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HomeMy WebLinkAbout1985-03-11_SPECIAL MEETINGSJ c (I- l �1i- 3 I rr�YJ� -, C11 r3d. / EDINA ADVISORY HEALTH COMMITTEE PUBLIC HEALTH I. Overview of Public Health A. Definition: The discipline and practice of managing the health needs of the public or the community. B. Focus: The public good: public, community, aggregate C. Major Values: 1. Public good: The greatest good for the greatest number at the least cost. 2. Distributive justice: reallocation of resources to provide the basic needs for all. 3. Responsibility of the individual: to self, family, community. 4. Responsibility of collective: to protect the many from the unsafe actions of the few. D. Major Goals: 1. Prevention: to prevent disease, disability and premature death. 2. Promotion: to promote health, wellness and quality of life. 3. Protection: to protect all from hazards and risks that lead to disease, disability, loss of independence and premature death. E. Major Intervention Strategies: 1. Education: teaching, guidance and counseling for individuals, families, groups, organizations and committees. 2. Engineering: changing, building, adapting, planning structures and products. a. Environmental: structuring, modifying, adapting things within the physical environment. 1. community: floridation of water, sewer system 2. organizations: chmical exhaust system within a'factory 3. family: deadbolt locks on doors, smoke detectors 4. individual: immunizations, wearing seat belt.in car b. Social: modifying behaviors of individuals, families, groups, organizations, communities U c. Management /Organizational: 1. Community: establishing overall health systems plan 2. Organization: administration and management of public health services, development of programs, allocation of resources, deployment of personnel 3. Family: assisting family in restructuring roles and activities . as needed during period or illness or crisis 3. Enforcement: legislation, regulations, law, monitoring and surveillence activities EDINA DVISORY HEALTH COMMITTEE AND CITY COUNCIL MEETING March 11, 1985 Excerpts from the Minnesota Coalition of Health Care Costs report, The Price of Life: Ethics and Economics., December, 1984, are noted here because of their relevance to our disucssion on Public Health: The ability to provide technology is exceeding our ability to pay, therefore rationing of health care resources is inevitable. Principles for rationing: 1. No person should be denied potentially beneficial medical care on the basis of limited health care resources unless waste and inefficiencies are first eliminated. 2. Society has an obligation to ensure equitable access to a "basic level of health care" to all people. There are three actions to reduce inefficiency which will forestall rationing: 1. Education. Extensive programs by government, health care.institutions, and other major actors in health care to educate health care providers, employers, third party payors, policy makers and the general public about the reality of the need to deal with limited health care resources. 2. Program Focus. A. Details of alternative actions to reallocate health care resources to slow drift toward rationing. B. Ethical, social, legal, theological and exonomic issues associated with allocations and rationing. 3. Prevention. Eliminate the current bias against prevention and public health programs. A. Develop new and expand existing prevention programs offered by employers, health maintenance organizations, other providers and payers of health care. B. Increase proportion of health care expenditures by state and local authorities in Minnesota devoted to public health, especially in prenatal care and health education. C. Employers, health care providers and public and private third party payers provide financial and other incentive to consumers to participate. in prevention programs. MINUTES OF THE REGULAR MEETING OF THE ADVISORY HEALTH COMMITTEE HELD WEDNESDAY, MARCH 5, 1985, AT 7:30 P.M. EDINA CITY HALL CONFERENCE ROOM MEMBERS PRESENT: Chairperson Barbara Reynolds, Holly Branch, Kris Hagen, Jim Hansen, Sharon Aadalen, June Schmidt, Virginia McCollister, Walter Wilder MEMBERS ABSENT: Effie McKerson, Stephen Sinykin, Margaret Rash STAFF PRESENT: David Velde, City Sanitarian OTHERS PRESENT: Yvonne Hargens, Bloomington Public Health I. Approval of the Minutes: January 30, 1985 Mrs. Schmidt moved for approval of the minutes and Mrs. Aadalen seconded the motion. Mrs. Reynolds recommended corrections to the minutes. She noted that Mrs. Aadalon was appointed to the Minnesota State Community Health Services Committee by the Mayor and City Council. She also noted the discussion regarding the commendable police referral work done in Bloomington and Richfield. Bloomington Public Health Services followed up on cases of domestic violence. It was decided that Kris Hagen and Sharon Aadalon would speak with the Edina Police Department and report back to the Advisory Committee. All were in favor of approval with the changes added; the minutes were approved. II. Business: Mrs. Reynolds expressed a need for an Executive Committee explaining that there were occasions when it could be necessary for only for two or three members to consult. This could consist of the Chair, the Vice and one other member. Discussion ensued regarding the functions and possibilities of an executive committee. The main purpose would be to facilitate communication and this Committee's ability to keep abreast with what is happening in the Community and contribute input. Mrs. Aadalon moved that an executive committee be created consisting of three members and Mr. Hansen seconded the motion. All were in favor; the motion carried. Mrs. Aadalon volunteered to act as the "Commission Member" or third member on the Executive Committee. Community Reports. Senior Task Force Report. Mrs. Reynolds stated that Joyce Omelianchuk and Clem Peterson presented their report at the last meeting. She summarized that the needs they found were elderly people who did not know how to obtain service. Mrs. Reynolds added that Edina has the largest suburban count of elderly. The lifespan has increased and therefore, we can expect a large growth in this population of 75 years of age and older. She noted that she had spoken with people from the South Hennepin Human Services Council who had published the book *. They are presently conducting a survey regarding the elderly similar to one they had done three years ago. The South Hennepin Human Services Council mentioned that hearing is a major health problem for the elderly. Perhaps community hearing tests and screenings could be conducted. The surveys also showed interests in home health care. Yvonne Hargens, Bloomington Public Health Nursing Services, addressed this issue. She stated that financing presented problems for the home health care. Also, the people are not taught how to care for themselves once their financial benefits are exhausted. Home health services were discussed. Many times nursing services are not need, however, some form of adult day care is. Mrs. Reynolds suggested a public health nurse be present at the Edina locations of food distribution in order to provide counciling for nutrition as well as direction for other health needs. There was discussion of the quality of care provided through the group health programs regarding the elderly. Youth Task Force. Holly Branch reported that the main problem uncovered was the lack of coordinated information of referral and access. She suggested an informative telephone number. She reported that they reviewed various youth concerns and offered the following suggestions: Mental Health: A family or youth counceling center or service available at the Edina Community Center would be appropriate— Chemical Dependency: * Public transportation to Fairview Detox. * Encourage the expansion of half -way houses. * AA related groups conduct meetings at the a Edina Community Center. * Support legislation to increase the drinking age to 21 years. Mental Disabilities: Presently only one mental health facility in Edina. It should be suggested that the Council encourage other activies or establishments in this community. Child Care: Latch -key program is very adequate, however, there is a need for infant programs and day cares. Family Violence: Dr. Hagen spoke with the Police Department and reported that weekends are the trouble times. Yvonne Hargens agreed that the largest amount of referrals from the Police Departments are received on Mondays. She spoke about the referral service. It was noted that the Edina Police Department did not participate, however, in this referral service. Ms. Hargens explained that the Edina Police Department was not interested in participating because of the possibility that the nursing services contract could be changed at any time. They hated to start a program which could possibly be discontinued in a short period of time. When questioned, the Police Department noted that few arrests were made in regards to family violence, because the complainant did not want to press charges. Ms. Hargens argued that it was the policeman's responsibility. Public Health Nursing. Mrs. Reynolds believed that a yearly renewal contract with nursing services was not beneficial. Large amounts of staff and committee time are spent each year evaluating contract renewals. The renewal period should be extended. Discussion ensued regarding this contract and how it should be presented to the Council. Mrs. Aadalon motioned that the Committee include in their recommendation to the City Council that the Bloomington Public Health Nursing contract extend for a minimum of two years that corresponds with the Community Health Service funding cycle. Dr. Hagen seconded the motion. Mr. Hansen motioned that this apply to a services whoever they are contracted with. Dr. Wilder seconded the motion. All were in favor; the motions carried. Sharon Aadalon presented to the Committe the following excerpts from the Minnesota Coalition of Health Care Costs report The Price of Life: Ethics and Economics. December, 1984: The ability to provide technology is exceeding our ability to pay, therefore rationing of health care resources is inevitable. Principles for rationing: 1. No person should be denied potentially beneficial medical care on the basis of limited health care resources unless waste and inefficiencies are first eliminated. 2. Society has an obligation to ensure equitable access to a "basic level of health care" to all people. There are three actions to reduce inefficiency which will forestall rationing: 1. Education. Extensive programs by government, health care institutions, and other major actors in health care to educate health care providers, employers, third party payors, policy makers and the general public about the reality of the need to deal with limited health care resources. 2. Program Focus. A. Details of alternative actions to reallocate health care resources to slow drift toward rationing. B. Ethical, social, legal, theological and exonomic issues associated with allocations and rationing. 3. Prevention. Eliminate the current bias against prevention and public health programs. A. Develop new and expand existing prevention programs offered by employers, health maintenance organizations, other providers and payers of health care. B. Increase proportion of health care expenditures by state and local authorities in Minnesota devoted to public health, especially in prenatal care and health education. C. Employers, health care providers and public and private third party payers provide financial and other incentive to consumers to participate= in prevention programs. 1 PUBLIC HEALTH PROBLEMS /CONCERNS IDENTIFIED BY THE EDINA HEALTH ADVISORY COMMITTEE March 11, 1985 "Public Health is the Discipline and Practice of Managing the Health Needs of the Community" OLDER ADULTS DEMOGRAPHICS: Edina has the largest suburban count of elderly people of any other suburb. The population between the ages of 75 and 84 will increase by 38 per cent and those aged 85 and over will increase by 72 percent in the next fifteen years. PROBLEMS AND CONCERNS 1.1. Seniors will be entering nursing homes who could, with personal assistance, be maintained at home. Q � � 1.2 Because of D.R.G., many seniors will be discharged from hospitals before they are well and able to manage for themselves. 1.3 Loss of hearing is a common problem among elderly causing problems related to safety, isolation and inability to communicate. PUBLIC HEALTH VALUES OR GOALS 1.1 Protect individuals from loss of independence. 1.2 Protect against disability, protect against premature death, promote wellness. 1.3 To prevent disability; to protect against loss of independence; to promote the quality of life. -1- POSSIBLE ACTION STEPS 1. 1 Provide a consultation service to seniors and /or their families regarding services available in the Community. (Chore services, meals on wheels, nursing care)etc. d. h� kw,,- how to aettif 1{1.ez Stydil" PROVIDER ORGANIZATION /INDIVIDUAL 1.1 Public health nurse or geriatric nurse practitioner at Bloomington Public Health Department. 1.2 Assistance in planning for : . 1.2 Public health nurse-is and coordinating service so that available to assist in planning services may be provided, if and coordination. necessary. When third party insurance for skilled nursing care runs out. 1.3 a.) Health education regard- 1.3 a.) Health educator at ing this problem targeted toward Bloomington Health Department sensitizing seniors and their 11 (Newspaper, talks, etc.) relatives; b.) hearing screening b.) Public Health Nursing clinics to identify cases and refer promote screening clinics for for help. oldsters. v' rio PROBLEMS AND CONCERNS 1.4 Lack of standards/ licensure for home care agencies: - quality assurance . - safe care - ethical conduct among providers 1.5 Mental health and chemical dependency problems among the elderly. Few resources available for individual and relatives who need help for oldsters. 1.6 There seem to be many services for elderly - meals on wheels, Bloomington Health Department, VEAP, Senior Comm- unity Center; but many elderly services - or there are elderly who are semi - reclusive and are over looked by service providers. PUBLIC HEALTH VALUES OR GOALS 1.4 It is the responsibility of the collective to protect the many from the unsafe actions of the few. 1.5 To prevent disease and disability; To promote wellness and quality of life. 1.6 To promote the quality of life. POSSIBLE ACTION STEPS 1.4 a.) To push for state licensure of home care agencies. b.) To provide educational programs for "buyers" regarding what to expect, ask for, and cost of home care, c.) to establish a process for handling grievances. 1.5 a.) To encourage use of mental health services by elderly and their relatives b.) To encourage the invi tation for expansion of services to oldsters in this Community. c.) To encourage churches, community groups, etc. to provide meaningful activities for seniors. PROVIDER ORGANIZATION /INDIVIDUAL 1.4 a.) Community Health Services administrator writes our state legislators to encourage licensure /some kind of standard setting. b.) Public Health Nursing Services provides consultation and /or information for buyers. c.) Community Health Services admins- trator determines from State Health Department, the grievance process. If there is none, consider ways to handle these. 1,5 a.) Profit /non - profit psychiatric and c.d, programs; provide flyers, radiolT . V . spots b.) Promote insurance for counseling coverage for the elderly. 1.6 Access and information flow to 1.6 a.) South Hennepin Human Services elderly to tell them about services. Council keep up -to -date information on services offered in Edina and act as an information and referral service to resident b.) Bloomington Health Dept. could pro- vide information and referral c.) Edina Community Center might be used to esta- b ish information and referral service. -2- I.� PROBLEMS OR CONCERNS 2.1 Lack of coordinated infor- mation, referral and access to information. V, 2.2 Diphtheria, Pertussii tetanus is in short supply. Danger of pert ussis occurance . 2.3 Mental disabilities among youth. PUBLIC HEALTH VALUES OR GOALS POSSIBLE ACTION STEPS YOUTH 2.1 To promote quality of life responsi- 2.1 To promote an information and bility of individuals to provide for self referral service regarding youth for and family. Edina, 2. 2 To prevent disease . 2.3 To prevent disease, disability. 2.2 Determine the extent of problem and dangers. 2.3 Encourage organizations interested in starting residential facilities, respite care or day care activities for mentally retarded, etc, here in Edina. PROVIDER ORGANIZATION /INDIVIDUAL 2.1 Community Center, Edina could be center for information and refer- ral; Our own "Jt5t Call for Help ". rl.l � 2.2 Community Health Services Administrator or Public Health Nurse Administrator pursue this question. 2.3 City Council be open to support- ing zoning for these purposes. 2.4 Lack of infant and day care 2.4 To promote health. 2.4 Encourage service providers to provide 2.4 --------------------------------- programs in Edina - (adequacy infant care in Edina. of latch key programs.) 2.5 School age youth in schools 2.5 To prevent disability to promote 2.5 Provide school nursing services in the 2.5 To develop a demonstration may not be receiving adequate health. schools,. to do case finding, to work with school where there is a full -time assessment and referral for families, teachers and the school communi- school nurse /PHN who provides school related injuries, for ties regarding health problems. assessment, education, counseling, behavioral and physical problems case finding consultations, infor- mation and referral sources. 3.1 Lack of knowledge of health status of those below the poverty level in Edina. There are approximately 325 individuals coming to Food Distribution Centers monthly. (Approxi- mately ten new people each month - mostly elderly and single parents �7 V_ 3.1 To prevent disease and disability. POVERTY 3.1 To interview individuals who apply for food at food distribution centers to. determine health status and suggest referral : resources, -3- J �✓ U" �rC Jn f„tc% Qt.y 3.1 To place public health nurses at each Food Distribution location to conduct interviews, to do health edu- cation, counselling, case finding and referral for health and human concerns. PROBLEMS OR CONCERNS PUBLIC HEALTH VALUES OR GOALS POSSIBLE ACTION STEPS 4.1 Police are called in for domestic disturbances which do not necessarily result in an arrest and where physical violence is not the primary reason for the call. It may be an argument between spouses, a suicide attempt, a chemical user who is behaving in inappropriate way - many of these families are well known by the police because of the frequency of the calls. 5.1 Lack of knowledge of services available to Edina citizens. Inability of residents to find and use health and human services, especially public health. DOMESTIC DISTURBANCES 4.1 To promote health 4.11 To do follow -up interviews with family members to determine source of the problem and appropriate follow up and' /or referral. 6.1 The Community Health Service Plan is written for a two -year period. This plan includes programs and services which will be provided as well as budget allocated. Large amounts of Staff and Committee time are spent each year evaluating the public health nursing - contract renewal. VISIBILITY OF PUBLIC HEALTH SERVICES IN EDINA 5.1 ------------ - - - - -- 5. 1, a.) Provide flyers on occasions to all residents to describe Public Health and other services in Edina. b.) To have a regular column in the Suburban Sun regarding health and human resources in Edina. c. To redo the Edina Suburban Dir cotr for 1986 so that it reflects Pu . Health Nursing Services on the page giving Edina services; to indicate in the directory the Community Health Services Administrator's role; also, to list function of Edina Advisory Health Committee at least every other year. PROVIDER ORGAN IZATIONANDI V-1 DUAL 4.1 To develop a referral service between Edina police and Bloomington Public Health nurses who are already working very successfully with the Bloomington and Richfield Police Departments. Ik�L, ,KA a- "LL(N6(" V-e 13 i} je e — 5.1 a.) Community Health Services Administrator jointly with Bloomington Public Health Adminstrator. b.) City Council to appoint a small task force including a member of the Health Advisory Committee to review the listings and to make recommendations for changes to the Sun by November, 1985, 6.1 To develop a two -year contract which coincides with the two -year Health Services Plan. This would provide a more reason- able time frame for contracting arrangements -4- L"b`�