May 2016
TABLE OF CONTENTS Executive Summary - - - - - - - page 2 COMMUNITY ASSESSMENT REPORT - - - - page 4 Introduction - - - - - - - page 4 Description of Community - - - - - - page 5 Who was Involved in Assessment - - - - - page 7 How Assessment was conducted - - - - - page 7 Identified Health Needs - - - - page 8 Community Assets - - - - - page 13 Summary: Assessments and Priorities - - - page 14 Approved by Board, signature - - - - - page 14 Attachments and Resources - - - - - page 15 Avera St. Mary s Hospital Community Health Needs Assessment 2016 1
Executive Summary The Health of Central South Dakota: A Community Health Needs Assessment is a comprehensive community health needs assessment conducted by Avera St. Mary s Hospital. It is modeled after the assessment process outlined in Assessing and Addressing Community Health Needs, a publication developed by the Catholic Health Association, with additional evidence-based practices offered by Avera Health, the parent organization for Avera St. Mary s Hospital, and the South Dakota Department of Health Good & Healthy Community Grant. The Health of Central South Dakota has two reports: Community Health Needs Assessment Report (CHNA) and Implementation Strategy/Community Benefit Plan. The CHNA has six sections: 1) Description of hospital and community served; 2) Who was involved in the assessment and the assessment process; 3) Health needs identified by stakeholders and what the secondary data told us; 4) Community assets identified; 5) Assessment and priorities, and 6) Summaries. The Implementation Plan includes: Action plans and Next steps. The three-pronged process gathering Stakeholder information on community perceptions of the health of Central South Dakota included a survey of three civic social clubs, interviews with identified community leaders, and several focus groups. The Community Health Needs Assessment (CHNA) Team met as a group and committees over the past year, with communication occurring via shared reports and information via email. Members of this Team conducted the survey, focus groups and interviews and prioritized the issues which helped develop the Action Plan. All members of the CHNA Team were selected for roles they have in the community by a matrix developed by the Avera St. Mary s Hospital Administrative Council and included attributes such as: uninsured/underinsured, parents of young children, close contact with underprivileged people to assure a voice in the process, health leaders with in-depth knowledge of the local health care environment, government, business, retired, South Dakota State Departments of health and social services, Urban Indian Health, and Rural Health Clinics. Stakeholders spoke of three common themes related to the health issues facing the counties: Cancer Treatment, Chronic Diseases associated with Obesity, and Mental Health. Other issues were mentioned far less frequently but included: poverty, the homeless, cultural issues and housing. The search for secondary data (data, in most cases, collected by someone other than the community partners) again confirmed the perceptions of the survey respondents and the stakeholders. The list of county-specific data sources included in the CHNA is extensive (see Appendices). The County Health Rankings is one of the data sources that will be utilized to measure our progress toward achieving improved health in the county. Avera St. Mary s Hospital Community Health Needs Assessment 2016 2
A summary of all information sources written survey, stakeholder interviews, focus groups and secondary data collection- shows that community agencies, including the hospital, need to be more effective utilizing their health care assets to improve the health of the people in the area. There needs to be better coordination among the various entities working on health issues and the shortage of primary care, mental health and dental providers, as well as the strongly identified need for specialists to serve the area. While we are proud of our community coalitions, such as Healthy Community/Healthy Youth, Suicide Prevention and Crisis Response team, the efforts and the awareness needs to be expanded and even better coordinated. While all are open to involvement and participation with Native American organizations and people, an active interaction and process needs development. The implementation strategy is our blueprint for improving the health of Central South Dakota over the next three years. It was developed in collaboration with a variety of community individuals representing several organizations and agencies. The implementation strategy will primarily address three core areas: Cancer Treatment, Diseases associated with Obesity, and Mental Health. In a more supportive role, Avera St. Mary s Hospital will explore, with its community health partners (South Dakota Department of Health, South Dakota Department of Social Services, City of Pierre, County governments and law enforcement, Capital Area Counseling Services, Rural Health Clinics, and Urban Indian Health), how the hospital can assist addressing the issues of: poverty, chemical dependency, cultural issues, and other important community health issues. A collective and integrated effort is needed to address these broader, societal concerns. Avera St. Mary s strategic plan, and the assessments currently being conducted for facility improvement and Behavioral Health, will be the foundation and cornerstone for this implementation strategy. Success in achieving the goals and objectives in the CHNA action plan depends upon further developing the relationships with the communities we serve and the continued participation in health improvement activities and strategies by individuals, organizations and agencies throughout Central South Dakota. The CHNA is a vital first step toward improving The Health of Central South Dakota. Avera St. Mary s Hospital Community Health Needs Assessment 2016 3
2016 Avera St. Mary s Hospital Community Health Needs Assessment Summary Central South Dakota An assessment of Hughes, Stanley, and Sully Counties, South Dakota was conducted by Avera St. Mary s Hospital. During 2015 and 2016, a community health needs assessment was conducted by Avera St. Mary s Hospital for the 22,063 residents of Hughes, Stanley and Sully Counties, South Dakota. Hughes County, population 17,642, includes the city of Pierre, the State Capital of South Dakota. Fort Pierre, located across the Missouri River from Pierre, is the County seat of Stanley County, population 2,983. Sully County, located north of Hughes County is sparsely populated with1,438 residents. (http://census.gov/) Based on the Avera St. Mary s Hospital Board of Directors recommendation, the 2013 community health needs assessment and implementation plan focused on increasing cancer treatment options and services, reducing the percentage of individuals who are overweight, and reducing the impact of mental illness. Following our Implementation Plan objectives, these are some highlights of accomplishments. An oncologist began medical oncology practice in 2014 and a feasibility/market/financial analysis for a cancer center was completed by a consulting group, with input from over 60 people. The results were shared with Avera Corporate. Avera St. Mary s has presented a capitol budget request for the next fiscal year. In 2015, improvements to our oncology treatment center were made, including offices for Dr. Donepudi, new flat screen televisions purchased through the Foundation, and a donor funded new oncology equipment. Through the Let s Move community committee, an initiative with National League of Cities is helping the City of Pierre adopt long-term policies that are sustainable, and holistic approaches that promote improved nutrition and increased physical activities. The Community Wellness Coordinator (sponsored by Avera St. Mary s Foundation and South Dakota Discovery Center) Harvest of the Month further developed a wrap-around approach, expanding from schools and after-school program to early childhood, grocery stores, gardens that include adults and families as well as children. 10 sites received funding from a Wal-Mart grant, including Juvenile Services Center and Oahe Inc. The City of Pierre has completed the 4th Street walk/play project. Eric Crouch, National runner/educator/community guide presented at Oahe Days Let s Move Coalition booth. Because of these and many other efforts, our overweight and obese school children measures showed a decrease over previous years. Reducing the impact of mental illness is a community effort. In February, 2015, an expanded Community Mental Health Task Force with city, state, county officials, mental health center, hospital, law enforcement, NAMI, schools, counselors, States Attorney, clergy and community members came together to determine the best ways to quickly provide mental health services, treatment and safe plans for people in crisis. A new Avera St. Mary s Hospital Community Health Needs Assessment 2016 4
Mobile Crisis Team is just launching for weekends, with law enforcement and mental health counselors working together to keep people who do not need hospitalization or jail safe at home and into local treatment. In 2014, Julie Cox, a PA with mental health certification, was hired at AMG-Pierre to help manage and coordinate mental health care in the clinic. Dr. Gammeter, Child Psychiatrist, is seeing youth via e-consult and Dr. Chiu, psychiatrist with Avera St. Luke s in providing once a month clinic for 8 hours a day at Avera St. Mary s. This CHNA report will be put on the Avera St. Mary s website and paper copies will be available at the hospital. Since the previous CHNA, no written comments were submitted to review. Description of Community Served by the Hospital St. Mary s Hospital was founded in 1899, when five Benedictine Sisters came from the Sacred Heart Convent in Yankton, South Dakota to start a school. They arrived with a total of $20. The community members, including physicians, brought their sick patients and family members to the Sisters, as a hospital was needed also. The Sisters initially operated both a hospital and a school, eventually transferring the school to the local parish and focusing on the hospital. Avera St. Mary s Hospital is now part of the Avera Health System, founded by the Presentation and Benedictine Sisters. Avera St. Mary's includes: Avera St. Mary's Hospital, Avera Maryhouse Long Term Care, and Avera ParkWood Independent Living Apartments in Pierre and Avera Medical Group Pierre, a clinic with over 40 physicians and mid-level practitioners. Avera Health is the leading health system in the region, at more than 300 locations in about 100 communities. Avera s unique partnership model makes possible a wide range of medical services through the expertise of specialists, sophisticated technology and cutting-edge research to meet the health care needs of local communities and providers. Management and other support services are provided through the Avera Central Office in Sioux Falls, SD, and its six regional centers: Avera St. Luke s Hospital in Aberdeen, SD; Avera Queen of Peace Hospital in Mitchell, SD; Avera St. Mary's Hospital in Pierre, SD; Avera McKennan Hospital and University Center in Sioux Falls, SD; Avera Sacred Heart Hospital in Yankton, SD; and Avera Marshall Regional Center in Marshall, MN. Avera St. Mary s Hospital is the only hospital in the area, with Avera Gettysburg Hospital (a critical access hospital) the next closest located 60 miles away in Potter County. Tertiary hospitals are on the borders of the state and at least a 3 hour drive from Pierre, one way. Avera St. Mary s Hospital Senior Leadership Team in June, 2015, determined the geographic area for this needs assessment would be Hughes, Stanley, and Sully Counties, which represent the primary service area of the hospital and with 70% of the hospital's residency data. While Hughes County has the largest population in Central South Dakota, including Stanley County and Sully County demonstrates community needs in the rural counties served by the hospital. This area includes medically Avera St. Mary s Hospital Community Health Needs Assessment 2016 5
underserved, low-income and minority populations. Avera St. Mary s Hospital is committed to meeting the needs of all who need care regardless of their ability to pay. Since 2010, all three counties showed population gains. Hughes County increased 3.6%, Stanley County increased 0.6% and Sully County increased 4.7%. These three counties are the primary service area of Avera St. Mary s Hospital. (http://census.gov/) Racial/Ethnic Composition According to the U.S. Census Bureau, Avera St. Mary s primary service area is comprised of 90.8% white, with 9.2% American Indian. White American Indian & Alaska Native African American Asian Hughes County 14,624 / 88.7% 1,608 / 10% 133 / 0.8% 128 / 0.8% Stanley County 2,619 / 90.2% 286 / 9.8% 0 0 Sully County 1,442 / 99.7% 4 / 0.3% 0 0 http://factfinder.census.gov/ 2010-2014 American Community Survey 5-Year Estimates Social & Economic Factors While Pierre is the Capital City of South Dakota, the three counties of Hughes, Stanley, and Sully are rural. Current median household income ranges from $57,614 in Hughes County, to $57,930 in Stanley County and $61,606 in Sully County. This demonstrates the larger agricultural holdings in these areas being held by a relatively small number of residents. (http://census.gov/) County Health Rankings show all three counties have impressive high school graduation rates, from 83% in Hughes County to 97% in Stanley County and 92% in Sully County. This is compared with the state average of 83%. Another bright spot in the statistics is the region s low unemployment rate, 3.0% in Hughes County, 2.7% in Stanley County, and 2.5% in Sully County. County Health Rankings also show that the uninsured rate is 12% in Hughes County, 16% percent in Stanley County (a 10% decrease since the previous CHNA) and 14% in Sully County (a 1% decrease). Children in poverty rates were reported at 14% for Hughes County, 14% for Stanley County and 7% for Sully County. The rate of children in single-parent households ranges from 22% in Sully County, 27% in Hughes County to 36% in Stanley County, all above the National Benchmark of 20%. Clinical Care For the region, according to County Health Rankings, health screenings are high, meeting or exceeding the South Dakota average, and approaching the National Benchmark. Diabetic screenings are: 87% for Hughes County, 78% for Stanley County, and limited data for Sully County, with South Dakota at 84% and a National Benchmark of 90%. Mammography screenings are: 73.9% for Hughes County, 67.3% for Stanley County, limited data for Sully County, with South Dakota at 66.5% and a National Benchmark of 70.7%. Avera St. Mary s primary service area has fewer primary care physicians and dentists than the South Dakota rate and the National Benchmark. Avera St. Mary s Hospital Community Health Needs Assessment 2016 6
Health Factors Since the previous CHNA, Hughes County has had a 1% decrease in the smoking rate, from 15% to 14% and a 2% decrease in adult obesity from 30% to 28%. For Stanley County, the smoking rate increased from 16% to 17% and no change in the obesity rate of 33%. For Sully County, there is no smoking rate reported for 2015 and a 4% obesity rate decrease from 36% to 32%. Physical inactivity rates are also a concern. The South Dakota benchmark is 25% and Hughes County is the only one below that value at 21%. The physical inactivity rate for Stanley County is 31% and for Sully County has 28%. Who was Involved in Assessment The assessment process was initiated by Avera St. Mary s Hospital in 2015. The municipal departments, school districts, Urban Indian Health, rural health clinics, mental health and all agencies providing health or related services within the counties were invited to participate in the community health needs assessment. To ensure input from persons with broad knowledge of the communities, invitations to participate were issued to people that ensured a wide spectrum of age, members of underserved populations, uninsured/underinsured, consumers of health care, parents of school aged children, United Way and other social service staff and organizations, local clergy, staff from state agencies on aging, social services, and health, government employees, emergency room physician, hospitalists, hospital leadership and persons residing in each of the three counties. Those who committed to the assessment and planning process, and to attending committee meetings, became part of the Community Health Needs Assessment (CHNA) Team. This report consists of the data collected from the surveys and interviews they conducted. How the Assessment was Conducted This assessment began with a presentation to the entire team by Heidi Schultz, Rural Health Program Officer, Focus on South Dakota, A Picture of Health a survey commissioned by the Leona M & Harry B. Helmsley Charitable Trust. This educational opportunity gave our team a clear look at unprecedented statewide survey data regarding behavioral health frequency and access to care, and introduced many issues, such as work force, that we are and will continue to face. Community surveys were completed by: Pierre/Fort Pierre Rotary, Pierre Lions Club, Pierre Kiwanis, Head Start and Parents Matter, and data from Pierre Area Referral, South Dakota Departments of Health and Education, County Health Rankings and Avera St. Mary s Hospital. The sub-committees met and decided to conduct interviews with key community members and to hold focus groups for special populations. Additionally, as part of a grant from the South Dakota Department of Health (DOH) the DOH CHNA Toolkit surveys were completed by interviewing community, government, workforce, and educational personnel. From this information, the CHNA Team discussed initial findings and developed a comprehensive list of community needs. (Attachments) Avera St. Mary s Hospital Community Health Needs Assessment 2016 7
Identified Health Needs Mental Health Services One of the most important community needs identified in the CHNA interviews, surveys and focus group is the need for increased psychiatric services, including recruitment of at least one psychiatrist and developing a regional approach to mental health crisis and mental health wellness. Secondary data from the Focus on Health study of the Leona M. and Harry B. Charitable Trust supports these findings. Avera St. Mary s Mental Health Emergency/Crisis Room Referrals The people and agencies in this area pride themselves on their ability to collaborate and face issues together. One example of this is our Suicide Prevention efforts, which started in the late 1990s after a series of teen suicides. Healthy Community/Healthy Youth Coalition (HC/HY) was developed to focus on building assets in youth. HC/HY continues to meet monthly, and has active committees 20 years after the initial crisis. Because of our effective coalition, the Turner Foundation awards $50,000 to HC/HY for youth driven projects each year. After years of having a Community Crisis Room serving the region s mental health needs, it was determined by the Department of Health and other members of the community s Crisis Team, that there was a better way to serve people who are under an involuntary mental health hold. As a response to this event, the Community Crisis Team is expanding to address this need and is committed to safely meet the community s needs. While much has been done, and continues to be done, by this coalition, the Community Mental Health Center staff, and other mental health professionals regarding mental health, the community knows that mental health is an evolving and growing need. Mental Health Emergency/ Crisis Room Referrals Total Voluntary Involuntary 0-17 Years 18-21 Years 22+ Years Age Range 2010 157 42 115 58 11 88 7 to 85 2011 130 16 110 41 12 77 8 to 83 2012 138 32 106 54 16 68 5 to 90 2013 154 27 124 43 22 89 10 to 77 2014 150 20 130 44 24 82 11 to 82 2015 191 24 167 78 10 103 10 to 85 Avera St. Mary s Hospital Community Health Needs Assessment 2016 8
Chronic Health Issues Another important community need identified in the CHNA interviews, surveys and focus group is the need for chronic disease reduction of cancer, diabetes, heart disease and obesity rates. Cancer Clearly identified in our interviews, focus groups and surveys was the community feeling we needed more physician specialists, including oncologist, psychiatrist, and dermatologist. These are also the specialists that Avera St. Mary s Hospital and Avera Medical Group have identified as priorities for recruitment. One of the clearest health care needs identified is the need for a Cancer Center, which includes oncology radiation. Cancer mortality is showing an increase in Hughes County and Sully County, while Stanley County, South Dakota, and the United States are showing a decrease in cancer mortality. Avera St. Mary s Hospital Community Health Needs Assessment 2016 9
Cancer Mortality Rates Per 100,000 Population 2004-2008 2006-2010 2010-2014 United States 180.7 175.3 163.2 South Dakota 189.3 166.3 163.2 Hughes County 138.4 144.7 155.6 Stanley County 261.8 210.4 158.7 Sully County 119.8 138.9 167.3 https://doh.sd.gov/statistics/2014vital/healthstatuscounty.pdf https://doh.sd.gov/statistics/2010vital/healthstatusbycounty.pdf https://doh.sd.gov/statistics/2008vital/countyprofiles.pdf Diabetes Diabetes is an area for wellness opportunities, especially in Stanley County, where 21.4% report they have been told by a doctor they have diabetes. This is compared with 11.4% in South Dakota, 16% in Sully County and 18.1% in Hughes County. Continuing to expand Harvest of the Month and other fruit and vegetable consumption programs (i.e. the USDA MyPlate) will positively impact and ideally reduce those with type 2 diabetes. Combined with healthy eating, physical activity is important for type 2 diabetes reduction. To encourage physical activity, Pierre was awarded funding to create a play trail with various play pods along the 4 mile path and was named a Playcore national demonstration site (http://ci.pierre.sd.us/civicalerts.aspx?aid=110&arc=172). Avera St. Mary s Hospital, Urban Indian Health Clinic and Vilas Pharmacy are partners in a HRSA Coordinated Care grant. The Coordinated Care teams are working with an RN Coordinator, Clinical Care Specialist, Social Worker and Certified Diabetes educator who are working with patients and the providers to remove the patient s barriers to health care success. Crock pots, cooking lessons, and tours through patient s grocery stores are all part of the coordination. This program is focused on newly diagnosed Avera St. Mary s Hospital Community Health Needs Assessment 2016 10
diabetes patients in Central South Dakota, including the Pierre area. In the three year demonstration grant, 20 patients will be enrolled each year and tracked for success. Heart Disease Another area for wellness opportunities is around heart disease. While heart disease mortality rates decreased for South Dakota and the United States since 2004, there is currently an increase in Stanley County. Hughes County and Sully County display an existing downward trend. Heart Disease Mortality Rates Per 100,000 Population 2004-2008 2006-2010 2010-2014 United States 200.2 186.5 169.8 South Dakota 191.2 163.9 152.7 Hughes County 145.6 161.5 134.5 Stanley County 100.3 58.8 89.6 Sully County 137.3 145.2 117.7 https://doh.sd.gov/statistics/2014vital/healthstatuscounty.pdf https://doh.sd.gov/statistics/2010vital/healthstatusbycounty.pdf https://doh.sd.gov/statistics/2008vital/countyprofiles.pdf Obesity The School Height and Weight Report for 2014-2015, prepared by the South Dakota Department of Health provides data regarding overweight and obese students in Avera St. Mary s primary service area. The report breaks the state into regions. Childhood obesity in Region 6 (2,687 children ages 5+ which includes Hughes, Stanley and Sully counties) decreased from the previous CHNA report. For overweight students, the decrease is 2.8% from 18.6% to 15.8%. For obese students, the decrease is 1.7% from 17.4% to 15.7%. This results in a combined decrease of 4.5% for students that are both overweight and obese from 36% to 31.5%. While this decrease is a positive trend, it still Avera St. Mary s Hospital Community Health Needs Assessment 2016 11
Percent indicates there is more work to be done regarding prevention efforts. School Height/Weight Data Region 6 % Reported 2011-12 2014-15 Change Overweight 18.6 15.8-2.8 Obese 17.4 15.7-1.7 Combined 36 31.5-4.5 https://doh.sd.gov/documents/statistics/heightweight2014-2015.pdf https://doh.sd.gov/statistics/assets/2011-2012report.pdf 45 School Height/Weight Data Region 6 35 25 15 2011-12 2014-15 Overweight Obese Combined One of the committees within HC/HY, the Let s Move coalition, continues to expand the Harvest of the Month (HOM) program. The goal of HOM is to introduce school children to various fruits and vegetables each month through a short educational program and then tasting the featured food during gym class. Since the previous report HOM has been implemented in two additional schools in Sully County and four afterschool sites in Hughes and Stanley Counties: Boys & Girls Club of the Capital Area, Oahe YMCA, Saint Joe s Afterschool Program, Southeast Community Center s Busy Bees Program, Stanley County GOLD Program. At each afterschool site, the youth review the HOM and make their own snack for an additional tasting. Additionally, HOM is presented each month by the Community Wellness Coordinator at the Hughes County Juvenile Services Center, with the incarcerated youth there learning about the featured fruit or vegetable and making their own snack. Smoothies are the popular favorite and the youth have shared they have made some HOM snacks at home with their families. Given the success of HOM in the schools, the coalition applied for funding from the Walmart Foundation and received $25K to implement HOM and MyPlate activities at both the Busy Bees program and the weekly Banquet, which is a meal prepared by local service organizations and served to low-income families. Funding is being used to Avera St. Mary s Hospital Community Health Needs Assessment 2016 12
purchase fresh fruit and vegetables to replace serving the more common processed options. Additionally, to continue the coalition s work on chronic disease prevention through healthy eating and nutrition, they were awarded a $75K grant from the Wellmark Foundation. The grant program will expand gardens at local sites, and engage youth in gardening and nutrition programs by training area high school youth to lead educational garden and nutrition programs. The grant will provide services at one site in Sully County, one site in Stanley County, and eight sites in Hughes County. Let s Move Coalition is also involved with efforts to provide access to fruits and vegetables to all, especially those with little to no financial means. The Coalition joins volunteers across the area to support Pierre Area Referral Service in the Food Pantry and BackPack program. The program offers backpacks of 12 food items every Friday to students identified by school teachers as likely to not have food available at home over the weekend, with 320 distributed weekly at a cost of $1040. Working with Feeding America, we can now include oranges and apples in the backpacks. Obesity, and in particular childhood obesity, was a frequently identified health concern in our surveys, focus groups and interviews. We know that obesity plays an important role in heart disease, diabetes and other chronic illnesses. The Avera St. Mary s Hospital strategic plan recognizes these needs and they are included in the future building and business line needs. Meeting the educational needs, support groups, screenings and providing care for those unable to afford these services will be one of the challenges to address in the community needs and action plan for the future. Several physicians and community members attended Healthy Kitchens/Healthy Lives training presented by Harvard TH Chun School of Public Health and the Culinary Institute of America. Several years ago, the first participants held community cooking classes that were well received by the public. The kitchen used was no longer available, and the classes were no longer offered. This year, several additional physicians attended this training and are ready to once again hold classes and bring good health information and cooking techniques to the public. We plan to explore various cooking kitchen opportunities, including Avera St. Mary s kitchen, Urban Indian Health cooking kitchen and the new kitchen being built at the Community Youth Involved Center in Fort Pierre. Community Assets Identified The assessment identified a number of strong community assets, including the walking paths and recreational opportunities in Pierre, community support of those going through tragedies and the coalitions like Healthy Community/Healthy Youth. The hospital and clinics were listed as assets, and appreciation for the new Urgent Care services and hospitalists. The people in the community are united, easy to talk to, and there is a spiritual connection through a variety of ways including Community Banquet Avera St. Mary s Hospital Community Health Needs Assessment 2016 13
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Attachment 3.a Avera St. Mary s Hospital Community Health Needs Assessment 2016 19
Attachment 3.b Avera St. Mary s Hospital Community Health Needs Assessment 2016 20
Attachment 4 Focus Group Report for CHNA 2016 Chronic Disease: Cancer cancer care, radiation Dermatology Mental illness mental health Gambling Adverse childhood events Weight/obesity Lack of healthy life styles Families Coordinated Care Special populations: Natives health & wellness Teens - suicide, places, pregnancy Low income adults Affordable housing childcare Elder care Support services for care givers Access to elder care Healthcare issues: Workforce Development Right Care/Right Place/Right Time Access to healthcare hours Cost of getting insurance Connecting people to services Taking more time for Medicare patients, discharge planning, Avera St. Mary s Hospital Community Health Needs Assessment 2016 21
Resources: (available at Avera St. Mary s Hospital or directly with source) Fort Pierre Trade Area Demographic & Retail Market Update by E.D. Hovee & Company, LLC Good & Healthy South Dakota, South Dakota Department of Health http://goodandhealthysd.org/ Hughes County Resource List Pierre Area Referral Service http://www.pierreareareferral.org/ Let s Move! Healthy Communities for a Healthy Future- National League of Cities http://www.letsmove.gov/ Needs Assessment Summary, Jones, Hyde, Hughes, Sully, Mellette and Stanley Counties, Oahe Child Development Center, Inc. http://www.oahechild.com/ South Dakota Care Transitions, South Dakota Foundation for Medical Care http://www.sdfmc.org/ Market Discharges, Days and Charges, South Dakota Association of Healthcare Organizations https://www.sdaho.org/ Avera St. Mary s Strategic Plan http://www.avera.org/st-marys-pierre/ Avera St. Mary s Hospital Community Health Needs Assessment 2016 22