Community Health Needs Assessment Report
The Health of Aitkin County
Riverwood Healthcare Center, Aitkin, Minnesota
September 30, 2013Community Health Needs Assessment
Riverwood Healthcare Center
Table of Contents
Introduction…………………………………………….page 4
Acknowledgements…………………………………...page 5
Executive Summary…………………………..………page 6
Community Assessment Process……………….…..page 7
Description of Process and Methods………….page 7
Data Sources…………………………………….page 8
Public Health Input………………………………page 9
Community Description……………………………….page 11
Demographic Data…………………………………….page 13
Population Trends
Household Trends
Ethnicity
Age
Workforce
Socioeconomic
Community Systems Data……………………….…..page 19
Healthy Community Data Key Indicators…………….page 20
Bridge to Health Survey
Prioritization Process of CHNA Needs……………….page 23
Community Input
Communication of Results……………………………..page 39
Strategies for Implementation…………………….……page 39
Riverwood’s Addressing of Needs
Conclusion……………………………………….………page 42
Attachments:
Community Health ResourcesAttachment A
Riverwood Wellness ResourcesAttachment B
Introduction
The Health of Aitkin County is a Community Health Needs Assessment (CHNA) developed by Riverwood Healthcare Center, in partnership with other health and wellness organizations. This document fulfills the requirements for community hospitals, as set forth by the Patient Protection and Affordable Care Act (PPACA).
The Patient Protection and Affordable Care Act set additional criteria for community hospitals to maintain their tax exempt 501c (3) status. This requirement applies for tax years beginning after March 3, 2012,and must be completed at least every three years, with input from the broader community including public health experts. This plan meets the requirements of IRS Notice 2011-52, which specifies information that needs to be included in the CHNA, including implementation strategies that address the issues identified by the assessment. The required information is contained in sections in this report, as summarized below.
Community Assessment Process
Community Description
Demographic Data
Community Systems Data
Healthy Community Indicators
Prioritization Process of CHNA Needs
Communication of Results
Strategies for Implementation
Conclusion
Acknowledgements
Special thanks to the many individuals and organizations that assisted with the completion of the Community Health Needs Assessment process. Most specifically to the Core Project Team who provided input and guidance on the project. Thanks also to the many Riverwood Healthcare Center staff who assisted during various phases including Arlene Wheaton and Connie Gretschmann. Special thanks to Shelli Urness Consulting, HBH Associates, and Health Planning and Management Resources, Inc. for their expertise and involvement. I especially want to thank the many community members who provided input via the Community Feedback Sessions and Telephone Interviews. An engaged community has contributed to the success of Riverwood Healthcare Center since our inception in 1955, and we have partnered with the community to meet the health and wellness needs of the residents and visitors of Aitkin County and the surrounding area.This assessment has been a true community endeavor.
Chad Cooper
CEO, Riverwood Healthcare Center
CHNA Core Project Team Members:
Jayne Anderson, Riverwood Healthcare Center, Aitkin, Minnesota
Cynthia Bennett, Aitkin County Public Health, Aitkin, Minnesota
Liz Dean, Riverwood Healthcare Center, Aitkin, Minnesota
Mike Hagen, Riverwood Healthcare Center, Aitkin, Minnesota
John Hodson, Aitkin ISD #1 Community Education, Aitkin, Minnesota
Lisa Kruse, McGregor ISD #4 Community Education, McGregor, Minnesota
Beth Leaf, Aitkin County CARE, Aitkin, Minnesota
Alison Matalamaki, Aicota Healthcare Center, Aitkin, Minnesota
Heidi Olesen, Aitkin ISD #1, Aitkin, Minnesota
Dan Schletty, Riverwood Healthcare Center, Aitkin, Minnesota
Judy Turner, Riverwood Healthcare Center, Aitkin, Minnesota
Shelli Urness, Shelli Urness Consulting, Brainerd, Minnesota
Executive Summary
Riverwood Healthcare Center (RHCC) operates a 25-bed critical access hospital serving Aitkin County and surrounding communities in north central Minnesota, with full service primary care clinics in Aitkin, Garrison and McGregor. Patients can access urgent care and a wide range of specialty care at our integrated hospital and clinic in Aitkin.
Our facility has achieved several designations that demonstrate our commitment to outstanding delivery of medical care. These include Level III Trauma Center, Level I Heart attack program protocol in affiliation with the Minneapolis Heart Institute at Abbott-Northwestern Hospital, and Comprehensive Advanced Life Support Hospital.
Riverwood delivers top quality medical care delivered with a team of caring healthcare professionals. Since 1955, we've been committed to providing our community with a comprehensive array of medical services close to home. Since 1955, we have expanded our portfolio of clinical services, added medical staff members, as well as increased the programs and number of sites to access care. Despite this growth in the range and extent of services, we have long realized that the full measure of accountability to the communities we serve is to improve and maintain health and wellness.
The Health of Aitkin County report is a comprehensive community health needs assessment (CHNA). The report outlines community health needs based on primary and secondary data sources. This report is intended to give Riverwood, our staff, and our community information on county health indicators that will serve to guide strategic activities and programs, and chart the course for future community health initiatives. Improving and sustaining community health is a collaborative effort that integrates many stakeholders including county public health, school districts, nonprofit organizations, and many other public and private entities. This CHNA report is the product of an 18-month process that sought community input, medical staff input, involved key representatives such as public health, and selected primary and secondary data sources to identify target areas and implementation plans.
Health and wellness is an issue of concern for all of us, and we hope that the information in this report creates conversation and action among the private and public sector, so that we all work to improve the health of our county.
It is Riverwood’s intention to continue to use research and data on a three-year rotating cycle, as this allows time to make some changes, recruit any needed personnel, develop more services, and communicate to the community the services available.
Community Assessment Process
In order to fulfill the new requirements set forth by the IRS, Riverwood Healthcare Center has undertaken a community health needs assessment (CHNA), the purpose of which is to gain input on community health needs and identify gaps and barriers to service, with the ultimate goal of better serving the health and wellness needs of Aitkin County.
Description of Process and Methods
RHCC enlisted the services of Shelli Urness Consulting to design a project plan and coordinate the construction of the CHNA and report.
Project Overview
The Community Health Needs Assessment is a new federal requirement for private, non-profit hospitals including Riverwood Healthcare Center (RHCC). Part of the Patient Protection and Affordable Care Act (ACA), the Community Health Needs Assessment is the requirement of additional criteria for Riverwood and other hospitals to maintain their tax-exempt, 501(c) (3) status. This requirement applies for tax years beginning after March 23, 2012. A CHNA must be completed at least every three years with input from the broader community, including public health experts. The CHNA describes how Riverwood will address needs identified in the community health needs assessment as well as identify any needs not being addressed and explain why not, and contain an implementation strategy. Riverwood Healthcare Center has contracted with Shelli Urness Consulting to facilitate the CHNA Project in conjunction with a Project Team of Riverwood Healthcare Center staff and other key stakeholders previously identified.
In addition, Riverwood regularly conducts specific research on its services and community awareness. Health Planning and Management Resources, Inc. (HPMRI) conducted primary research in both 2008 and 2011 to help RHCC Management better understand the needs of the communities they serve. HPNRU completed telephone surveys-one in 2008 and one in 2011- of 400 randomly selected households in the market area. Because the related questions were asked for all household members, information was obtained for well over 500 persons residing in the market area. The telephone calls and analysis of the results were completed by professional market research firms. RHCC’s management has used this information in the development of its strategic plan, including development of new services to serve the community needs.
HBH Consultants obtained input from residents in Riverwood’s primary service communities: Aitkin, Garrison and McGregor. Through community input sessions telephone interviews and email questionnaires, we have evaluated perceptions regarding health and wellness resources available through both Riverwood and the wider community and have identified some missing links. Details of community input are detailed later in this report.
Project Approach
RHCC took a phased approach to the CHNA.
- Phase 1 – Planning
- Phase 2 – Compiling/collection
- Phase 3 – Strategy analysis
- Phase 4 – Action/execution
- Phase 5 – Evaluation and measurement
CHNA Riverwood Healthcare Center – Timeline
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Data Sources
In addition to the primary data sources noted earlier (surveys, community input sessions, phone contact), extensive secondary data was utilized as a reliable basis of information. The list of data sources used includes:
Minnesota Department of Health
US Census Bureau
Minnesota Hospital Association, Community Health Needs Assessment Requirements, Matt Anderson Vice President, Regulatory/Strategic Affairs, January 12, 2012
County Health Rakings and Report 2012
Bridge to Health Survey, Northeastern Minnesota and Northwestern Wisconsin Regional Health Status Survey, Aitkin County Data Tables 2010
Riverwood Healthcare Market Study 2012, Maureen Swan, MedTrendInc.
Community Health Needs Assessment (CHNA) Done Right: A Practical Guide, 10/2011, RSM McGladrey, Inc.
Consumer Survey Regarding Health Services in the Aitkin Market Area, Patricia McCollough, Health Planning and Management Resources Inc. Edina, MN September 2011
Healthy People 2020, Association for Community Health Improvement
IRS Form 990 and attachments, including Schedule H (Hospitals) – page 4
Riverwood Healthcare Center Strategic Plan 2012-2014
Aitkin County Wellness Initiative Information
Public Health Input
Community Health BoardsThe Community Health Board (CHB) is the legal governing authority for local public health in Minnesota, and CHBs work with the Minnesota Department of Health in partnership to prevent diseases, protect against environmental hazards, promote healthy behaviors and healthy communities, respond to disasters, ensure access to health services, and assure an adequate local public health infrastructure.
CHBs have statutory responsibility under the Local Public Health Act and must address and implement the essential local public health activities. Additionally, CHBs must assure that:
- - A community health assessment and plan are completed on a regular cycle.
- - Community health needs are prioritized in a manner that involves community participation.
- - Needed public health services are developed and implemented.
- Single-County
- Multi-County
- Statutory (City-Based)
- Human Services Board
- Contracted Services
Organizational and Governance Changes
Over the past decade, several counties and CHBs have made changes to their public health organizational and governance structures, and more changes are being considered as local elected officials look for ways to address significant budget concerns, create efficiencies, and anticipate the retirements of public health leaders. Between May 2009 and May 2010, 28 percent of county boards and 28 percent of CHBs considered, proposed, or decided to change their organizational or governance structure. Some top public health officials expressed satisfaction with current structures, whereas others identified limitations with current structures or concerns about the motivation for changing structures.
The CHB for the Aitkin County region is Aitkin-Itasca-Koochiching Community Health Board includes and includes:
- Aitkin County
- Itasca County
- Koochiching County
Cynthia Bennet, Aitkin County Public Health Supervisor, was a member of Riverwood’s CHNA Core Project Team. Tom Burke, Human Services Director from Aitkin County,also participated in a telephone interview. Aitkin County Public Health is also conducting a Community Public Health Assessment as a requirement to Minnesota’s Local Public Health Act, which requires local health departments to conduct a comprehensive assessment and planning process ever five years. They are working in collaboration with other Public Health groups in their region and expect completion of the report in 2014.
In 2012 Dr. Ed Edhlinger, Minnesota Commissioner of Public Health, also commented on the County Health Rankings and Roadmap for Aitkin County (referenced later in this report). He said: “We spend only a fraction of the amount on prevention that we spend on medical care in this county. We need to do a better job of investing in disease prevention within communities if we really want to improve the health of Minnesotans and get a handle on rising health care costs.”
Community Description
The CHNA identifies the Community as primarily all of Aitkin County for the purposes of this report. Riverwood Healthcare’s Aitkin Clinic and Hospital, the Specialty Clinic, and the McGregor Clinic are all located in Aitkin County. It should be noted that a portion of Crow Wing County is also served by Riverwood Healthcare’s Garrison Clinic. Community input was solicited from the entire service area.
It can be reasonably expected that the hospital and clinics can serve the majority of the health needs of Aitkin County. It includes a primary population served of approximately 18,000 people.
Riverwood Healthcare Center Market Area
RiverwoodHealthcareCenterServiceArea Definitions
ZipCode / Community / 2011
Population
56431 / Aitkin / 8,615
56444 / Deerwood / 3,227
55760 / McGregor / 2,887
56469 / Palisade / 1,439
55748 / Hill City / 1,192
55787 / Tamarack / 672
Total / 18,032
PrimaryService Area Secondary Service Area
TotalPrimary and Secondary ServiceArea2011Population:55,166
Demographic Data
Population Trends
Aitkin County population in July 2011: 16,220 (all rural); it was 15,301 in 2000. The population density was 8.9 people per square mile (3/km²). As of the censusof 2010, there were 16,202 people, 7,542 households, and 4,458 families residing in the County.
LowGrowth,2.5%intheRiverwoodTSAMarket
2011–2016ProjectedPopulationChange
Thetotalmarket is projectedtogrowby1,392 or 2.5% over nextfiveyears
PopulationChange2011-2016
1
-0.9%
Garrison Isle Deerwood Brainerd Palisade Crosby McGregor Tamarack Aitkin
HillCity
-1%
(63)
(132) (112) (881) (39) (70) (36)
(7) (63)
(-11)
1.2%
1.0%
0.7%
1.6%
3.0%
2.7%
3.5%
5.4%
5.2%
ThePSAwill growby
246or1.4%
PercentageChangeandabsolutegrowth in() Source:Claritas, 2011
1
CHNA Riverwood Healthcare Center
Household Trends
There were 6,644 households out of which 22.60% had children under the age of 18 living with them, 57.50% were married couples living together, 6.30% had a female householder with no husband present, and 32.90% were non-families. Of all households,28.70% were made up of individuals and 14.00% had someone living alone who was 65 years of age or older. The average household size was 2.28 and the average family size was 2.76.
Average household size:
Aitkin County / : 2.0 peopleMinnesota: / 2 people
Estimated median household income in 2009: $36,760 ($31,139 in 1999)
Aitkin County / : $36,760Minnesota: / $55,616
Median contract rent in 2009 for apartments: $420 (lower quartile is $273, upper quartile is $576)
Aitkin County / :$420Minnesota: / $683
Estimated median house or condo value in 2009: $170,582 (it was $86,200 in 2000)
Aitkin County: / $170,582Minnesota: / $200,400
Lower value quartile - upper value quartile: $106,009 - $272,433
Mean price in 2009:
Detached houses: $199,468
Aitkin County: / $199,468Minnesota: / $247,637
Townhouses or other attached units: $2,568,324
Aitkin County: / $2,568,324Minnesota: / $193,158
In 2-unit structures: $20,230
Aitkin County: / $20,230Minnesota: / $233,138
In 5-or-more-unit structures: $242,671
Aitkin County: / $242,671Minnesota: / $177,950
Mobile homes: $121,465
Aitkin County: / $121,465Minnesota: / $34,666
Occupied boats, RVs, vans, etc.: $318,878
Aitkin County: / $318,878Minnesota: / $94,976
Median monthly housing costs for homes and condos with a mortgage: $1,233
Median monthly housing costs for units without a mortgage: $309
Institutionalized population: 195
Ethnicity
The racial makeup of the county was 95.63% or 15,494 people White, 0.35% or 57 people Blackor African American, 2.4% or 390 people Native American, 0.17% or 27 people Asian, 0.025% or 4 people Pacific Islander, 0.13% or 21 people from other races, and 1.29% or 209 people from two or more races. Of the population with two or more races, 0.9% of the population were Hispanic or Latino of any race. 29.5% were of German, 14.3% Norwegian, 13.0% Swedish, 6.2% Irish, 5.3% United States or American and 5.2% Finnish ancestry.
Age
According to the US Census Bureau (2010) In the county the population was spread out with 20.90% under the age of 18, 5.50% from 18 to 24, 21.60% from 25 to 44, 29.10% from 45 to 64, and 23.00% who were 65 years of age or older. The median age was 46 years. For every 100 females there were 101.60 males. For every 100 females age 18 and over, there were 99.90 males.
This trend has changed slightly demonstrating the aging of the population, according to July 2011 data (City-Data.com) the average age and gender is as follows:
Median Aitkin County resident age: / 51.0 yearsMinnesota median age: / 37.0 years
Males: 8,205 / (47.6%)
Females: 7,997 / (52.4%)
Workforce