director with a unit for about 18 years. Probably also goes to show how much I believe in the work that we're doing. Despite the hospital and the unit being located in a rural community. You know, we started out with an 11 bed geriatric unit, and the demand increased so significantly that we then expanded into a 17 bed inpatient unit, as Holly was mentioning.

00;07;59;26 - 00;08;30;17
Sabooh Mubbashar, M.D.
We received referrals from much larger metropolitan areas, including New Haven, Hartford, Albany, upstate New York areas, Massachusetts. And I think some of that all to do with the unique location of Sharon Hospital, because we're at the northwest border of Connecticut. So we are right at the at the border of New York and Massachusetts. But also it has a lot to do with the with the very unique patient population that we serve.

00;08;30;22 - 00;08;38;16
Sabooh Mubbashar, M.D.
Expansion is really part of, as I said, much larger national reality with the patient population that we serve.

00;08;38;22 - 00;09;01;23
Rebecca Chickey
Well, the baby boomers are aging. And I think I heard a statistic about something like 10,000 people turned 65 every day. So if one out of every four of those has a psychiatric or substance use disorder in the year, then the math is clear that the demand is going to increase. Holly shared what her unit looks like physically and how it's staffed.

00;09;01;24 - 00;09;06;01
Rebecca Chickey
Can you share some similar perspectives for the listeners?

00;09;06;04 - 00;09;35;04
Sabooh Mubbashar, M.D.
Absolutely. So, you know, I think that given the uniqueness of this population, as Holly was describing it, I could hear a lot of overlapping themes. So what makes geriatric psychiatry unique is that, you know, their symptoms in psychiatry are rarely isolated from the rest of medicine. These are patients with significant medical frailties, mobility limitations, swallowing difficulties, chronic medical illnesses.

00;09;35;04 - 00;10;13;08
Sabooh Mubbashar, M.D.
So as far as the multidisciplinary care model is concerned, all patients getting admitted to our 17 bed unit get evaluated by a psychiatrist and an internist within 24 hours of admission, or multidisciplinary team has physical therapy, occupational therapy, speech therapy, and these evaluations are all completed within 24 to 48 hours of admission. Because these are again frail patients from nursing homes, sometimes from community, high aspiration risks functional decline around their mobility.

00;10;13;09 - 00;10;51;23
Sabooh Mubbashar, M.D.
So we really like to get a sense from the get go about what we're working with from the moment they come in. A staffing includes registered nurses, licensed practical nurses, mental health workers, full time social workers, activity therapists and we also actually incorporate massage therapy several days per week. And we also have pet therapy several times a month as part of our therapeutic environment, because we find that both these modalities actually go a really, really long way in helping some of these patients.

00;10;51;23 - 00;11;16;14
Sabooh Mubbashar, M.D.
So the structure of the unit is that we have five private rooms, we have six semi-private rooms, we have two large day rooms and two small TV rooms. We also have a quiet room, as Holly mentioned, which is to, you know, separate if a patient is looking for a relatively low stimulation environment. So we can utilize that from time to time as well.

00;11;16;16 - 00;11;39;17
Rebecca Chickey
Both of those units sound so phenomenal, both in their structure, their staffing, and the incredibly integrated way in which you treat the whole person, not just their mental illness or addiction, but all of their health and getting upstream about it when they're first admitted so that you're not dealing with complications later on. Thank you so much for that.

00;11;39;18 - 00;12;03;06
Rebecca Chickey
I'm going to turn now to Christina, president of Sharon Hospital. And Christina, the two programs that have been described here are really for older adults in need of acute inpatient psychiatric care. But Sharon has begun to go upstream to provide prevention services. Can you share a bit about the senior meals program for adults aged 65 and older?

00;12;03;08 - 00;12;40;02
Christina McCulloch, RN
Yes. Thank you Rebecca. So our senior meals program has really been an honor to stand up here at Sharon Hospital. Our journey really started over a year ago and looking at our community through our community health needs assessment, through assessing our service area that we serve. And there were a few themes that were identified through that assessment. The first is really emphasizing that we are serving an aging population, and we really needed to implement new measures and initiatives to really support the full well-being of the seniors in our community.

00;12;40;07 - 00;13;17;18
Christina McCulloch, RN
28% of Sharon Hospital's service area is age 65 or greater, compared to the average 19% nationally, the significantly higher. And when we look at our future predictions, we know that that population is only going to grow as both Holly and doctor had mentioned. Also, through our assessment, we identified two other opportunities, one being food security, especially in a rural setting where transportation isn't as easily accessible as some other communities in the in the last being mental health.

00;13;17;19 - 00;13;46;25
Christina McCulloch, RN
And so when we looked at these opportunities, we saw a program at one of our sister hospitals that they called the Senior Supper Program, and we set forth to implement that program on a small scale. Here in Sharon, we call it the Senior Meals Program. We started with providing meals at lunchtime at a discounted rate. So we were able to provide affordable, healthy meals to seniors in our community here at the hospital.

00;13;47;02 - 00;14;12;28
Christina McCulloch, RN
We saw that there was great interest in the program. There was a lot of demand. So over the year we grew. We added days that the service was available. We added educational seminars, we invited clinicians, we hosted dinners, and the program really has grown into what it is today, which we call the C program. It's a senior education and engagement program.

00;14;13;04 - 00;14;38;18
Christina McCulloch, RN
We're looking to further expand this program so that we can have these offerings outside of the hospital, out in the community. We've already hosted a couple of events at different settings in different towns in our community, where seniors can go out to a venue, have a nice meal, listen, connect with one of our clinicians on a topic related to aging.

00;14;38;21 - 00;14;59;08
Christina McCulloch, RN
We've done seminars on heart healthy fall prevention, and so our goal over the next year is really to continue to expand. In addition to having affordable, accessible meals, this is really helping to combat that social isolation that so many of our seniors are facing in our community.

00;14;59;09 - 00;15;35;20
Rebecca Chickey
So it sounds to me that you're addressing the loneliness epidemic that you are addressing food insecurity that you're able to perhaps prevent, as you indicated, the social isolation, which can often trigger depression, and really getting into the prevention mode so that perhaps you won't have to expand the unit again by more beds. I'd like to ask each of you to maybe give a sentence or two of what call to action would you share with the listeners?

00;15;35;21 - 00;15;37;11
Rebecca Chickey
Holly, I'll start with you.

00;15;37;15 - 00;16;00;26
Holly McCormack, DNP, RN
Well, I think what we've already discussed regarding the aging of our country and how important it is that we provide services for patients that need our help, especially the geriatric community. But it's not only the patients, it's the families. What we see with the caregivers often is there's a high degree of burnout trying to care for their loved one, trying to find the services they need for their loved one for many, many years now.

00;16;00;26 - 00;16;18;23
Holly McCormack, DNP, RN
And they are feeling guilty about not being able to provide that support. And so that's something that we need to consider. And it's also important for us when our patients come to us, they're frightened. They're often grieving. They're confused. Sometimes there's a loss of independence. And so we need to help them cope with that. And we need to help families cope with that.

00;16;18;24 - 00;16;40;13
Holly McCormack, DNP, RN
The last thing I'd like to leave with all of you about the Ray of hope is we say that we measure success differently at the ray of hope, and this came directly from my nurse practitioner that works on the unit. She likes to say we help people sleep through the night. We reduce fear, we reduce stress, we avoid restraints, and we return them safely to their community or to long term care environment.

00;16;40;13 - 00;16;46;20
Holly McCormack, DNP, RN
And we provide families with hope and guidance so that we can help them get through a very overwhelming time period.

00;16;46;22 - 00;17;06;00
Rebecca Chickey
I mean, if each and every one of us could go home every day saying that that's what we did with our time, what a beautiful place this would be. So thank you for that very much, doctor. I'll turn to you. How would you inspire others to go on this journey, since you've been doing it for 18 of the 20 years that the unit has been open?

00;17;06;02 - 00;17;47;25
Sabooh Mubbashar, M.D.
Yeah, I really believe that when it comes to serving this patient population, rural hospitals can make a profound difference when it comes to treating older adults with dignity, humanity and clinical sophistication. With the right model development that I'm very proud that we have been able to emulate at senior behavioral health, multidisciplinary infrastructure and a long term institutional commitment, rural programs can actually develop a highly specialized, niche serving population at times that larger tertiary care hospitals come to rely upon.

00;17;47;25 - 00;18;12;06
Sabooh Mubbashar, M.D.
So this only is not only is an area of great need, this can actually be a lifeline on many levels for rural hospitals. And I think I strongly feel that this is how it should be looked at as not only a clinical need, but something that actually would probably help the bottom line of most rural and small hospitals that are struggling.

00;18;12;10 - 00;18;40;19
Sabooh Mubbashar, M.D.
I'm very aware of the almost crisis like shortage of specialists, especially psychiatrist. Not well. Health now also has a residency program and we actually have residents rotate for about three months. And I can tell you as a as a teacher and mentor that they will routinely say that out of all of their rotations, working with geriatric patients is actually some of the most satisfying work that they do.

00;18;40;19 - 00;18;46;02
Sabooh Mubbashar, M.D.
So there is plenty of hope for us to be able to deal with this shortage of psychiatrists as well.

00;18;46;05 - 00;18;59;04
Rebecca Chickey
We need to get that message to every medical school across the country. So, Christina, I'd like you to bring us home. What are you going to leave the listeners with in terms of inspiring them to go on this journey with you?

00;18;59;04 - 00;19;31;04
Christina McCulloch, RN
So my call to action is for more advocacy. We need advocates not only for seniors and their families, but we need advocates for our hospitals, our communities. We need funding. We need resources in order to provide these services that have such a great impact on this population. And so advocacy is critical. And so my call to action is advocate for your community, advocate for your hospital, both at a local, state and federal level.

00;19;31;05 - 00;19;42;13
Christina McCulloch, RN
Because in order for us to provide these this comprehensive care to support the full well-being of our seniors, what we all do is crucial.

00;19;42;16 - 00;20;07;07
Rebecca Chickey
That's phenomenal. So, Holly, Christina, doctor, thank you so much for being willing to share your time and expertise with the listeners to inspire them to consider the fact that their rural hospital can become a center of excellence for the treatment of older adults with mental illness and or addiction. Thank you so much for what you do each and every day.

00;20;07;09 - 00;20;16;01
Tom Haederle
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