By Scott Swanson
Of The New Era/Lebanon Local
Sweet Home residents struggle with getting medical care, for a wide variety of reasons, a group of COMP-Northwest medical students reported Thursday, May 11, to Sweet Home Health Committee members.
The four medical students reported the results of a research study of Sweet Home residents’ health needs that they conducted in recent months, five years after a similar study was done in the community by another group of COMP-Northwest students.
Di Lacey, associate vice president at COMP-Northwest, told committee members that the students who conducted the 2017 study are “just now finishing up their residencies,” which is a final step before becoming a full-fledged medical doctor.
She and the current students noted that one of three “big needs” that came out of the 2017 study were youth mentorship in Sweet Home, the need for a clinic in Sweet Home and the need for more health resources.
Current student Holley Carlson-Riddle told the committee that she and the other three had just finished their final day of the MIKE mentorship program for Sweet Home High School students, which has continued since 2018 – virtually during the COVID, Lacey said.
“That was really exciting,” Carlson-Riddle said of her experience with the high school students. “We’ve been able to build a relationship there.”
Lacey told the committee that when she told students who worked on the 2017 study that ground had been broken for a clinic in Sweet Home, “two of them were in tears about that and just could not believe that that would actually happen.”
The current students reported that they held three focus groups, one in December for 10 “community leaders” and two in January for community members, in which 14 people participated, they reported. Central concerns that were voiced in those meetings were concerns about mental health, literacy and resources, as well as drug abuse, nutrition and transportation issues.
They noted a few significant changes from 2017 to the present.
One was a fairly significant increase in the number of total patients in the Sweet Home area, from 13,977 in 2017 to 17,840 in 2022.
The number of patients over 60 has also increased, from 4,813 in 2017 to 6,650 in 2022. In particular, the number of those over 80 has grown, from 987 in 2017 to 1,587 in 2022.
“What we see here is that those numbers are growing, so there’s a lot more people in the 80-plus category needing care,” student Jordyn Lacey said. “What this tells us is that the population is aging and therefore their health needs are changing.”
Other reported changes included an increased number of obstetrics hospitalizations at Samaritan Lebanon Community Hospital since 2017 and a surge in the number of continuous care visits – such as physical exams, vaccinations and wound care – at Sweet Home Family Medicine.
Lacey suggested that an explanation for the latter may be that “after COVID, people are finally getting in to see their family physician after not seeing them for so long.”
She said that the OB case numbers “just shows that the Sweet Home population has more pregnancies and deliveries.”
Students Mira Patel and Michelle Riedel highlighted some of the primary concerns they heard from surveys and focus groups.
Riedel noted that the survey questions were the same as the ones asked in 2017, plus five that were added based on responses from the previous survey.
They outlined eight topics that Riedel said “were continuously brought up” through the three focus groups: medical care, specialties, literacy, transportation, mental health, inadequate use of resources, drug abuse and nutrition.
Difficulty Establishing Medical Care
Patel reported that the biggest issues were poor physician retention and difficulties in accessing care.
She said a recurring theme was that people reported difficulties in finding physicians, then “every year having to find someone new,” which contributed to difficulty in establishing “follow-up care.”
“The physicians that they get comfortable with are moving on to different places or are getting involved in administration, and they’re losing their physicians,” Patel said.
Access to care is “difficult,” she said.
“The nearest place of care was Lebanon, which is a 30-minute drive, and even further. People would have to go to Albany, Corvallis or even up to Portland for their care and for the medications.”
Also, she added, “It’s very frustrating to navigate through the system to us to establish appointments being bounced around between different phone calls.”
Lack of Specialties
Riedel said those needs include diabetes management, dentistry, special needs, pediatrics, geriatrics and sight.
“Something that was very interesting, which we found from the quantitative data, was there’s a very obvious increase in the growing elderly population,” she said. “And it was mentioned several times throughout all three focus groups that family medicine physicians just don’t really understand the needs of the geriatric population. So that was a concern that was continuously brought up.”
Literacy Lack
Riedel said the issue is not just language, but cultural literacy.
“Ever-changing technology” presents a problem for those, particularly the elderly, who have difficulty navigating it, she said.
“People are having difficulty filling out documents and just navigating the healthcare system,” she said, citing examples such as Samaritan Health’s MyChart online health information portal, or simply long waits on the phone.
“They’re being redirected and then continuously waiting on those phone lines as well,” she said, adding that such individuals are often “insecure about their ability to advocate for themselves.”
Committee member Jim Gourley responded that he knows people have difficulty checking their MyChart or checking in ahead of time for appointments.
Transportation Issues
Riedel said students heard that residents may not be able to afford a vehicle, let alone fuel, and often need to travel extended distances to access care. Plus, they heard that there is “just hesitancy using public transportation.”
“Many individuals are traveling to many places for care,” she said.
Mental Health
Patel said students heard from focus group participants that “Sweet Home is a very depressed community.”
“There are changing community dynamics, neighbors no longer know each other and they no longer help each other out. Children are leaving. Small businesses are no longer able to make a profit and they are leaving.
“So with this changing community dynamic people are feeling more depressed. And this has increased the burden, especially on our children and on our elderly people in the community.”
She said participants described local youth as “more anxious and stressed” by “traumatic events” such as school shootings and the pandemic.
“COVID has only exacerbated these concerns,” she said.
Drug Abuse
People are also concerned about the presence of drugs and children’s exposure to that, Patel said.
She said participants mentioned that there is a “stigma” associated with needle drop stations in the community “because they were concerned about supporting drug abuse.”
Inadequate Use of Resources
Riedel said this problem is multi-faceted.
She said available health resources “are not being used at the level they should be” – “some really do utilize a lot of the resources while others just don’t use them at all.”
A question, she said, is whether people are unaware of them or whether there are stigmas associated with them – “individuals just don’t want to look a certain way, using these resources.”
Citing the example of Samaritan’s mobile medical clinic, which regularly visited Sweet Home before the pandemic, she said, “some have a hard time walking into the medical bus because they fear the future of their health.”
She noted that Manna Meals was shut down in January, which traditionally has been “their busiest season.”
Nutritional Health
Patel said that “a lot” of Sweet Home’s population are “living under the poverty line,” “such that this ends up becoming food deserts and people don’t really know how to maximize nutrition when they’re on a budget.”
“Because of this, there’s an increasing prevalence of childhood obesity and growing incidence of childhood disease, heart disease and other comorbidities that are very concerning.”
Recommendations
The students offered two recommended “action plans.”
One was to hold a monthly Community Education Forum, to which residents could bring questions and get educated about public health-related concerns.
“People can have an opportunity to be informed about the different resources that are there and that would help them out,” Patel said, adding that the community could also offer classes in mental health, nutrition and “substance abuse emergencies.”
Riedel said another good idea would be to offer refrigerator magnets or key chains that could be distributed in the community and that would provide emergency numbers such as 211 for essential services, the 988 Suicide and Crisis Lifeline, and or the Hope Center shelter for women.
“If the lack of real use of resources is due to the lack of knowledge, these could possibly help spread the word.”
She suggested that a future study could also focus on the question of why people aren’t using resources more.
She also advocated continuing the MIKE program at the high school and working with local residents through nutrition or fitness clubs, in conjunction with COMP-Northwest students, and having medical students volunteer in efforts to improve nutritional awareness and at Sweet Home’s homeless shelter or the Hope Center.
Patel recommended reviving the mobile health clinics “on a more regular basis” and including psychiatric and dental services.
Also, she suggested a partnership with Samaritan “to employ someone to help advocate for patients and navigate through the healthcare system and the healthcare system process.”
She also suggested that the new clinic in Sweet Home include “more trauma-informed primary care and specialty care physicians” in areas such as geriatrics, pediatrics, encodrine and specialty services and mental health.”
Riedel also recommended that the study be repeated in five years.
Committee member Bob Dalton said he’s been working to get the mobile clinic back to Sweet Home “just in the last month” and he suggested that COMP-Northwest students could “partner” with the clinic.
Committee member Kelsey Wray, of the Linn County Health facility in Sweet Home, asked if the students had gotten data from any other health providers in the county.
Carlson-Riddle said they had “strictly” worked with Samaritan in gathering data.
Gourley suggested that the Cascade Council of Governments also “does a lot of capturing information” that, although it may not pertain directly to medical, does include housing data, which might pertain particularly to the aging population.
Lacey thanked the community for welcoming the students and working with them.
“I’ve been in healthcare for 40 years and I have never seen a community that is more engaged or that is more progressive than this community,” she said. “You have welcomed our medical students for the last five years.
“You guys are the role model right now for community health in a very rural community – very engaged.”
Improving Communication
Following the students’ presentation, committee members discussed options for making people aware of resources and otherwise improving communication.
Dalton said his church has a “prayer chain” arrangement in which participants call on people on their list.
“You reach out and it’s just automatic – dial, dial, dial. If you live in a neighborhood where you knew 10 neighbors and they were on a call list on your desk at home and that emergency crisis comes down, if you initiate such a program, as simple as that sounds: ‘Are you OK? Do you have a need?'”
He said planning doesn’t have to be complicated.
“Sometimes, simple is better.”
Member Dick Knowles noted that he’s had experience with Meals on Wheels and suggested that people who deliver meals regularly to clients “probably see more in the community than anybody I know.”
“If I go to a home and somebody’s wearing their gown and slippers and I go there the next week, and they’re wearing the same gown and slippers and I go the week after and they’re wearing the same gown and slippers and I have to stand farther and farther back, somebody isn’t taking a shower and nobody’s paying attention. I’m the only one that knows.”
He suggested that people like bus drivers, neighbors, Meals on Wheels, post office employees might be able to provide alerts in situations where someone might need attention.
Homeless Situation Update
City Manager Kelsey Young reminded committee members that the city issued an emergency declaration relating to the homeless situation in March and is preparing its “ask,” the specifics of what Sweet Home needs in assistance from the state, which is due later this month.
Sweet Home will be asking for emergency family housing, as well as funding for a children’s shelter, she said.
It will also ask for 20 more huts for the FAC facility at the north end of 24th Avenue, as well as 20 transitional housing units for FAC clients who are ready to get jobs but aren’t quite ready for apartments yet.
“We don’t expect to get all of it, but we’re asking for a lot of it with the idea that it’s scalable,” Young said later. “If we can get some of it, it will help our community.
The city’s request doesn’t address senior housing or a teen center, “both of which we need,” she said, adding that the city will pursue those later.