New England Rural Health Association
August Newsletter
Organization News
Hello Everyone,

I hope you all are enjoying the lovely summer weather. I’d say it has been overwhelmingly beautiful except for the raging winds and rain that hit us hard here in my town. Tropical Storm Isaias left us without power for two days. While this was only a minor inconvenience for me – losing all our food in the fridge, not having the ability to work, and limited communications due to poor cellular service and no Wi-Fi where I live in rural Maine. I felt grateful that we were safe, had no damage to our home, and had family we could stay with. However, the situation made me worry for those who were in a more vulnerable state, socially isolated, and medically dependent on power.


There is a great webinar opportunity that I wanted to share from FEMA addressing these issues (see our events section for registration information). Please join the National Preparedness Division to learn how people who rely on electricity- and battery-dependent assistive technology and durable medical equipment can prepare for emergencies.  Subject matter experts will offer emergency preparedness tips and resources, including checklists, to assist in planning for a power outage. They will also provide guidance on how people with disabilities and access and functional needs (AFN) can prepare for extreme heat events.

While I did not grow up participating in scouts, I do believe that you can never be too prepared – if you’ve ever travelled with me you know I’m an over packer! If you can, join the webinar and take a look at your emergency preparedness plans. Lastly, check in on your neighbors, even if still distanced… give a call, stop by from the driveway, leave a note. It takes a village and as you’ll read in the article “Village Versus Virus: Rural Ethos Protects Where Public Health Fails” included under recent news, New England rural communities know how to take care of each other. The authors write, “many see rural communities and the village mentality that permeates them as a vestige of the past. In our data, we find a rural ethos—a constellation of compassion, pragmatism, and solidarity—that was translated into practical action to offer protection against a virus that has resisted the most aggressive public health strategies and a vision of a more equitable future”.
 

Be well and stay safe,

Ann Marie Day

Executive Director

 

President's Corner

 

Equity is an issue that rural healthcare must address. The COVID-19 pandemic has starkly illuminated the true magnitude of health disparities suffered by our minorities, and particularly people of color. Rural areas illustrate these disparities perhaps even more clearly than their urban counterparts. Let me give one example.

I work at a community health center serving the rural towns of outer Cape Cod. As of the last U.S. Census, Cape Cod (Barnstable County, MA), had about a 3.7% black population. Our service area is still whiter. According to the HRSA UDS Mapper, which combines data from the U.S. Census, American Home Survey, CMS, and other sources into a graphical data warehouse, the numbers in our service area averaged only 2% black for 2013-2017. While the Cape is known to most as a vacation destination with multi-million dollar second homes, many year-round residents work two and three jobs just to make ends meet. They often work without benefits in the service sector driven by the tourism industry. A significant fraction of these service workers are people of color, and include seasonal migrant workers from Jamaica, Brazil, and other offshore locations. New data shows that this population is at a much higher risk of COVID infection than white people.

A recent Cape Cod Times article noted that “Black Barnstable County residents have contracted COVID-19 at a rate three times as high as the county’s white residents.” In the rural Outer Cape towns, where black residents make up only about 2% of the population, testing data indicate infection rates that are at least four to one where race was reported. However, more than a fifth of people who tested positive so far are in the Unreported/Refused to Report Race category. As we know, the Public Charge rule has had a chilling effect on immigrant/migrant people’s willingness to disclose information due to perceived fear of deportation. As a result, it is likely that the actual rate of total positive COVID tests for people of color in our rural area is significantly higher than for the county, compared to white people. Our rural communities are clearly mirroring the disturbing trend of health inequity seen nationally for people of color for COVID-19 infection. The raw numbers in rural areas are smaller, but the magnitude of the problem remains, and we in rural healthcare must address it.

Now let me add another consideration. In a recent joint op-ed in CommonWealth Magazine, Massachusetts League of Community Health Centers Deputy CEO Michael Curry and Massachusetts Health Council CEO David Martin wrote compellingly in a piece titled, “We Must Address Black, Brown Mistrust of COVID-19 Vaccine.” How true! When a COVID vaccine eventually comes along, we have an enormous hill to climb to convince our population of color to “trust us” (this time) that the vaccine is safe, effective, and equitable. Overcoming decades of mistrust from outrages such as the Tuskegee syphilis experiments will not be easy. But, a failure to do so will compound the inequities stemming from the higher rates of COVID infection for our most vulnerable populations. Furthermore, a failure to achieve a high rate of immunization across all segments of the population could render the effort to achieve nationwide “herd immunity” ineffective.

Given the greater difficulty of reaching people in low-density, geographically isolated communities,those of us in rural healthcare face an even higher hurdle. It will take a well-planned, culturally sensitive, consistent communications campaign from all of us to move the needle (no pun intended) on this one. And while PSAs from state and federal government are part of the solution, they are unlikely to be tailored for New England’s rural populations. We know our communities, and we will have to do our own targeted messaging to be sure we reach our audiences with the word that vaccination is safe for all and critical to a return to life without masks and daily death counts. It will take both formal and informal communications, outreach, and education through all channels. As usual, word of mouth will likely be the most important channel of all, and every one of us is a valuable player that must contribute. Don’t underestimate the importance of everything you say or write. It all counts.

Rural healthcare has always been rooted in our communities and dedicated to all rural residents, but the data show that our residents of color are still being left behind. Rural health equity demands that we do this right, and we are equal to this challenge.

My very best,

Andy

 
Member Spotlight
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Save The Date!

Event Description

This presentation will provide participants with a background to understanding whole-person care. Her presentation will focus on understanding how biases impact the ability to engage in partnerships of care. She will discuss the concepts to reduce stigmatizing behavior toward patients, families and co-workers and engage the audience in developing personal and professional humility as it relates to learning about and caring for patients and families.

Registration

Registration will become available soon! Please be sure you are signed up as a member and on our mailing list so that you will be notified as soon as it is open.
 

Further Event Announcements Coming Soon

 

NATIONAL HEALTH CENTER WEEK - August 9-15, 2020

We hope you all were able to celebrate National Health Center Week. Please feel free to share any pictures or special events from over the last week. Below is an infographic on the amount of people served by Community Health Centers. 

Resources

COVID-19 and Dentistry: Challenges and Opportunities for Providing Safe Care

This primer summarizes best practices for infection control and prevention in the dental office setting, reviews Department of Health and Human Services (HHS) guidance on treating dental patients with suspected or confirmed COVID-19, discusses access issues for patients needing oral healthcare, and offers various Federal and professional resources to support the reconfiguration of dental practice, the implementation of teledentistry, and the prioritization of dental care needs after practices reopen. This primer concludes with key policy and research priorities to support safe and effective dental care during and after the COVID-19 pandemic.

Rural Health Care Surge Readiness Web Portal 

Rural health care facilities face unique challenges in the fight against COVID-19. Developed by the Rural Surge Readiness Team, COVID-19 Healthcare Resilience Working Group, the Rural Health Surge Readiness web portal provides essential resources, tools, and trainings for rural health care systems preparing for and responding to a COVID-19 surge. The material spans a wide range of health care settings appropriate for executives, managers, and providers, and covers topics including behavioral health, operations, and telehealth.
HHS Telemedicine Hack

photo of a woman on a telehealth call with a doctor

HHS has put together a 10-week learning community to accelerate telemedicine implementation to ambulatory providers, called HHS Telemedicine Hack.

Key components of the HHS Telemedicine Hack include:

  • Five teleECHO sessions on key topics (e.g., workflows, documentation, reimbursement) highlighting best practices and case studies from the field.

  • Five virtual “office hour” discussion panels with case presenters, government agencies, topical experts, and stakeholder associations responding to your questions.

  • Inter-session peer-to-peer learning facilitated via virtual discussion boards and ad hoc interest groups.

  • CME/CEU credits are available for attending, at no cost to participants.

Learn more (PDF - 853 KB) and register.

National CMS/CDC Nursing Home COVID-19 Training

 Thursdays at 4:00 pm ET.

Through the Quality Improvement Organization Program, the Centers for Medicare & Medicaid Services (CMS) and the Center for Disease Control and Prevention (CDC) host a weekly webinar series (every Thursday, 4-5 pm ET) to provide training for infection control processes in nursing homes. Trainings are scheduled every week until January 7

Community Health Access and Rural Transformation (CHART) Model Fact Sheet

Provides an overview of the Community Health Access and Rural Transformation (CHART) Model, which aims to increase financial stability for rural providers, provide operational and regulatory flexibility for rural providers, and enhance Medicare and Medicaid beneficiaries' access to health care services. Describes the two tracks available in the model, and outlines the model implementation time.

Recent News

New Hampshire Anesthesiologists Lead Tele-Intensive Care Unit Innovation for COVID-19 Patients in Rural Areas during Public Health Crisis - Physicians in New Hampshire have innovated with a Tele-Intensive Care Unit (TeleICU) hub to collaborate with physicians in rural hospitals. This hub helps ensure COVID-19 patients across the state get critical care expertise while accessing services close to home. TeleICU is a remote video technology platform that connects doctors in rural hospitals to critical care specialists. These conferences take place at the patient’s bedside between the conferring physician and the anesthesiologist at Dartmouth-Hitchcock Medical Center. Physicians supply guidance on multiple medical scenarios to more than 20 rural hospitals, giving patients access to the same expertise as those in urban areas.
 


 

Village Versus Virus: Rural Ethos Protects Where Public Health Fails

When disease forecasts predicted a surge of COVID-19 cases across Northern New England, some expected the pandemic would write the final chapter for the region’s most rural communities. Rural populations are older, and on average, in poorer health, than their urban counterparts. Rural hospitals have struggled to stay open amid dwindling population and financial pressure; many have shuttered their doors, leaving vast areas without access to emergency and maternal health care. We, at Dartmouth College, too, feared that even a small number of COVID-19 cases could collapse health systems and imperil communities when we undertook research to understand the impacts of the pandemic on rural health equity in New Hampshire and Vermont.Our research revealed many factors that contributed to early success in rural Vermont and New Hampshire and highlights lessons for other areas grappling with the failure to protect vulnerable populations from sharp disparities in outcomes.
 



Maine’s community health centers need long-term funding

As the U.S. slowly opens back up, many Americans worry about whether our country’s health care system can support the spikes in coronavirus infections happening around the country. Thanks in large part to Maine’s rational approach to the pandemic, the number of COVID-19 cases in our state remains relatively stable. Yet, we cannot overlook the toll that the pandemic has taken on our state’s economy and on our health and well-being.

Community health centers need stable, long-term funding in order to offer complete health care, as well as compete with urban markets elsewhere in New England in order to recruit, train and retain quality staff and physicians to rural locations. Without the financial support we need, we cannot ensure Mainers will have close access to the quality health care they deserve.
 



Rural Monitor: Healthcare’s Unique Position in Response to Human Trafficking

This in-depth article in The Rural Monitor features a rural hospital CEO, a State Office of Rural Health director, a Sexual Assault Nurse Examiner, and a Safe Harbor Regional Navigator sharing their experiences combating human trafficking. 
 

The U.S. Department of Health and Human Services (HHS), through the Health and Resources and Services Administration (HRSA), awarded over $101 million to combat substance use disorders (SUD) and opioid use disorders (OUD). The awards support 116 organizations in 42 states and the District of Columbia, with many targeting high-risk rural communities. HHS Secretary Alex Azar stated  “The pandemic has created particular stresses for many Americans struggling with substance use disorders, and these HRSA awards will help strengthen prevention, treatment, and recovery services, especially in rural America, at this difficult time.” Read the release.
 
Advocate and Take Action

Congress needs to hear from you!


Community Health Centers are essential to our communities! Congress needs to know that you expect them to prioritize our families’ and communities’ health and well-being.

The Senate recently released their version of the 4th COVID-19 Relief Bill — which included $7.6 Billion for CHC Emergency Funding. The House and Senate will begin working together on a compromise funding bill soon.

We must keep the pressure up! 

Please ask your Members of Congress to persuade Congressional Leadership to include the following in the final compromise bill: 

  • The inclusion of health center look-alikes in those able to access the $7.6 billion of emergency COVID-19 relief funds;

  • An extension of the PPP that would allow health centers with over 500 employees to be eligible for the program; and,

  • Equal reimbursement for health centers' for Medicare telehealth visits.

The inclusion of these asks is critical to ensure that Community Health Centers can continue providing quality primary care to nearly 30 million patients nationwide.

We must keep the pressure on Congress to make sure that CHC emergency and long-term CHC funding are Congressional priorities.


Community Health Center patients and staff are counting you! 


Please contact your member of Congress today.  


With gratitude, 

Your Grassroots Advocacy Team

Contact  Congress Now
Funding & Opportunities

Center on Rural Addiction Best Practices Scholarship Program

An opportunity for two days of in-person comprehensive training and consultation at the University of Vermont with Center on Rural Addiction faculty and staff experts. The Program is intended for teams of up to 4 individuals from practices in rural counties in Vermont, New Hampshire, Maine, and northern New York.

Application Deadline: Aug 31, 2020
 



AAFP Health Equity Fellowship – October 1.  The American Academy of Family Physicians (AAFP) offers one year fellowships that feature curriculum, faculty, and events tailored to address a topic of significant relevance to family medicine. Tracks include rural health, academic medicine, and traditional family medicine. Applicants practicing in rural areas and/or from populations under-represented in medicine will receive preference. 
 



Vermont Educational Loan Repayment Program for Dentists

Loan repayment assistance for dentists serving in designated shortage areas or documented special need areas in the state of Vermont.
 



Vermont Educational Loan Repayment Program for Nurses

Loan repayment assistance for LPNs and RNs working in shortage areas of Vermont.
 



Vermont Educational Loan Repayment Program for Primary Care Practitioners

Loan repayment assistance for primary care physicians, nurse practitioners, and physician assistants who agree to practice in an underserved area of Vermont.

Application Deadline: Sep 10, 2020
 


 

OMH Reducing Disparities in Racial/Ethnic Minority Populations – August 26. The Office of Minority Health (OMH) at the U.S. Department of Health & Human Services will invest $6.5 million to help build the capacity of state, tribal, and territorial health agencies to reduce health disparities in tribal communities.  Eligible applicants include state, local, and tribal governments; U.S. territories; nonprofit organizations; and public and private non-profit institutions of higher education.
 



NIH Research on Palliative Care in Home/Community Settings – September 8, 2022.  The National Institutes of Health (NIH) will support research aimed at determining needs and best practices for integrating palliative care into home and community settings.  Applications should consider approaches that may be implemented in rural/remote areas, as well as urban areas, and that are sensitive to ethnicities and cultures.
Upcoming Events

Stay Tuned For More NERHA Virtual Event Updates Coming Soon!



Join Us: COVID-19 Rural Healthcare Surge Readiness web portal demonstration and stakeholder engagement

The Federal Healthcare Resilience Working Group (HRWG) is pleased to announce the release of a Rural Healthcare Surge Readiness web portal, a collection of essential resources, tools, and trainings that target rural healthcare organizations and workers. The information spans the continuum of healthcare settings including EMS, inpatient hospital care, ambulatory care, and long-term care to prepare for and respond to COVID-19.

Monday, August 17th from 3-4pm ET - Join Here 

Wednesday, August 19th from 9:30-10:30 am ET - Join Here



Healthy People 2030 Launch August 18, 1 p.m. - 2 p.m. EDT

The U.S. Department of Health and Human Services (HHS) will unveil the latest edition of Healthy People.
Join US
Interested in becoming a new member or need to renew your membership? Join the New England Rural Health Association now to take advantage of networking opportunities including our regional conference, members only networking events, and educational sessions.
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