United Health Services Hospitals Community Service Plan

Transcription

1 United Health Services Hospitals Community Service Plan Sept ptem embe r www. w.uh s.ne t

2 United Health Services Hospitals Governance Michael Scullard, Chair Diana Bendz, Immediate Past Chair Bruce Bowling, MD, 1st Vice Chair Matthew Salanger, FACHE, 2nd Vice Chair Susan Mistretta, Esq., Secretary Sean Brady Jerome Canny Barbara Chaffee, MD Horatio Denson James Jewell, MD Ronald Lesch Sarah Gueldner, DSN Carol Miller, MD Judith Peckham James VanVoorst Matthew Salanger, FACHE, President/CEO United Health Services Inc. Governance Michael Scullard, Chair Martin Dietrich, Vice Chair Judith Peckham, Secretary Diana Bendz, Treasurer Ferris Akel Sherman Bodner Bruce Bowling, MD Thomas Emerson, Esq. Helen Johnston, RN James Leonard, CPA Susan Mistretta, Esq. Edward Schott Mark Shumeyko, MD Natalie Thompson Shawn Yetter Matthew Salanger, FACHE, President/CEO It is our Vision that by 2011, United Health Services will be a tightly integrated health care system recognized as the leading provider of health care services in our region and distinguished for superior quality in clinical care and service. The United Health Services Hospitals Mission is to serve the people of our region, to improve or maintain their health, and to provide patient-centered, contemporary health services in a caring, competent, and convenient manner. Services will be affordable and well organized to meet the needs of our patients and their families. Community Service Plan Comprehensive 3-Year Plan Published September 2009 Introduction United Health Services Hospitals (UHSH) is proud to continue the tradition started in 1992 of issuing an annual Community Service Plan to the New York State (NYS) Department of Health (DOH), and to report a 2009 plan which again demonstrates our commitment to meeting the health care needs of the community. In 2008, NYS DOH developed a Prevention Agenda that established 10 priority areas with 2010 goals and measurable objectives. As part of a statewide effort to emphasize local health planning, United Health Services (UHS) collaborated with the Broome and Tioga County Health Departments and other community partners to determine two public health priorities which form the basis of our plan. UHSH is an important part of a larger system of integrated delivery of care, which provides additional benefits to the community. As a result of the formation of UHS in 1981 and the subsequent transformation of the combined organization into a health care system, our region today offers more complete and advanced care than many communities five times our size. This report captures the benefits specific to UHSH. The other hospital members of the UHS system, Chenango Memorial Hospital, and Delaware Valley Hospital submit separate reports. United Health Services Hospitals Mission Statement At the bottom left is the mission statement that identifies the hospital s commitment to the community it serves. This is reaffirmed by the Board of Directors annually. Above it is the shared Vision of the United Health Services System; and on the facing page are the shared Values of the United Health Services System. These were developed as part of the Strategic Plan adopted by the System Board in November United Health Services Hospitals is a not-for-profit provider of health care services and is part of an integrated health care delivery system serving New York s Southern Tier and surrounding areas. United Health Services Hospitals fulfills its mission by working together with the community, physicians, and other health care providers to continuously improve the availability and quality of services and the ability to provide: A comprehensive range of short-term inpatient acute and rehabilitative services, as well as outpatient diagnostic and treatment services, on its Wilson Medical Center and Binghamton General Hospital campuses. Primary care services which are the foundation for serving the community with a coordinated system of care, with special attention to underserved areas. Select specialized services that serve a broad geographic service area. Educational programs in which graduate, undergraduate, and continuing medical education, as well as nursing and other professional and technical training and scholarship programs, make available well-trained health care professionals and advanced clinical services and medical practices. Programs and services which educate our patients, their families, businesses and the community at large about promoting healthy lifestyles, facilitating understanding of personal health status, increasing knowledge of health care options, and encouraging effective utilization of the health-care system. Changes to the Mission Statement No changes have been made to the mission statement since the last Community Service Plan report.

3 The United Health Services statement of Values We are committed to the values of United Health Services, which we believe reflect those of the people and communities we serve. These values guide our daily actions and decisions. We are committed to living by these values each and every day. CARING means that we show compassion in how we treat others. We show sensitivity to their concerns, problems, or pain. We reassure them that they are not alone. SERVICE means helping others get what they need, and where possible giving even more than they expect. We pledge to provide service to all in need regardless of their financial means, race, creed, or other life circumstances. PARTNERSHIP means we use teamwork to accomplish more than any of us could working alone. We believe we can best serve and care for others by blending the talents and dedication of many caring people and organizations. LEARNING means improving our knowledge and skills to benefit others. We seek the knowledge, wisdom, and insight that will enable us to best serve and care for others. INTEGRITY means we are honest in what we say, and we are true to our word. Honesty and competence are fundamental to our relationships with others. RESPECT means seeing the best in others regardless of who they are. We offer each person we serve or work with our respect and understanding, recognizing their special needs and individuality in our words and actions. STEWARDSHIP means we use our community s health resources wisely. The community has entrusted us with responsibility to manage our health system for the benefit of both current and future generations. United Health Services Hospitals is a not-for-profit provider of health care services and is part of an integrated health care delivery system serving New York s Southern Tier and surrounding areas.

4 United Health Services Hospitals United Health Services Hospitals (UHSH) is affiliated with United Health Services, Inc. in Binghamton, New York. United Health Services Hospitals, Inc. is a 501(c) 3 not-for-profit corporation, whose sole member is United Health Services, Inc., also a notfor-profit corporation. United Health Services is a health care system that primarily serves the counties of Broome, Tioga, Chenango, and Delaware along the southern tier of New York State. System members span the continuum of care from primary and specialty medical care through high-tech tertiary hospital care, home care, medical equipment, and nursing home services. Service Area United Health Services Hospitals encompasses the Wilson Medical Center in Johnson City, New York, Binghamton General Hospital in Binghamton, New York, 8 Family Care Centers and other outpatient services. Wilson Medical Center is a 280-bed teaching hospital which provides a full range of medical-surgical services, including: cardiology nephrology perinatology ophthalmology emergency medicine maternity care pulmonary medicine renal dialysis neonatology pediatrics neuroscience Wilson is a regional referral center for the advanced practice of emergency medicine, neurosurgery and newborn intensive care. It is also the site for the practice of openheart surgery and other advanced cardiac procedures. Binghamton General Hospital is a 220-bed facility offering: mental health services orthopedic and reconstructive surgery dialysis rehabilitation/brain injury center transitional care unit The eight Family Care Centers are located throughout the multi-county service area: Binghamton (Family Care & Pediatric locations) Clinton Street (Binghamton) Northern Tioga Deposit Windsor Johnson City Candor Other outpatient services: 2 school based health centers Chemical Dependency Dialysis Center Diabetes Management Stay Healthy Center and Education Center The service area was determined by examining inpatient origin by zip code and by county. Because the majority of the service area falls into Broome and Tioga Counties, collaboration to identify Public Health Priorities took place at the county level. UHSH s service area is centered in Broome County, with 73% of patients coming from Broome County communities, and another 19% from Chenango, Tioga, and Delaware Counties. UHSH s 75% zip code service area includes the Broome and Tioga communities of: Endicott, Binghamton, Johnson City, Vestal, Owego, Windsor, Greene, Norwich, Harpursville, Deposit, Port Crane, Whitney Point, and Apalachin.

5 Public Participation Participants UHSH is proud of the tradition of partnering with many community agencies, both formally and informally, to help meet the health needs of the community. In order to assess community health needs for this plan, UnitedHealth Services Hospitals collaborated with the Broome and Tioga County Health Departments and a task force of representatives from community agencies: UHSH: Binghamton University Broome County Council of Churches Broome County Department of Social Services Broome County Environmental Management Council Broome County Health Department Broome County Mental Health Department Broome County Office for Aging Broome County Urban League Broome County Youth Bureau Excellus BlueCross Blue Shield Lourdes Hospital Mothers & Babies Perinatal Network of SCNY SUNY Upstate Medical University Clinical Campus at Binghamton United Health Services Hospitals United Way of Broome County The Broome and Tioga County Community Health Assessments are the result of this collaboration and the basis for selection of the Public Health Priorities framing this plan. UHSH continually invites the public to participate in its self-assessment process by means of surveys, primary market studies, focus groups, and comments submitted through our comprehensive internet site. Throughout the year input from staff, the public and board members are utilized in determining and shaping the hospital s response to the community s health care needs. The UHS Inc., Strategic Plan was also integral to assessing community health needs. Outcomes Representatives from community agencies participated on the task force and were notified of meeting times and dates by the steering committee. Monthly steering committee meetings were held on the first Tuesday for one and one half hours from October 2008 to September The MAPP process was used to conduct assessments of: Community Themes & Strengths, Local Public Health System, Community Health Status, and Forces of Change. The process relied heavily on the capture and analysis of data through focus groups and surveys, and the analysis of existing data sets (The Community Health Data Set, County Health Assessment Indictors, BRFSS, YRBS, SPARCS, and other county level data available on the NYS Health Information Network) in comparison to the 2013 Prevention Agenda goals. UHSH enhanced the PQI data by added incidence data for Broome County residents who use PA hospitals. The steering committee synthesized the assessments in order to identify strategic issues, formulate goals and strategies. The steering committee will continue to meet periodically in order to implement the action cycle. Assessment of Public Health Priorities Criteria of Public Health Priorities The Steering Committee used the following criteria to rate the Prevention Agenda priorities and additional priorities identified by task force members: Potential Costs to the Health Care System Absolute Number of Individuals Affected Worsening Trend Over the Past 5 Years Underperforming Healthy People 2010 and/or New York State 2013 Prevention Agenda Goals. Work Time Lost or Disability Particular Areas of Concern (Disparities) Feasibility for Potential Intervention Availability of Funding for Initiative Forces of Change (Trends, Factors and Events) Measurability over Time Selected Prevention Agenda Priorities The Broome County steering committee chose two Public Health Priorities along with their related focus areas. Access to Quality Health Care increase healthcare coverage increase access to mental health services increase access to prescription medications Chronic Disease and Chronic Disease Prevention Chronic Disease Prevention: Physical Activity and Nutrition decrease the proportion of children and adults who are obese Chronic Disease: Diabetes reduce the prevalence of diabetes reduce diabetes-related hospitalizations Chronic Disease: Heart Disease reduce hospitalizations due to heart failure Tioga County also focused on Access to Quality Health Care. Details about each priority area are included in the table on the following page. Status of Priorities The selected priorities represent a mix of new community initiatives and enhancement of existing programs through input and support from community partners as detailed in the table on the following page. Priorities Considered in Assessment Process Provide a description of the scope and of all hospital public health programs considered in the assessment process, including the two or three selected Prevention Agenda priorities. The task force considered the following priorities in addition to the Prevention Agenda priorities: Increase access to prescription medications Increase access to mental health services Decrease inappropriate substance abuse Increase availability of services for dual diagnosis/co-occurring dependencies Reduce the proportion of adolescents who smoke during pregnancy Cerebrovascular disease (stroke) mortality COPD hospitalizations among adults

6 Three Year Plan of Action -- Strategies for Selected Priorities PRIORITY AREA # 1: ACCESS TO QUALITY HEALTH CARE FOCUS KEY PARTNERS CURRENT / APPROACHES Access to Quality Health Care: Increase Healthcare Coverage Southern Tier Health Link Mothers & Babies Perinatal Network of SCNY Action for Older Persons Rural Health Network Community Alternative Systems Agency (CASA) Broome Cover the Uninsured Week Coalition Communities Joined in Action Community Free Clinic Binghamton VA Outpatient Clinic Department of Social Services Broome County Health Department Coordinated approach to the administration of grant funded educational and service programs (private and government funded) through community coalitions. Coordinated approach working with the local health department and local service providers and agencies to increase coverage to address community need. Facilitated enrollment for insurance products for which individuals may be eligible Examples of Current Initiatives: Implementation and utilization of a financial screening and enrollment program/software called Medicaider. Lourdes hired six financial counselors to assist the uninsured with the Medicaider program. This program provides quick screening to determine eligibility for New York State programs. Broome County Covered the Uninsured Week. Hospital participating in the NYS Prenatal Care Assistance Program. Hospitals provide financial screening for this program in addition to providing comprehensive prenatal care and newborn services. Referrals at the free clinic. As changes in reimbursement occur, continue to identify & remove barriers to coverage through coordinated enrollment in private and public sectors. Develop strategic alliances to streamline administration of programs and funds which serve at risk populations including, but not limited to, the under & uninsured and Veterans Administration recipients. Develop an implementation strategy to identify and replicate successful services and programs throughout the service area. Increase the coordination of safety net programs to maximize use of federal, state, and community grant programs and services. Develop primary, secondary, and tertiary care strategies to address effective implementation of health care reform Percentage of adults with health care coverage [BRFSS] Percentage of children with healthcare coverage Percent uninsured [Current population Survey] Percentage of adults who have a regular health care provider [BRFSS] Number of women enrolled in the Prenatal Care Assistance Program Percent early entry into prenatal care [NYSDOH] Infant mortality number of deaths & mortality rate [SPARCS] Consider other Agency for Healthcare Quality & Research (AHRQ) safety net indicators PRIORITY AREA # 1: ACCESS TO QUALITY HEALTH CARE FOCUS KEY PARTNERS CURRENT / APPROACHES Access to Quality Health Care: Increase access to mental health services Broome County Mental Health Department Mental Health Association of the Southern Tier Greater Binghamton Health Center Community Free Clinic Binghamton University Catholic Charities of Broome County The Family & Children s Society Department of Social Services (DSS) Broome-Tioga Board of Cooperative Education Services (BOCES) Keep Youth Doing Something (KYDS) Coalition United Way of Broome County Broome County Office for Aging (OFA) Broome County Youth Bureau Law Enforcement Homeless Coalition Provision of mental and behavioral health services through: (a) state, county, and private agencies and providers/medical community; (b) grant funded programs; and (c) education system (counseling services). Outreach and education through community agencies (OMH, DSS, OFA), education system, medical community. Examples of Current Initiatives: Child & Family Clinic Plus [Broome County Mental Health Child & Adolescent Clinic] Safe Healthy Action Requires Education (SHARE) [BOCES] Broome County Single Point of Access (SPOA) for children and Single Point of Entry (SPOE) for adults [Catholic Charities] Nurse Direct [United Health Services] First Call for Help [United Way] 6. Faith in Action [Binghamton University] 7. Lourdes Youth Services (The Corner), Mental Health Juvenile Justice Project, Detention Alternative After School Program, Juvenile Arrest Diversion Endeavor, Student Assistance Program, Alcohol & Drug Education Prevention Program, Teen Nurturing Parenting Program. Refine care models to maximize the delivery of mental health/ behavioral health services across the continuum of care and in various care delivery settings such as primary care, specialists, utilization of allied health professionals. Expand linkages with Binghamton University to increase service learning and community-based projects. Explore grant funding opportunities and evidencebased strategies for increasing access to mental health services. Develop an implementation strategy to replicate successful services and programs throughout the service area. Expand partnerships to support new Psychiatric/ Mental Health Nurse Practitioner Program at Binghamton University Number of individuals accessing Mental Health services [NYS OMH] Suicide mortality [NSDOH]

7 Three Year Plan of Action -- Strategies for Selected Priorities continued PRIORITY AREA # 1: ACCESS TO QUALITY HEALTH CARE FOCUS KEY PARTNERS CURRENT / APPROACHES Access to Quality Health Care: Increase access to prescription medications Pharmacists Health care providers with prescriptive privileges Rural Health Network of South Central New York Action for Older Persons Broome County Health Department Community Alternative Systems Agency (CASA) Rural Health Network of SCNY Our Lady of Lourdes Memorial Hospital United Health Service Hospitals Community Free Clinic Mothers & Babies Perinatal Network of SCNY Broome County Health Department Pharmaceutical companies Examples of current initiatives: Nurse Direct referrals to prescription assistance programs Hope Dispensary of the Southern Tier (a free pharmaceutical program, opened in August 2009, with the support of a community coalition and a partnership with Ascension Health s St. Thomas Hospital in Nashville, Tennessee). Lourdes Hospital operates the Hope Dispensary. The Hope Dispensary provides a screening process for existing health care coverage programs, as well as provides assistance in obtaining a Medical Home. Elderly Pharmaceutical Insurance Coverage (EPIC) Enrollment in Prescription Assistance Programs (PAP) by: - Community Free Clinic - Rural Health Network Pharma Rx Program (national program) & other low cost programs Increase the coordination of pharmacy safety net programs. Education for providers about Prescription Assistance Programs (PAPs) and prescribing practices. Increase awareness of PAPs and expand number of programs and organizations that will assist patients to complete applications. Number of individuals enrolled in prescription assistance programs Developmental: Track referrals, sales, reimbursement through Medicaid or Medicare PRIORITY AREA # 2: CHRONIC DISEASE & CHRONIC DISEASE PREVENTION FOCUS KEY PARTNERS CURRENT / APPROACHES Physical Activity & Nutrition [Chronic Disease Prevention]: Decrease the proportion of children and adults who are obese Stay Healthy Center Family Enrichment Network Strategic Alliance for Health BOCES Food Service WSKG Radio Binghamton Metropolitan Transportation Study (BMTS) NYS Department of Transportation Education system (public & private) Broome County Office for Aging Aging Futures Partnership Rural Health Network of SCNY Cornell Cooperative Extension Farmers Markets Community Free Clinic Mothers & Babies Perinatal Network of SCNY Broome County Parks and Recreation Department of Social Services Broome County Health Department Outreach and education to promote physical activity and nutrition. Intervention & prevention through engaging the community in health lifestyle and behavioral changes. Policy and systems level changes in schools and worksites. Examples of Current Initiatives: Strategic Alliance for Health: - Involving pediatricians, making healthy choices easier to make through environmental changes and social marketing, - Implementing evidenced based programs such as the parent component of WE CAN. Steps to a Healthier NY: BC Walks, Working on Wellness, Mission Melta-way Team Act Coalition Employer health insurance plan incentives promoting healthy life style, e.g., Excellus BCBS s Healthy Rewards Community initiatives to expand walking trails and parks. 6. School-based initiatives to improve dietary options and promote healthy eating in schools: Power-Up with Breakfast, Rock-on Café, Five-a-Day, Farm-to-Schools 7. Fitnessgram testing and BMI measurement of children in schools. 8. Lourdes Primary Care Network BMI initiative Develop (community, business, and population specific) sustainable behavioral modification programs to address factors contributing to obesity: mental/emotional, physical, environmental, and nutritional. Modify physical environment and infrastructure to increase physical activity Increase access to public spaces where residents can be physically active and safe Develop food systems changes that support access to healthy locally grown foods Involve media in social marketing campaigns for physical activity and nutrition initiatives Explore grant funding opportunities and evidencebased strategies for increasing physical activity and improving dietary choices Develop an implementation strategy to replicate successful services and programs throughout the service area Expand linkages to local colleges that offer health careers for community health education Prevalence of overweight and obesity in adults [BRFSS] Prevalence of overweight and at risk for becoming overweight in children [YRBS] Percent of WIC & PCAP children who are overweight [WIC & PCAP] Percentage of adults who engage in some type of leisure time physical activity [BRFSS] The percentage of adults who consume at least five servings of fruits & vegetables per day [BRFSS] The percentage of adults who consume at least five servings of fruits & vegetables per day [YRBS] Percentage of mothers participating in the WIC program who breastfeed for at least 6 months [WIC]

8 Three Year Plan of Action -- Strategies for Selected Priorities continued FOCUS PRIORITY AREA # 2: CHRONIC DISEASE & CHRONIC DISEASE PREVENTION KEY PARTNERS CURRENT / APPROACHES Chronic Disease: Diabetes Reduce the prevalence of diabetes Reduce diabetesrelated hospitalizations Hospital-based Endocrinology & Diabetes Centers [Lourdes & UHS] Endocrinology specialty practices Primary care providers Stay Healthy Center & Nurse Direct [UHS] Local support groups Rural Health Network of SCNY Community Free Clinic Broome County Office for Aging Aging Futures Partnership Community Alternative Systems Agency (CASA) Senior Centers Meals on Wheels Hospital-based diabetes education programs Chronic disease self-management programs Case management of patients with diabetes Examples of Current Initiatives: Rural Health Network Chronic Disease Case Management Project Community collaborative efforts through the American Diabetes Association. Develop innovative programming such as move your A1c to help motivate diabetics. Expand linkages to local colleges that offer health careers for community health education Healthcare provider education Explore grant funding opportunities and evidencebased strategies for increasing self-management and case management of patients with diabetes. Develop an implementation strategy to identify and replicate successful services and programs throughout the service area. Address disparities in morbidity through engagement with specific sub-populations 6. Prevalence of diabetes in adults [BRFSS] Prevalence of diabetes in children [YRBS] Hospitalizations for acute complications (ketoacidosis, hyperosmolarity, coma) [SPARCS/PQI] Hospitalizations for chronic complications (renal, eye, neurological, circulatory, or complications not otherwise specified) [SPARCS/PQI] Diabetes selfmanagement practices (self-blood glucose monitoring, self-foot exams) [BRFSS] Outpatient diabetes management by health care providers (A1c, foot exams, eye exams) [BRFSS] PRIORITY AREA # 2: CHRONIC DISEASE & CHRONIC DISEASE PREVENTION FOCUS KEY PARTNERS CURRENT / APPROACHES Chronic Disease: Heart Disease Reduce hospitalizations due to heart failure Emergency Medical Services Hospitals Nursing homes Home health agencies American Heart Association Community Free Clinic Primary care sites Health care providers Stay Healthy Center & Nurse Direct [UHS] Local support groups Rural Health Network of SCNY Broome County Office for Aging Aging Futures Partnership Community Alternative Systems Agency (CASA) Senior Centers Meals on Wheels Provider-patient & provider-hospital initiatives to identify and provide disease management to patients with congestive heart failure. Provide innovative home care programming and continuum of care to patients when they leave the hospital. Home Health tele-health monitoring services. Post-hospital discharge follow-up calls. Provide continuum of care to monitor and assist patient with compliance issues. Provide innovative home care programs and services for management of heart failure. Expand linkages to local colleges that offer health careers for community health education Explore grant funding opportunities and evidence-based strategies for increasing disease management of patients with heart failure. Develop an implementation strategy to replicate successful services and programs throughout the service area. 6. Address disparities in morbidity through engagement with specific sub-populations Number of hospitalizations due to heart failure [SPARCS/ PQI] Heart failure hospitalization rates [SPARCS/PQI]

9 Financial Aid Program Successes and Challenges United Health services serves those in need regardless of religious belief, ethnic background, or ability to pay. We have a long and growing history of providing services to community residents for which we are not fully compensated (either free, at amounts less than full charges, or below cost). UHS provides financial aid to those in need in accordance with Public Health Law 2807 (k) (9-a). One of the challenges we face in assisting patients is reconciling New York State regulations with Federal Medicare regulations regarding which information we are permitted to gather to determine patient eligibility for aid. We are currently working with the Healthcare Association of New York State (HANYS) to clarify how best to handle these differences. In this uncertain and challenging economy, we have been successful in increasing the number of people we provide assistance to year after year. In addition to qualifying people for UHS financial assistance, we help them to enroll in other programs such as Medicaid and Family Health Plus. Changes Impacting Community Health/Provision of Charity Care/Access to Services Potential Impacts There have been no changes to the hospital s operation or financial situation that would impact the care of the community, financial assistance and/or access to health care. Public Information The Community Service Plan is made available to the public through a link on our website in our About Us section. The report is downloadable in Adobe Acrobat format (PDF) and information is provided regarding how to obtain free hard copy. The UHS.net website includes extensive information regarding public health programs on our Stay Healthy page and throughout the site. Our patient and visitor information site includes a link to our financial assistance page which includes information regarding: Online Services Online Forms Patient Billing Financial Assistance Gloassary of Terms FAQ Online Bill Pay UHSH provided over $45 million in community benefit in 2008: Bad Debt/Uncompensated Care/Charity Care...$23 million Community Benefit Programs...$9 million Programs Operated at a Deficit...$20.4 million Financial Statement The Department of Health has collected financial data from the UHSH Institutional Cost Report.

10 United Medical Associates United Health Services Foundation United Medical Associates, an affiliate of United Health Services, is a multi-specialty group of over 130 physicians representing more than 25 medical and surgical specialties, at locations throughout Broome, Chenango, and Tioga Counties. United Health Services Foundation supports innovation, service and quality at United Health Services by educating the community, attracting donors and managing gifts wisely. United Health Services Hospitals Chenango Memorial Hospital Delaware Valley Hospital Ideal Senior Living Center United Home Care United Health Services Hospitals operates Wilson Medical Center, Johnson City, NY; and Binghamton General Hospital, Binghamton, NY, with Family Care Centers in Broome and Tioga Counties. With 500 inpatient beds and extensive outpatient services, United Health Services Hospitals offers general medical/surgical services and is a regional center for cardiac surgery, neurosurgery, renal dialysis, oncology, neo-natal intensive care, trauma, reconstructive surgery, physical rehabilitation, mental health, and chemical dependency treatment. UHS/LS/PS/09/09 Chenango Memorial Hospital is a 138-bed facility in Norwich, NY, which includes a hospitalbased skilled nursing facility. Chenango Memorial offers general medical/surgical services, 24-hour physician staffed emergency services, OB/ GYN services, intensive care unit as well as in and outpatient surgical services. Chenango Memorial Hospital has extensive outpatient services including laboratory and diagnostic imaging services, CV Stratton Center for Therapies, walk-in center, family health centers and school based health centers throughout Chenango County, a women s health center and dental health center. Delaware Valley Hospital is a critical access, 25-bed facility located in Walton, NY. Serving Delaware County, the hospital offers a wide range of services including 24-hour emergency care, inpatient medical care and addiction treatment, inpatient and outpatient rehabilitative services, diagnostic and treatment modalities, ambulatory procedures, services and surgery and is the local access point for specialty care. It operates three Family Health Centers in Walton, Downsville and Roscoe, as well as offering extensive occupational health and wellness programming. Diagnostic and treatment modalities include: laboratory, extensive radiology services, physical therapy, cardiopulmonary services. Ideal Senior Living Center, Endicott, NY, is a multi-level long term care campus that offers three types of housing on one site: modern, comfortable rental apartments for seniors who can live independently; private or semiprivate rooms for those who need some physical assistance; and a 150-bed skilled nursing facility. Ideal also provides comprehensive home health care services. Professional Home Care, Vestal, NY, offers advanced home care services including home infusion services (nursing and pharmacy), comprehensive respiratory services, rehabilitation/ mobility services, durable and high-tech equipment, and a wide range of medical supplies and services supporting the home-bound and ambulatory patient. Also located in Norwich, Walton, and Ithaca, NY. Twin Tier Home Health, also in Vestal, provides nurses, aides, and specialists for home telemonitoring, physical and occupational therapy, and wound care 24 hours a day, seven days a week. Project H.E.A.R. (Home Emergency Alarm Response system) provides reassurance of help for those who need it.