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“There is no better
place to live than Lee County, Iowa.
However, there are many things we can improve, so we cannot accept
the status quo. We must be bold,
innovative, and willing to change”
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SECTION C. HEALTH AND HUMAN SERVICES
The subcommittee for Health and
Human Services was established to provide input and recommendations that can
be included in the Lee County Comprehensive Plan. The committee is pleased to
provide this summary report of findings and recommendations on five
significant areas of emphasis that include:
·
Day Care
·
Health care
·
Human Services
·
Mental Health
·
Senior Living Issues and Programs
The
committee established a framework of evaluation and analysis for each of
these five areas of Health & Human Services emphasis. The overall framework used attempted to
utilize five specific criteria or measures for each of these significant
areas in order to establish goals and objectives in each area. The specific criteria used to measure
effectiveness included; Quality of Services, Quantity of Services,
Affordability of Services, Accessibility of Services, Awareness &
Knowledge of Services.
The
overall committee goals and objectives are as follows:
#1:
"To analyze and evaluate each of the five areas of
emphasis to determine their current status and identify opportunities for
improvement in each."
#2:
"To make recommendations for inclusion in the
development of an overall Lee County Comprehensive Plan".
#3:
"To provide a 'reality check' overlay of our economic,
demographic, and political environment in which these needs and those
identified by other subcommittees can be addressed and/or modified for
maximum effectiveness and utilization of limited resources."
This
report should not be seen as an ending point, but rather as a starting point
for further discussion, analysis, and development of comprehensive plans for
the residents, taxpayers, and employers of Lee County. It is also emphasized that Lee County does
not exist in isolation from the bigger regions of the Tri-State area,
Midwest, and the United States as a whole and that influences, actions, and
developments outside of our county boundaries can and will impact these
plans.
SECTION I:
"REALITY CHECK"
The
committee, in their deliberations, felt strongly that any comprehensive
planning effort must take into account the overall environment in which we
all live and work. This was felt to be essential to avoid the temptation to
just recommend, "more of everything" and to have the recommendations
be posed in terms of what can realistically be achieved. This does not mean
that recommendations can be "easily" achieved and will, in most
cases, require substantial effort, change, and realignment of both historic
thought and structure.
There
is no reason, however, to develop plans that are obviously unattainable and
wishful. It is felt that such an approach leads to predictable disappointment
and frustration and ultimately with abandonment of the plans established. Our "reality check" would include
the following aspects and factors:
- Lee County has and is
predicted to continue to experience a slow decline in total population.
- Lee County's
population is aging and a greater percentage of senior-aged residents is
predicted while a decline in younger-aged residents is also occurring.
- Lee County's
populations have greater needs and demands for health and human services
than state averages due to historic and current socio-economic
conditions in the immediate and surrounding area.
- Lee County's economic
climate is not overly positive with higher than state average
unemployment, recent and current declines in the number of employers,
jobs, and salary levels.
- The above stated
factors have led to a decline in the tax base for municipalities and Lee
County in general resulting in fewer resources available for such
services and/or raising taxes of those who are residing here.
- The State of Iowa and
the Federal Government are also experiencing cutbacks in funding of
programs which has the effect of "pushing" the problems to the
local levels.
- Many of the current
structures for the provision of health and human services do not provide
incentives for recipients to become self-supporting and may, in some
instances, actually provide disincentives for such expectations.
- The historical
provincial, competitive environments between the north and south Lee
County regions have not always led to the most effective coordination of
resources and services that the future environments described above may
require.
Summary: While this
"reality check" may seem pessimistic, it does seem to be the
generally held perspective of those who live and work here and seems to be
supported by data and experiences in Lee County. There seem to be several
general conclusions about our environment:
- Expectations that
more money or resources will become available from government or public
sources are probably not realistic.
- Public-Private
partnerships may have to be developed to address concerns and identified
needs.
- Economic development
is THE cornerstone for Lee County if it is to progress and develop.
- New structures for
the planning, delivery, and funding of health and human services must be
sought, encouraged and implemented.
- A realignment or
reallocation of resources from treatment and "fixes" of
problems to education and energies directed at the prevention of such
problems needs to occur if there is any hope of changing the current
situation in the future.
It
is with this backdrop of reality that the subcommittee provides it's input,
analysis, and recommendations on the important and essential issues related
to Health and Human Services. It
should be noted the recommendations in all five (5) areas have NOT been
listed in order of importance.
SECTION II: AREAS
OF EMPHASIS; Evaluation,
Identification of Opportunities for Improvement, and Recommendations.
Introduction: In this section we will present a summary review of each of the
five significant areas of emphasis identified in the opening of this report. Each area will be supported by addendums
that may include statistics, data, and documentation of resources related to
each particular area. For brevity's
sake, only the major conclusions of the committee are included in this
section. As indicated in the opening
remarks in this report, each area has been evaluated using the criteria of
Quality, Quantity, Affordability, Accessibility, and Awareness.
AREA #1:
CHILD CARE
ISSUE STATEMENT:
Because
of its impact on employment, education, life-style, and family values, Child
Care was identified as one of the major areas of emphasis for Health &
Human Services.
Summary of Findings & Evaluation: There appear to be enough day care
providers in the region and there have been considerable unused capacity identified
in licensed providers. It is less well documented what the capacity and
quality of private providers are, though they make up a substantial segment
of the childcare service market. It
would appear that personal networks (parents, grandparents, neighbors,
friends, etc.) are at least as important and widely utilized as are formal
organizational networks (i.e., licensed day care centers, etc.) in matching
the needs with the services.
Logistics and geography also play important roles in the utilization
of childcare selection and use.
Working or otherwise active parents attempt to minimize their travel
time and select providers that they know and trust from experience or
references. While there is some data on the program content and facilities
used by licensed providers, there is little hard information on private,
unlicensed providers. The cost of child care is probably the number one
determinant of child care provider selection by working families and may be
the number one limitation to access and quantity of providers available to
those families.
Goal Statement: To promote and make available quality child care services and
networks to those for whom the lack of such services is a barrier to becoming
productive parts of the work force, furthering their education, or becoming
active participants in their communities.
- The County needs to
expand their list of licensed and unlicensed childcare providers. This list is currently available at
Department of Human Services and CCR&R but should also be made
available at City Hall and other area organizations.
- The County needs to
continue to provide support for local initiatives for childcare and
empowerment. (i.e., TANF dollars, positive verbal reinforcement etc. to
those currently providing services)
- Lee County needs to
provide an ongoing evaluation to address the need, if any, for second (2nd)
and third (3rd) shift employees who are in need of child care
providers. Once a need has been
established the County shall act promptly to address the need through
current providers or recruit new providers.
- Lee County should
evaluate the need for a day care for special needs children. (i.e.,
mentally and physically challenged).
Once a need has been established the County shall act promptly to
address the need through recruitment of a new provider or special needs
training for existing providers.
AREA #2: HEALTH CARE
ISSUE STATEMENT:
While this topic may be worthy of an entire report of its own because of how
pervasively it impacts almost everyone who lives, works, or operates a
business in this and every county, the committee did attempt to address
several major basic aspects of Health Care that have been become focal points
for societal and economic discussions across this country. Those would
include: Acute/Emergency Care, Outpatient/Rehab Care, Public Health,
Post-Acute/Home Care, Physician/Health Provider Services, Dental Care,
Pharmacy/DME Services, Long Term Care. (Mental Health has been addressed in a
separate area.)
Summary of Findings & Evaluation: Lee County has
well-defined, high quality health care systems made up of the all of the
aspects identified above. Two modern, fully staffed and equipped community
based, not-for-profit hospitals operate in the county with distinct cost
advantages over regional providers. They provide a full range of Inpatient,
Emergency, Outpatient, Rehab, and home health services as well as several
specialty units (Psych, Skilled Nursing, Ambulatory Clinics, etc.)
Approximately 80 licensed physicians practice full-time in the county as well
as other licensed independent health care professionals (DDS, DC, LPT, OT,
PA. NP, Speech, MSW, Psychologists, Therapists, etc.) There are also
specialty clinics held in sub-specialty areas where full-time practitioners
cannot be justified or attracted. (Cardiology, Oncology, Dermatology,
Neurology, etc.) There is a well-defined Public Health department operating
in the county, which also provides home health and community health education
services. There are six (6) Long Term Care facilities in the county with over
300 licensed beds and an array of intermediate, skilled, assisted and
independent living facilities and specialty units (Alzheimer’s). There are
approximately nine (9) retail and consulting pharmacies in major communities
in the county providing prescription drug and medical supplies to those
needing such services. There are several durable medical equipment suppliers
who also provide specialty high tech home therapies, equipment, and services. There are approximately 18 Dentists and
Oral Surgeons practicing in the county. There are also well-established
relationships for referrals to the University of Iowa, Mercy Iowa City,
Davenport, Springfield, and St. Louis etc. for specialty services and care
not available here and quality emergency medical transportation to get
patients to these centers.
Significant opportunities for improvement include:
- Access to
physician/professional providers for low income, working poor. Not all
providers accept Medicaid because
of the low reimbursement, higher risk patients, and perceived problems
with patient compliance with prescribed treatment protocols.
- Transportation
networks to improve access for seniors and those without personal
transportation. The ability of patients without transportation to access
the system is limited.
- There is a not a
thorough awareness and knowledge of all of the services and programs
available in the County.
- There is at least
some duplication of services, programs, and facilities operating in this
area and there may be room for more collaboration to replace some of the
competition.
- Iowa receives the
nation's lowest reimbursement for federally supported programs
(Medicare, Medicaid, etc) putting providers and organizations at a
competitive disadvantage for attracting/retaining professional staff,
replacing/obtaining facilities and equipment, providing broad ranges of
services and coverage for subscribers, and creating needs to cost-shift
to other commercial payers.
- Although not a
federally designated manpower shortage area for physicians, there
continues to be needs for recruitment of additional physician providers
as older physicians retire or curtail their practices. There are current
professional shortages in nursing, just about every technical field
(X-ray, Ultrasound, Nuclear Med, Laboratory, PT, OT, RPh, EMT, etc.)
This is also very evident in the shortage of Dentists in the county and
those who accept low income, Medicaid patients.
- Like every region of
the country, access to and the ability to pay for drugs and
pharmaceuticals remains a significant barrier to low-income families and
senior citizens.
- Likewise the ability
to fund long-term care remains a significant problem for many elderly
residents who need such services and would like to do so without
depleting all of their assets accumulated over their life. Increased
needs for diversified long-term care programs (not just nursing home
beds) will manifest themselves as our population ages.
- The structure of how
low income, working poor obtain access to basic health care services
needs to be changed so that these people are not forced to use the most
expensive care (Emergency) for their needs. For example: a
sliding fee scale.
- Basic, affordable,
insurance coverage packages for working poor should be more available
through employers and/or private/public sources.
- Programs aimed at
increasing awareness and knowledge of existing services should be
developed as well as encouraging Lee County resident to "shop
locally" for health care to insure that our current quality of care
or better can be continued into the future.
- The need to direct
more resources toward prevention and professional manpower
recruitment/retention will become important factors in our future
ability to meet the demands on healthcare.
Goal Statements:
To
inventory, develop, and promote a comprehensive, efficient, accessible and
affordable health care system for the residents and employers of Lee County.
To
work toward equitable treatment of Iowa patients and providers covered by
Federal health programs.
To
develop and provide a basic safety net of health services and preventive care
for all Lee County residents.
To
work towards fine-tuning the existing system to reduce waste, duplication and
increase the effectiveness of scarce resources.
RECOMMENDATIONS:
- The County needs to
continually provide support for the establishment of a Community Health
Care Center that will provide, at all times, free/affordable, quality
health care for all residents.
- The County needs to
provide ongoing public education and awareness of all health services
available throughout the county.
- The County needs to
provide ongoing public education and awareness of all public
transportation services available throughout the county to transport
citizens to their health care facilities.
- The County needs to
establish an Adult Day Care program that provides respite for the
caregivers of our aging population.
- The County needs to
explore ways to promote career development in the health care
fields.
- North and South Lee
County must collaborate together to recruit and retain quality health
care professionals.
- The County needs to
expand on the development of a “working poor” insurance program.
- The County needs to
encourage and acknowledge innovative thinking by current health care
providers for the establishment of new programs and services with a
research based, proven track record and preventative programs.
AREA #3: HUMAN SERVICES
ISSUE STATEMENT:
Because of the identified needs of our population base in Lee County, any
Comprehensive Plan should include evaluation of the Human Services currently
being provided and the structures in which they are organized and funded.
Summary of Findings: Lee County, like most counties in Iowa,
has a comprehensive array of mandated and supportive programs (both public
and private) aimed at meeting the human services needs of those residents who
experience temporary difficulty and require assistance. The scope of these services range from
pre-natal and mother/infant education and nutrition, parenting, counseling,
legal representation, food stamps, abuse, addiction, housing, basic health
care, transportation, etc. For many,
this is the safety net that enables them to survive and function at the most
minimal of levels. Even at these subsistence levels, there are personal,
structural, and organizational barriers that must be overcome and as
identified in our "reality check", these needs have grown at the
local and county levels because of cutbacks in federal and state budgets. The
structures, in which many of these programs are mandated to operate, create
disincentives for participants to move beyond these subsistence levels and
have created ongoing dependencies on these programs and low societal
productivity. Other barriers include the bureaucracy required to participate,
and the stigmas associated with and frustrations that accompany what is
received. The economic realities hit this area very hard as well. As funding
is spread across more and more recipients, there are concerns with quality,
accessibility, burnout amongst those providing the services, and concerns
about more potential recipients "falling through the cracks"
unnoticed and unattended. It's been likened to trying to squash a balloon
full of air. You can squeeze it in
the middle or anywhere along the balloon, but it just reappears somewhere
else; places like the court systems (adult and juvenile), public safety,
jails, institutions, abuse centers, medical examiners cases, emergency rooms,
etc. It is here that the committee sees the biggest potential for results
through prevention, education, training, and restructuring to provide
incentives for those who show initiative and progress toward a more self-sufficient
life style.
Goal Statement: To identify
ways to maximize the impact of limited human resources within our region
through more preventative and educational programs.
RECOMMENDATIONS:
- The County needs to
encourage and acknowledge innovative thinking by providers for the
establishment of new programs with a research based, proven track record
and preventative programs.
- The County needs to
assess current funding to maximize utilization of programmed monies
received. The County or an
appointed committee needs to monitor outcomes of programs and their
goals.
- The County needs to
continually promote and support the education, awareness, and marketing
of current services.
- The County needs to
partner with the Department of Human Services and other entities and
recognize their program limitations and use them as a “clearinghouse” of
knowledge.
AREA #4: MENTAL HEALTH
ISSUE STATEMENT: Like previous descriptions of significant
areas of emphasis, the issues related to mental health services are certainly
worthy of inclusion in any comprehensive plan. Because of the seriousness and pervasiveness of these problems
for individuals who suffer from these maladies as well as the impact that
these problems have on the entire community of residents, employers, and
public service providers, such needs must be addressed in such plans.
Summary of Findings: Lee County, because of its socio-economic
mix and other demographic aspects, has a historical high utilization of
mental health services. The county has a well-established network of public,
private, and public/private partnerships providing mental health services.
The county also has one of the more comprehensive ranges of service from
acute inpatient facilities and programs, outpatient and community-based
programs, institutional facilities, and a well-integrated referral network
with state providers and the court system. From a financial standpoint, a
significant portion of the county budget is allocated to mental health services
and there are innovative and progressive programs in place or planned to
integrate long-term mental health residents into community settings. While
there are currently an adequate number of mental health professionals in the
county, some continuing needs for recruitment of psychiatrists remains and
needs to be addressed as current providers reach retirement ages. There are many employers who contract for
or provide employee assistance programs for their employee populations and
these also integrate with county providers, although several non-Lee County
providers are also involved in significant ways.
Goal Statement: To plan for
and coordinate the provision of a comprehensive system of mental health
services and programs for Lee County residents that can meet current and
future needs and do so in a manner that best serves the individual clients
and the general county priorities.
RECOMMENDATIONS:
- Lee County should
continue to subsidize the psychiatric unit at the Keokuk Area Hospital.
- The County should pursue
the creation of a 211-directory assistance (711 for the hearing
impaired), which would continually provide information on services
currently available. The County
should also create Public Service Announcements/Media Blitzes by way of
utility bills, tax bills, newspapers, fliers, brochure racks, to
continually provide updated information to county citizens on services
available.
- The County needs to
continually subsidize and/or offer incentives for the recruitment of
qualified psychiatrists and mental health professionals, when needed.
- The County needs to
provide a strong continual base of resources after discharge from
hospitals or residential facilities.
- The County needs to
maintain a focused and proactive approach regarding preventive measures before
services are needed.
- The County should
permit citizens to apply for their choice of appropriate, individualized
services and service provider.
- The County needs to
improve and expand leisure activities for those residing in assisted
living housing sites throughout the county.
- The County needs to
develop and implement public transportation services for those unable to
transport themselves to their mental health appointments that would
subsequently reduce “no show” appointments.
AREA #5: SENIOR LIVING ISSUES
ISSUE STATEMENT: Because of the projections
for larger numbers of senior citizens for Lee County and Iowa as a state, any
comprehensive plan should and must include specific attention to and thought
about the needs that communities and individuals will be faced with as this
demographic trend unfolds.
Summary of Findings:
The needs identification for an increasing
population of 65+, 75+, 85+, age citizens are just beginning to be realized
and discussed. Obvious opportunities for innovative and progressive
approaches to these issues are available to those who understand and plan
accordingly. Many of the needs can and should be addressed through private
and/or entrepreneurial enterprises, but there is, once again, the need for
some type of minimal safety net for all seniors regardless of their ability
to use their own accumulated resources to meet these needs. In particular the
issues of long term care, pharmacy prescriptions, independent or assisted
living facilities, social/recreational opportunities, transportation, and
access to services should be addressed through social and/or political
changes in the way we provide (or don't provide) senior services.
Goal Statement: To identify specific senior living issues
and make recommendations for inclusion in the comprehensive plan that will
lead to quality of life enhancements for this important segment of our
population.
RECOMMENDATIONS:
- Lee County needs to
equalize with other parts of the country to ensure Lee County residents
receive reasonably priced prescriptions with increased Medicare
benefits.
- The County needs to
take a proactive and supportive approach in the development of
preventative programs such as senior fitness, educational sessions, and
health screening clinics provided by the health department, senior
citizen centers, local hospitals, and health fairs.
- Current senior
facilities need ongoing evaluation by the County to assure senior
citizen needs are being fulfilled and that those facilities can
accommodate our growing senior population.
- The County should
increase utilization of senior centers by installing computers with
Internet access.
- The County should
encourage the implementation of educational programs - students teach
seniors and seniors teach students, creating a mixing of generations.
- The County should
create countywide awareness and support for senior issue support
groups.
- The County needs more
utilization of Retired Senior Volunteer Program (RSVP) and expand its
efforts throughout the county.
CONCLUDING REMARKS:
The
Health and Human Services Subcommittee has presented this report as a summary
of our best efforts to sort out hours of discussion, reams of data, and the
thoughts and ideas of all of those talented and dedicated individuals who
participated in the process. We feel it is a good report, but obviously less
than all encompassing in the broad area assigned; Health and Human Services.
We can also reiterate that these particular areas of emphasis and the
recommendations presented cannot be viewed in isolation, but rather must be
seen as a part of the overall picture of life and work in our part of the
state and nation. There may be a need for fundamental changes in the
expectations and responsibilities of public entities, private enterprises,
and individuals if significant progress is to be achieved in future decades.
No one has all of the answers, and no one has all of the responsibility for
changing societal expectations for quality, support, and productive
contributions of the people who live in Lee County. We do, however, see the
need to change attitudes and perspectives to one of identifying and pursuing
possibilities rather than preserving outdated or ineffective structures,
programs, and incentives that have proven to have less than optimal results
that we desire.
We
appreciate this opportunity to participate in this important process and look
forward to working in a constructive manner to make Lee County a caring,
compassionate, and quality place to live, work, and prosper.
STATISTICAL
OVERVIEW
LEE
COUNTY MENTAL HEALTH AND DEVELOPMENTAL DISABILITIES SERVICES
Number of individuals served FY
2000:
Disability Group Children Adults Total (unduplicated)
Mental Illness 38 247 284
Chronic Mental Illness 3 127 130 Note:
two persons
Mental Retardation 3 132 134 turned age 18
Developmental Disabilities
0 18 18 this year
Totals 44 524
564
Source: Statistics from Lee County CPC
Commonly used services by Disability Group:
(number of persons)
Service Description
|
Mental Illness
|
Chronic M.I.
|
Mental Retardation
|
Developmental Disabilities
|
|
Outpatient Counseling
|
218
|
33
|
1
|
2
|
|
Case Management
|
2
|
32
|
74
|
6
|
|
Payee
|
1
|
43
|
28
|
5
|
|
Sheltered Workshop
|
1
|
24
|
45
|
2
|
|
Residential Care Fac. 16+bed
|
2
|
57
|
34
|
0
|
|
Supported Comm. Living
|
0
|
1
|
50
|
2
|
|
Community Support Program
|
|
