COMMUNITY HEALTH NEEDS ASSESSMENT(CHNA) Triennial …...The main focus of this report is the results of our 2016 CHNA. The data collected will impact HSC’s decisions on programs

Hospital for Special Care

COMMUNITY HEALTH NEEDS ASSESSMENT(CHNA)

Triennial Report for FY ending 3/31/2016

3/24/2016

As a requirement of the Affordable Care Act (ACA), not-for-profit hospitals in the United States must complete a

Community Health Needs Assessment (CHNA) every three years. Once needs are identified, the hospitals create an

implementation strategy to outline programs to meet those needs and to track the outcomes of the programs. This

process was created to assure that, as tax-exempt organizations, hospitals are working with their communities to

meet the health needs of residents. Hospital for Special Care (HSC) performed its first required assessment in 2013

and has been working to impact the stated needs for three years. Program updates and progress are included in this

report.

The main focus of this report is the results of our 2016 CHNA. The data collected will impact HSC’s decisions on

programs and services for 2016 – 2019. Acute care hospitals usually consider their “community” to be a geographic

area surrounding their facilities. At HSC, we define our community as individuals living with chronic conditions or

physical disabilities, statewide. This definition impacts the population we survey, the comparative data we collect,

and the services we offer.

Community members and “key informants” (representatives of organizations that serve or support HSC’s

community) were surveyed regarding health status, services needed, and barriers to care. Results of surveys and

research on state and national data are presented here, with identified health needs prioritized. Following approval of

this report by the HSC Board of Directors, an implementation strategy will be developed toward impacting those

needs in the next three years.

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Table of Contents

Introduction ........................................................................................................................ Page 2

Results of 2013 CHNA Implementation Strategy ........................................................... Page 5

2016 CHNA Methodology ................................................................................................. Page 9

Assessment Summary: Identified Health Needs ........................................................... Page 12

Prioritized Community Health Needs ............................................................................ Page 46

Next Steps ......................................................................................................................... Page 49

Attachment ....................................................................................................................... Page 50

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INTRODUCTION

Hospital for Special Care

Hospital for Special Care (HSC) is one of the 10 largest, free-standing long-term acute care

hospitals (LTACH) in the United States and the nation’s only LTACH serving adults and

children. Established in 1941 as The New Britain Memorial Hospital, it was a municipal hospital

for “the medical and surgical treatment of all persons suffering from chronic or other diseases.”

Over the years the hospital changed its name to Hospital for Special Care, has grown to 228

beds, and is celebrating its 75th

anniversary in 2016.

As an LTACH, HSC provides a full spectrum of medical rehabilitation services for both

inpatient and outpatient care for complex rehabilitation and chronic diseases for both children

and adults. HSC is recognized for advanced care and rehabilitation in:

Pulmonary (including ventilator weaning and management)

Brain injury

Medically-complex pediatrics

Neuromuscular disorders

Spinal cord injury

Cardiac (including CHF1 and LVAD

2)

Autism spectrum disorders

Located in New Britain and Hartford, HSC operates inpatient and outpatient facilities serving

Connecticut and beyond on a not-for-profit basis. An important regional resource HSC prides

itself on being the answer to solving difficult healthcare problems for other hospitals, for state

and federal government agencies, and most importantly, for the community.

The hospital is set amid a beautiful campus of walking paths and flower gardens designed to

enhance the patient experience. For people with disabilities, HSC has made a special

commitment to assure that they may strive to achieve their fullest physical and recreational

potential.

Mission Statement

We will ensure exemplary care within our continuum, with the active involvement of

those we serve, so that they can achieve enduring improvements in their quality of life.

We will anticipate and be responsive to changing needs of our communities and a

changing healthcare environment by creating an innovative, fiscally sound, cost effective

system of care.

We will support the practice of rehabilitation and continuing medical care through

research and education.

We will create a work environment and climate where employees are supported to

provide excellent care, and find opportunities for personal and professional growth.

1 Congestive Heart Failure

2 Left Ventricular Assist Device

3

We will be, in all of the above, responsive and accountable to our communities, for

whose benefit we exist.

Demographics of HSC’s Community and Connecticut

Catastrophic illnesses and accidents occur regardless of personal demographics, income levels,

insurance coverage, or ability to pay for care. Because of the unique inpatient and outpatient

services we offer, people statewide choose HSC for their care. In the past two years our

clinicians and medical staff cared for:

outpatients from 95% of Connecticut’s 169 towns

children with autism spectrum disorder (ASD) from 71% of CT towns

inpatients admitted from 74% of CT towns

as well as patients from outside Connecticut

For these reasons, we consider Connecticut’s demographics to represent persons served by

HSC’s inpatient, outpatient, and community programs. Connecticut demographics are detailed in

a chart, Attachment 1.

While most of our newly admitted inpatients have healthcare coverage, many become Medicaid-

eligible during their stay. Our social workers and case managers support patient and family

efforts through the Title XIX application process. All of our programs accept Medicaid patients.

Community-based programs have free services or sliding scale services. Special Care Dental

Services, operating since 1997, was specifically designed to provide oral health care to uninsured

and underinsured children, with no geographic restriction. The program now dedicates some

clinic days to children with ASD, so they can receive care in a quiet environment, from

experienced staff.

Previous Community Health Needs Assessments

In 2007 and 2013 HSC partnered with The Hospital of Central Connecticut (HOCC), a

neighboring not-for-profit acute care hospital, to complete health needs assessments for residents

of the greater New Britain area. Both assessments included household telephone surveys and key

informant interviews. The findings from each assessment were utilized by HSC and HOCC to

prioritize public health issues and develop a community health implementation plan focused on

meeting the needs of that geographic community.

Questions asked in past CHNA data collection included a broad range of health issues of interest

to acute care providers. Many of these topics are not relevant to services offered by an LTACH

(e.g. obstetrics, surgical care, emergency department, and many acute illnesses). Additionally,

we were not afforded an opportunity to ask detailed questions on chronic diseases, limitations

posed by disabilities, and challenges facing caregivers of our typical populations. Responses to

such questions would provide useful data to help HSC address the needs of our patients and

program participants.

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2016 Community Health Needs Assessment

To improve upon the defined community served by HSC and to ask more specific questions of

that community, the 2016 CHNA was conducted independently. HSC provides care to inpatients

and outpatients from nearly every town in Connecticut, not to a small geographic area typically

defined by community-based healthcare systems.

When partnering with an acute care system, the focus is on more and broader groups of patients

(e.g. individuals with diabetes or cancer) commonly treated in such systems. At HSC, our

“community” is defined as individuals living with chronic conditions or physical disabilities,

statewide. An independent CHNA provided the opportunity to gather details on those conditions

and disabilities, gathering data that will be used to refine our implementation strategies. The

2016 assessment has been completed without a consulting service.

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Results of 2013 CHNA Implementation Strategy

The goal of the 2013 CHNA Implementation Strategy was to improve individuals’ abilities to

manage chronic conditions and physical disabilities through coordination of care.

Objectives and the results of HSC’s efforts are summarized here. No written comments were

offered in response to HSC’s 2013 CHNA report. Individuals researching community health

needs and students have called to inquire and verbally offered positive comments on the report

and Implementation Strategy.

Objectives Action Steps/Result

1: Improve access to primary care for persons with chronic conditions and physical

disabilities Establish a medical home for

specific groups Research and implement medical

homes for populations in need

The Autism Center at Hospital for Special Care was certified by the

NCQA (National Committee for Quality Assurance) as a PCSP

(Patient-Centered Specialty Practice): in February, 2015. It is the only

Autism PCSP in the USA.

In response to the need demonstrated in the outpatient Center, HSC

opened the only inpatient autism unit in Connecticut in December

2015.

COPD Disease Management program was formally launched in May,

2013 and has provided services to 122 patients. 33 new patients were

admitted to the program in 2015, with 79 patients actively participating

in March, 2016.

Although not NCQA certified, it functions as a PCSP.

Coordination of care for

persons with chronic

conditions Expand HSC’s role in

coordinating healthcare needs of

persons with chronic conditions

The Neuromuscular Center offers a model for coordination of care for

individuals with ALS, Muscular Dystrophy, and other neuromuscular

conditions. Evaluation of the Center toward PCSP certification in 2015.

2: Reduce obesity and overweight by increasing physical activity levels of persons with

chronic conditions and physical disabilities Promote community

membership in the Aquatic

Rehabilitation and Fitness

Center (ARC)

Membership is offered to community residents, with no geographic or

ability restrictions.

New ARC members 2013 = 313, 2014 = 370, 2015 = 433

There is no membership charge for members of the Adaptive Sports

program or for HSC inpatients. A fund is available to supplement

membership charges for those with economic need. Reduced rates are

offered for students, family membership, seniors, senior couples, group

home membership, and HSC employees and their families. The Silver

Sneakers program (www.silversneakers.com ) reimburses the Center by

member visits.

Metrics: A survey was conducted in 2014 and 2015, measuring the

improvement in fitness levels among members.

http://www.silversneakers.com/

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Offer Pulmonary Exercise

Program (PEP)

A growing number of patients enroll in PEP following their pulmonary

rehabilitation program. In 2014, 20 of 36 individuals continued to

exercise in the community; in 2015, 26 of 39 continued. 13 participants

reduced their BMI in 2014, as did 19 in 2015.

Increase participation in the

HSC Adaptive Sports Program

HSC uses Foundation funds to allow our Adaptive Sports program to be

free-of-charge.

HSC Ivan Lendl Adaptive Sports Camp continues to attract new

campers. (2013 = 7, 2014 = 11, 2015 = 14)

An Inclusive Recreation program for families of youths living with

physical disabilities was launched in 2013 with 3 programs.

In 2014 it was expanded to serve youths with autism (2014 = 6, 2015 =

14)

As “Team Special Care”, HSC’s involvement in the Hartford Marathon

event:

2013, 7 athletes with disabilities competed in the 5K

2014, 11 athletes with disabilities competed in the 5K the half

marathon

2015, 12 athletes with disabilities competed in the 5K

HSC hosted Gateway to Gold event (May, 2015), free to the public to

introduce people living with physical disabilities to the opportunities in

track and field (11 participants), and swimming (7 participants).

Support Parkinson’s Exercise

Program

HSC provides a New Britain location for a statewide twice-weekly

exercise program open to community members. (May 2014)

Program expanded to three day/week. (in Autumn 2014)

The trainer reports a consistent number of participants and measures

improvements in balance and ambulation.

Offer Special Care Equipment

Exchange

Donated durable medical equipment is given to community members

enabling them to increase their independence and physical activity

levels. 2013 = 477 items distributed, 2014 = 660 2015 = 667

The program is possible thanks to the 500-600 annual hours of

volunteers’ work.

3: Enhancing the ability of like groups to communicate and share aspects of their

conditions Promote existing support

groups

HSC-based support group meetings are posted on website calendars and

submitted to local print and internet media. (May 2013)

Future: Trial social media posts for effectiveness.

Develop new venues for

support groups through

technology

Explored on-line potentials to reach consumers unable to attend the

traditional meeting-style groups and expand the geographic reach.

Conference call-in numbers and webinar options made available; no

interest demonstrated. (March 2014)

SCI Committee considering teleconferencing/webinar equipment so

group members may attend meeting remotely. Exploring funding. (June

2015)

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New support group topics Explored emerging subjects for new support groups to meet the

interests of our target populations.

2013 – 2015 New support groups established for:

Alpha One Antitrypsin

Stroke

Parkinson’s

Balance/Dizziness

HSC requested the assistance of Hanger, Inc., a recognized prosthetic

and orthotic company, in establishing an Amputee Support Group.

(Spring 2014)

Hanger offers a peer mentors, work with inpatients. Rather than

duplicate services HSC refers inpatients, outpatients, and sports

participants to the Hanger program. Education was provided to

HSC clinicians on the Hanger program.

In-patients informed of HSC’s adaptive sports programs for

seamless transition and supports.

Hanger sponsored motivational speaker Cameron Clapp twice,

to audiences of 50-100 people. Cameron, a triple amputee, is the

Honorary Team Captain for Team Special Care at the Hartford

Marathon.

Program support for Camp No Limits, for individuals with limb

loss. National program, in CT 2015.

Future: Explore Siblings Support Group/mentorship for siblings of

children with chronic conditions

4: Provide education and support to encourage people to make healthy lifestyle choices Reduce smoking through

smoking cessation program

Participants increased from 8 in 2014 to 25 in 2015, with 40%

remaining smoke-free at a three- month survey.

Reduce overweight/obesity

through promotion of healthy

food choices

When contacted (June 2014) about offering a community site at HSC,

Weight Watchers declined. HSC convinced them to restart an employee

program in 2015.

While the data suggests a need in this area, despite the many weight

loss and healthy food choice programs in the community, individuals

do not express interest in participating. This strategy will not be

pursued in the new plan.

Increase health literacy

through healthcare

information/resources

Health Sciences Library services are now promoted to the community.

(Nov 2013)

Update and reorganize the Consumer Health Resources webpage,

http://hfsc.org/resources/overview . (Dec 2013)

HSC website adds a link to access consumer online database Health

Library. (April 2014) FY15: 2081 visitor hits; average of 5 page views

per day, with each visitor visiting an average of 1.69 pages.

http://hfsc.org/resources/overview

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Addressing mental health and

substance abuse issues

HSC does not offer mental health or substance abuse treatment

programs. Patients are screened and referred to existing community

resources.

Aware of the risk for the population with chronic conditions and

physical disabilities, clinicians include key questions (using a suicide

protocol grid) in inpatient and outpatient evaluations. Inpatients receive

appropriate services while at HSC, beginning with a psychology

consult. Outpatient therapists refer patients to community mental health

services. Outpatient therapists’ referrals.

2013 = 3, 2014 = 6, 2015 = 4

5: Improve access to resources for caregivers

Providing resources to

caregivers Expanding availability of

resource information from family

members of HSC patients to

caregivers of individuals in the

community

Inpatient social workers provided their resources to the HSC website.

(Jan. 2014) See objective 4 on health literacy.

Future: Exploring community support for a Caregivers health fair

sponsored by HSC. If well-attended, HSC can offer similar fairs at local

Senior Centers.

Develop a caregiver support

group

Monthly support group for parents of chronically ill children on HSC’s

Pediatrics Unit. It is open to parents of inpatients and discharged

patients’ parents. Attendance is 2-5 persons monthly.

Feasibility study: HSC social worker experience was that it is difficult

for caregivers to get away to attend a support group. They recommend

on line blogs (www.thecaregiverspace.org).

Future: continue to research options to create an online caregiver

support group; see objective 3.

http://www.thecaregiverspace.org/

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METHODOLOGY

2016 CHNA Methodology

Data included in this assessment was obtained through surveys and interviews of community

members and key informants, research, and statistics from related organizations (government and

healthcare) and Connecticut acute care hospitals. Most data was collected from November 2015 -

March 2016. We solicited and obtained input from individuals across the state and a variety of

organizations. HSC appreciates the time and information shared by everyone who completed a

survey.

Collection processes

We used a community member survey to identify the significant health needs. This survey

offered insight directly from individuals within HSC’s community. A key informant survey

targeted organizations that work with individuals within our statewide community.

Research returned some very useful data, but there are gaps in data collection regarding several

of the challenges faced by individuals living with chronic conditions or physical disabilities.

Primary sources of data included:

United States Census Bureau

State of Connecticut

DataHaven (New Haven, CT)

American Lung Association

National Cancer Institute

Centers for Disease Control and Prevention (CDC)

The Henry J. Kaiser Family Foundation (Kaiser Family Foundation)

National Council on Disability (NCD)

United Health Foundation

National Coalition Against Domestic Violence (NCADV)

Community member survey

An important component of the CHNA is the data provided by community members. The

traditional method for gathering this data is a Behavioral Risk Factor Surveillance System

(BRFSS), a telephone survey conducted with randomly-selected community residents. BRFSS

was used in our previous assessments (2007 and 2013). In preparing for the 2016 assessment,

HSC concluded that a BRFSS survey would not adequately reach our defined community. It

would be unlikely that the survey could reach a sufficient number of individuals living with

chronic conditions or physical disabilities within a geographic area as large as a state.

For this assessment, we created an online survey, using typical questions posed on past health

needs surveys, with added questions specific to our targeted population. Telephone surveys and

paper surveys were offered as alternatives to the on-line survey.

The survey was distributed widely throughout the state using a variety of methods:

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Mailings, both email and postal mail, to 823 participants in HSC programs including

dental services, aquatic fitness center members, therapeutic horseback riding, inclusive

recreation, and volunteers

Paper surveys and the link to the online survey were available in outpatient service

waiting areas

Paper surveys and the link to the online survey were distributed at seven HSC support

groups

Social media postings on HSC sites. These posts were shared by organizations and

individuals familiar with HSC. Initial posts reached 674 people on Twitter and 1,114 on

Facebook. The Facebook post was boosted, resulting in 11,500 individuals reached.

Collaborative organizations (Spinal Cord Injury Association-CT, Brain Injury Alliance-

CT, Autism Families CONNECTicut, Muscular Dystrophy Association-CT, ALS

Association-CT) used email, social media, and newsletters to ask members to complete

HSC surveys

Key informant survey

A second component of the CHNA is data collected from organizations across the state that

represent underserved groups and serve our community members. HSC regularly works with

facilities, organizations and associations that support our community. An online key informant

survey was created and distributed to 73 individuals across 56 organizations, asking each to

explain the priority health needs of individuals served by their organization. Those contacted

included acute care hospitals, state departments, community-based human services agencies, not-

for-profit organizations and advocates representing individuals within HSC’s community. Public

health and healthcare professionals shared knowledge and expertise about health issues, and

leaders and representatives of community-based organizations provided insight on the

populations they serve, including medically underserved, low income, and minority populations.

For example, Community Health Centers offer services to otherwise underserved, low-income,

and minority populations. The Hispanic Health Council and Pathways Senderos serve a minority

population. New Britain Housing Authority, Opportunities Industrialization Center, and Billings

Forge Community Works serve low income families. A LinkedIn post was also used to reach key

informants. The post was seen by over a thousand people, although it is not possible to determine

how many are be key informants in Connecticut.

Organizations on Key Informant List

Advanced Physical Therapy

Aetna: Product Strategy & Insights

ALS Association - CT

American Lung Association-CT

Andrew House Health Care

Autism Families CONNECTicut

Berlin Mosque

Billings Forge Community Works

Brain Injury Alliance of CT

Bristol Hospital

CCARC

Coginchaug Regional High School

Community Health Centers (Middletown,

New Britain, New London, other

locations)

Connecticut Interscholastic Athletic

Conference

Corporation for Independent Living

CT Society for Respiratory Care

CW Resources

Dentist, private practice, Kensington

Gorzoch Associates

Grove Hill Medical Center (Starling

Physicians)

11

Hanger Prosthetics

Hartford Behavioral Health

Hartford Healthcare Rehabilitation Network

Hartford Hospital

Hartford Neighborhood Centers, Inc.

Harvest Development Group

Hispanic Health Council

Hospital of Central CT

Journey Found, Inc.

KeepMeHome, LLC

LeadingAge Connecticut

MidState Medical Center

Money Follows the Person

Muscular Dystrophy Association-CT

Neighborhood Housing Services of New

Britain

New Britain Board of Education

New Britain EMS

New Britain Health Department

New Britain Housing Authority

Opportunities Industrialization Center of

New Britain

Pathways Senderos

Patient Advocate for You

Saint Francis Hospital and Medical Center

School Street Apartments Wellness Center

Seabury Retirement Community

Small Miracles Natural Health Center

Spinal Cord Injury Association-CT

The Edward & Mary Lord Family Health

Center

United Community and Family Services,

The Edward & Mary Lord Family

Health Center

University of Connecticut, Hartford campus

University of Saint Joseph

Wheeler Clinic

Women's Health USA

YWCA of New Britain

Because the survey was anonymous, we cannot confirm exactly which organizations responded,

however, the demographic data collected reflects a wide variety of organizations representing

healthcare, public health, mental/behavioral health, not-for-profit, government, and other service

groups. Following the CHNA report in 2013, we hosted a meeting of key informants to discuss

potential programs to meet community health needs. A similar meeting will be held in the spring

of 2016 and will provide the opportunity to confirm and enhance information submitted in the

surveys.

Survey Results

The results of both key informant and community member surveys are presented in this report in

separate sections.

Community member survey

Online, paper, or telephone surveys were completed by over 180 Connecticut residents. Common

adult health needs reported include overweight, chronic illness (especially asthma, arthritis, and

depressive disorder), and a limited ability to participate in activities. Many respondents function

as caregivers. Children in the household were generally reported as healthy. The few reports of

chronic conditions in children were primarily asthma and autism.

Key informant survey

Online or telephone surveys were completed by 46 key informants, allowing us to obtain input

on the health needs of the group(s) they represent. In addition to medically underserved, low

income, and minority populations, data on individuals with chronic conditions or physical

disabilities was provided by organizations representing these specific groups.

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ASSESSMENT SUMMARY: IDENTIFIED HEALTH NEEDS

Community Member Survey

The 89 questions in the survey of Connecticut residents (HSC Survey) have been grouped by

topic. Available state and/or national statistics are included in the survey results section to serve

as a comparison to data collected from the HSC Survey.

General Health

HSC community members rate their health somewhat lower than state and national data, but

most report few days of poor/fair health. 70% report their weight is higher than desired.

1. Would you say that in general your health is: 3

Answer

Options HSC Survey

Number

HSC Survey

Percent CT Percent

National Percent

Excellent 23 13% 27% 12.6%

Very Good 49 27% 35% 34.4%

Good 73 40% 23% 38.0%

Fair 32 17% 10% 10.8%

Poor 7 4% 4% 2.0%

Responses 184

2. For how many days during the past 30 days would you rate your physical health as poor or

fair? 4

Answer

Options

HSC Survey

Number

HSC Survey

Percent CT Average National Average

0 days 62 34%

3.30 days

3.90 days

1-2 days 50 27%

3-5 days 19 10%

6-9 days 10 5%

10 or more

days 43 23%

Responses 184

3 http://www.ctdatahaven.org/reports/datahaven-community-wellbeing-survey , http://hints.cancer.gov/question-

details.aspx?PK_Cycle=7&qid=744 4 http://www.americashealthrankings.org/CT

http://www.ctdatahaven.org/reports/datahaven-community-wellbeing-survey

http://hints.cancer.gov/question-details.aspx?PK_Cycle=7&qid=744

http://hints.cancer.gov/question-details.aspx?PK_Cycle=7&qid=744

http://www.americashealthrankings.org/CT

http://www.americashealthrankings.org/CT

13

7. How would you describe your weight? 5

Answer Options HSC Survey

Number

HSC Survey

Percent CT (BMI)

Underweight 4 2% 2%

At your desired weight 51 28% 37%

10-25 pounds over your

desired weight 70 39% 36%

More than 25 pounds over

your desired weight 55 31% 26%

Responses 180

Access to Healthcare

Less than 3% of HSC community members do not have healthcare coverage and just 5% do not

have a personal physician. 80% have been able to see a doctor when they wished and 81% have

had a checkup within 12 months. 84% receive care at a doctor’s office and visits to emergency

departments are fewer than the state average.

8. Do you have any kind of health care coverage, including health insurance, prepaid plans

such as HMOs, or government plans such as Medicare? 6


Number

HSC Survey

Percent

CT Percent

age 19-64

National Percent

age 19-64

No 5 2.8% 10.0% 14%

Yes 171 97.2%

Employer 67.0% 59%

Non-Group 8.0% 8%

Medicaid 12.0% 14%

Other Public 3.0% 5%

Responses 176

9. Do you have one person you think of as your personal doctor or health care provider? 7

Answer

Options HSC Survey Number HSC Survey Percent CT Percent

No 9 5.1% 14.0%

Yes, only one 80 45.5% 86%

More than one 87 49.4% n/a

Responses 176

5 http://www.ctdatahaven.org/reports/datahaven-community-wellbeing-survey

6 http://kff.org/other/state-indicator/adults-19-64/ , http://kff.org/other/state-indicator/adults-19-64/ 7 http://www.ctdatahaven.org/reports/datahaven-community-wellbeing-survey



14

10. Was there a time in the past 12 months when you needed to see a doctor but could not? 8

Answer Options HSC Survey Number HSC Survey Percent CT Percent

No 141 80.6% 79% Yes 34 19.4% 21% Responses 175

13. About how long has it been since you last visited a doctor for a routine checkup? 9

Answer Options HSC Survey Number HSC Survey Percent

Never 3 2%

0-12 month 141 81%

1-2 years 19 11%

2-5 years 5 3%

5 years or more 6 3%

Responses 174

14. In general, where do you go when you are in need of medical care? (please choose one)


Doctor’s Office 147 84.5%

Health Clinic 6 3.4%

Emergency

Department 6

3.4%

Walk-in/Urgent Care

Center 16

9.2%

Responses 174

15. In the past 12 months, did you receive care in an emergency room? 10

Answer

Options HSC Survey

Number

HSC Survey

Percent CT Percent National Percent

No 136 77.3% 73% 10%

Yes 40 22.7% 26%

Responses 176

8http://www.ctdatahaven.org/reports/datahaven-community-wellbeing-survey




15

Oral Health

HSC respondents match the statewide figures for visiting a dentist within the last 12 months.

This figure is considerably higher than national numbers. Of the 19.5% that do not have regular

dental services, over half state cost or lack of insurance coverage as a reason. Six individuals

avoid dental care due to fear or aversion to pain.

Special Care Dental Services provides oral health care to children who are uninsured or

underinsured, including those on the autism spectrum. As the schedule allows, both Special Care

Dental Services and our hospital-based clinic treat adults who find receiving care at community

practices to be challenging. Education in overcoming fear of dental care is a small, but identified

need.

16. How long has it been since you last visited a dentist or dental clinic for any reason?

Answer Options HSC

Survey

Number

HSC

Survey

Percent

CT-1 %

2014-

2015

CT-2 %

2012 (within

12 months,

No/Yes)

National-1

Percent

2012 (within

12 months)

National-2

Percent 2013

(within 12

months)

Never 0 0.0% 1.0% 23.9% 34.6%

0-12 months 135 77.6% 76.0% 76.1% 65.4%

Age 18-64:

61.7%

Age 65+:

60.6%

1-2 years 23 13.2% 10.0%

3-5 years 6 3.4% 11.0%

5 years or more 10 5.7%

Responses 174

17. Do you visit a dentist or dental clinic for regular check-ups?


No 34 19.5%

Yes 140 80.5%

Responses 174

18. Why don't you visit a dentist or dental clinic for regular check-ups? (please choose all that

apply)


Cost 18 52.9%

Lack of transportation 3 8.8%

Provider would not

accept your insurance 4 11.8%

Other (see next page) 17 50.0%

Responses 150

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Other Reasons:

Need partials but price is too much.

My state insurance only covers cleaning

When I turned 65 last year, I no longer could afford dental insurance.

Fear

Having troubles w anxiety

Have dentures

Rough with me and it hurts me

No teeth. MD Does oral exam

Fear and co pay costs

Just haven't made the time

Fear

False Teeth

No dental insurance

Have dentures

No dental insurance

I'm afraid of pain

Exercise / Activities

HSC community members are less active for fitness purposes than statewide numbers, likely due

in part to physical or emotional problems limiting their ability to participate in such activities.

Over 30% rely on DME (durable medical equipment) for ambulation or daily care. 25% report

recent falls (40 total), some requiring a decrease in activity level for at least a day.

Increasing physical activity and preventing falls are identified needs in our community.

6. During the past month, other than during your regular job, did you participate in any

fitness activities or exercises? (Examples: running, walking, calisthenics, golf, gardening) 11

Answer Options HSC Survey CT

Number Percent Percent

No 57 32% 17%

Yes (how many days) 123 68% 83%

Responses 180

11



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32. Are you limited in any way in any activities because of physical problems? 12

Answer

Options

HSC Survey

Number

HSC Survey

Percent

National % age <65, with

disability

No 83 51.6%

Yes 78 48.4% 8.5%

Responses 161

33. Do you have any health problems that require you to use special equipment? (Examples:

cane, crutches, walker, wheelchair, special bed, special telephone)

Answer

Options HSC Survey Number HSC Survey Percent

No 111 68.5%

Yes 51 31.5%

Responses 162

34. Are you limited in any way in any activities because of mental or emotional problems?

Answer


No 152 93.8%

Yes 10 6.2%

Responses 162

35. Does a physical disability prevent you from visiting a health care provider?

Answer


No 156 96.3%

Yes 6 3.7%

Responses 162

36. In the past 3 months, how many times have you fallen?

Answer

Options HSC Survey

Number

HSC Survey

Percent Total Yes

None 122 75%

1-2 28 17.3%

25% 3-5 9 5.6%

6-9 2 1.2%

10 or more 1 0.6%

Responses 162

12

https://www.census.gov/quickfacts/table/PST045215/00

https://www.census.gov/quickfacts/table/PST045215/00

18

37. How many of these falls caused an injury (caused you to limit your regular activities for

at least a day or to go see a doctor)?

Answer Options HSC Survey Number HSC Survey Percent Total Yes

None 103 87%

1-2 13 11.0%

13% 3-5 1 0.8%

6-9 0 0.0%

10 or more 1 0.8%

Responses 118

Lifestyle

HSC survey respondents demonstrate a much higher rate of receiving influenza vaccinations than

state or national averages. The average age of individuals who completed the survey is under age

65, so it is expected that state and national data show higher rates of pneumonia vaccinations.

42. During the past 12 months, have you had a seasonal flu shot? 13

Answer

Options No Yes Responses

Response

Percent NO Response Percent YES

HSC Survey 42 119 161 26.09% 73.91%

State, 2014 41.00%

National, 2014 43.70%

43. Have you ever had a pneumonia shot? 14

Answer Options No Yes Responses Response

Percent NO

Response Percent

YES

HSC Survey 94 68 162 58.02% 41.98%

State, age 65+, 2014 70.60%

National, age 65+,

2014

58.70%

Prevalence of cigarette smoking among HSC respondents is about half that of state and national

averages. A number of individuals who responded in the negative to question 39 also responded

to question 40, making the number not quitting higher than it might otherwise be. As an LTACH,

many of HSC inpatients and outpatients have pulmonary diseases, making smoking cessation an

essential component of many programs. It is not surprising that people that choose HSC for

healthcare or community programs are non-smokers.

13

http://www.lung.org/assets/documents/research/pi-trend-report.pdf 14

http://www.lung.org/assets/documents/research/pi-trend-report.pdf



19

38. Have you smoked at least 100 cigarettes in your entire life?

Answer

Options HSC Survey HSC Percent

No 92 57.14%

Yes 69 42.86%

Responses 161

39. Do you now smoke cigarettes every day, some days, or not at all? 15

Answer

Options

HSC

Survey HSC Percent CT, use rate National, use rate

Every day 11 7.24% 15.40% 16.80%

Some days 2 1.32%

Not at all 139 91.45%

Responses 152

40. During the past 12 months, have you stopped smoking for one day or longer because you

were trying to quit smoking?

Answer

Options HSC Survey HSC Percent

No 92 85.98%

Yes 15 14.02%

Responses 107

The percentage of community survey respondents who have felt the need to decrease use of

alcohol or drugs is slightly higher than the statewide figure. We will seek additional data from

our community so we may address these topics in support groups, other community programs,

and in resources for caregivers.

41. During the past 12 months, have you ever felt the need to cut down on your drinking or

drug use? 16

Answer

Options HSC Survey Number HSC Survey Percent CT Percent

No 135 87.66% 91%

Yes 19 12.34% 8%

Responses 154

Individuals living with physical disabilities may be vulnerable to violence at home or in the

public, making this an important question to pose to our community.

15

http://www.lung.org/our-initiatives/tobacco/reports-resources/sotc/state-grades/highlights.html,

http://www.lung.org/our-initiatives/tobacco/reports-resources/sotc/federal-grades/highlights.html 16


http://www.lung.org/our-initiatives/tobacco/reports-resources/sotc/state-grades/highlights.html

http://www.lung.org/our-initiatives/tobacco/reports-resources/sotc/federal-grades/highlights.html


20

4. In the past 12 months, have you felt unsafe or physically threatened in your home? 17


Number

HSC Survey

Percent National

No 179

1 in 3 women and 1 in 4 men have been

victims of (some form of) physical

violence by their intimate partner within

their lifetime Yes 4

Responses 183

Chronic Illnesses and Conditions

HSC offers a wide range of inpatient and outpatient services and community programs for

individuals with chronic conditions. Questions posed in the survey will provide details on the

challenges these individuals experience within their community. Items of concern include the

number of individuals reporting chronic conditions, and the specific data on asthma, COPD,

arthritis-related conditions, and depressive disorders. 87% of respondents are receiving treatment

for the condition on a regular basis; some that responded negatively are not currently

symptomatic.

19. Has a doctor, nurse, or other health professional ever told you that you have a chronic

illness?


No 82 49.7%

Yes 83 50.3%

Responses 165

20. Has a doctor, nurse, or other health professional ever told you that you had a heart attack,

also called a myocardial infarction?18


No 160 96.4% 93%

Yes 6 3.6% 5%

Responses 166

17

http://www.ncadv.org/learn/statistics 18

http://www.ctdatahaven.org/sites/ctdatahaven/files/DataHaven2015%20Greater%20New%20Britain%20Pub.pd

f

http://www.ncadv.org/learn/statistics

http://www.ctdatahaven.org/sites/ctdatahaven/files/DataHaven2015%20Greater%20New%20Britain%20Pub.pdf

http://www.ctdatahaven.org/sites/ctdatahaven/files/DataHaven2015%20Greater%20New%20Britain%20Pub.pdf

21

21. Has a doctor, nurse, or other health professional ever told you that you have angina or

coronary heart disease?


No 156 94.5%

Yes 9 5.5%

Responses 165

22. Has a doctor, nurse, or other health professional ever told you that you had a stroke?


No 160 96.4%

Yes 6 3.6%

Responses 166

23. Has a doctor, nurse, or other health professional ever told you that you have asthma?


No 131 79.9%

Yes 33 20.1%

Responses 164

22

24. Has a doctor, nurse, or other health professional ever told you that you have COPD (chronic

obstructive pulmonary disease), emphysema, or chronic bronchitis? 19

Answer

Options HSC Survey Number HSC Survey Percent CT Percent National Percent

No 142 85.5%

Yes 24 14.5% 5.7% 6.3%

Responses 166

25. Has a doctor, nurse, or other health professional ever told you that you have some form of

arthritis, rheumatoid arthritis, gout, lupus, or fibromyalgia?


No 94 57.3%

Yes 70 42.7%

Responses 164

26. Has a doctor, nurse, or other health professional ever told you that you have some form of

neuromuscular disease? (Examples: ALS, Lou Gehrig’s Disease, Muscular Dystrophy,

Parkinson's Disease)


No 154 95.1%

Yes 8 4.9%

Responses 162

19

http://www.copdfoundation.org/What-is-COPD/COPD-Facts/Statistics.aspx ,

http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6146a2.htm?s_cid=mm6146a2_w

http://www.copdfoundation.org/What-is-COPD/COPD-Facts/Statistics.aspx

23

27. Has a doctor, nurse, or other health professional ever told you that you have a depressive

disorder?


No 123 75.5%

Yes 40 24.5%

Responses 163

28. Has a doctor, nurse, or other health professional ever told you that you have kidney disease?


No 159 97.0%

Yes 5 3.0%

Responses 164

29. Has a doctor, nurse, or other health professional ever told you that you have diabetes?


No 144 86.7%

Yes 22 13.3%

Responses 166

24

30. If you answered "yes" to any of questions 19-29, are you:


Number

HSC Survey

Percent

Seeing a primary care/family doctor for follow up

treatment and monitoring

22 21%

Seeing a specialist for follow up treatment and monitoring 23 22%

Seeing both your primary care/family doctor and a

specialist for follow up treatment and monitoring

46 44%

Not receiving any follow up treatment or monitoring

(Reason?)

13 13%

Responses 104

30. If you answered "yes" to any of questions 19-29, are you:


Seeing a primary care/family

doctor for follow up treatment

and monitoring

22

21%

Seeing a specialist for follow up

treatment and monitoring 23

22%

Seeing both your primary

care/family doctor and a

specialist for follow up treatment

and monitoring

46

44%

Responses 104

31. About how many times in the past 12 months have you seen a doctor, nurse, or other

health professional for any condition listed in questions 19-29?

Answer


None 59 38%

1-2 40 26%

3-5 25 16%

6-9 9 6%

10 or more 23 15%

Responses 156

Emotional Health

25

HSC respondents report few days of “feeling down” than the state average. However, when

caregiver responses to a combination of questions are studied, numbers suggest the need for

further study of that group.

3. During the past 30 days, have you been bothered by feeling down, depressed, or hopeless? 20


No 113 66.9% 46%

Yes 56 33.1% 52%

Responses 169

5. How often do you get the social and emotional support you need? 21

Answer Options HSC Survey CT

Percent Number Percent

Always 50 27%

93% Usually 73 40%

Sometimes 37 20%

Rarely 17 9%

Never 7 4% 6%

Responses 184

27. Has a doctor, nurse, or other health professional ever told you that you have a

depressive disorder?


No 123 75.5%

Yes 40 24.5%

Responses 163



No 152 93.8%

Yes 10 6.2%

Responses 162


20

http://www.ctdatahaven.org/reports/datahaven-community-wellbeing-survey 21




26


No 152 93.8%

Yes 10 6.2%

Responses 162

Caregivers

A much higher number of HSC respondents serve as caregivers to family or friends than the

national average. While tasks performed are varied, maintaining the home and providing

transportation are the top two tasks. Caregivers report a number of serious difficulties as a result

of the responsibility, including stress and the impact on time for themselves, family, and work.

Studying individual answers shows many of the caregivers have emotional problems and impacts

on their lifestyle (smoking, use of alcohol or other substances).

44. During the past month, did you provide regular care or assistance to a friend or family

member?22

Answer

Options

HSC Survey

Number

HSC Survey

Percent National % (care for an adult >65)

No 95 59.01% 24% of adults age 45-64, and 17% of

those >65, care for an aging adult. Yes 66 40.99%

Responses 161

45. What age is the person to whom you are providing care?

6 individuals under age 20

4 individuals age 21-40

average age (41-96) is 79

46. What is the person's gender?


Male 28 45.2%

Female 33 53.2%

Other 1 1.6%

Responses 62

47. What is the person's relationship to you? 23

22

http://www.bls.gov/news.release/elcare.nr0.htm 23

http://www.pewresearch.org/fact-tank/2015/11/18/5-facts-about-family-caregivers/

http://www.bls.gov/news.release/elcare.nr0.htm


27


Number

HSC Survey

Percent

National %

(care for parent, >65)

Parent 23 37% approx. 44%

Parent-in-law 8 13%

Child 10 16%

Spouse 5 8%

Sibling 1 2%

Grandparent 3 5%

Grandchild 2 3%

Other relative 3 5%

Non-relative 7 11%

Responses 62

48. In which of the following areas does the person you care for need your help? (please

choose all that apply) 24

Answer Options

HSC

Survey

Number

HSC

Survey

Percent

National %

(care for

parent, >65)

Personal care 27 44% 14%

Taking medications 25 40%

Wound care, injections, or other medical

treatments 10 16%

Maintaining household 37 60% 58%

Communicating with others 23 37%

Learning or remembering 15 24%

Seeing or hearing 9 15%

Moving around within the home 21 34%

Transportation outside of the home 42 68%

Relieving/decreasing anxiety or depression 14 23%

Other (please specify)

8 13%

Financially

28%

Responses 62

49. Please indicate which of the following difficulties you have faced as a caregiver.(please

choose all that apply) 25

24

http://www.pewresearch.org/fact-tank/2015/11/18/5-facts-about-family-caregivers/ 25




28


Number

HSC

Survey

Percent

National %

(care for parent,

>65)

No difficulty 18 30%

Creates a financial burden 13 21%

Doesn't leave enough time for yourself 20 33%

Doesn't leave enough time for your family 12 20%

Interferes with your work 13 21%

Creates stress 30 49% 32%

Creates or aggravates your health problems 12 20%

Affects family relationships 19 31%

Other difficulty (please specify) 6 10%

Responses 61

Children

The demographics on children provided by the respondents are comparable to state averages.

However, comparison stats were not available for each segment in contrast to the adult section.

50. Do you have children under the age of 18 living in your household?


No 121 77%

Yes 36 23%

Responses 157

51. What is the age of the child in your household?

Average is 10.7 years of age.

52. What is the child's gender?


Boy 20 54%

Girl 16 43%

Other 1 3%

Responses 37

53. Which one of these groups would you say best represents the child’s race?


Caucasian/White 26 74%

29

Black or African American 3 9%

Asian 1 3%

Native Hawaiian or Pacific Islander 0 0%

Native American, Alaskan Native 0 0%

Hispanic 0 0%

Other (2 or more races) 5 14%

Responses 35

54. How are you related to the child?


Not related in any way 0 0%

Parent (biological, step, adoptive) 29 81%

Grandparent 6 17%

Foster parent or guardian 0 0%

Sibling (biological, step, adoptive) 1 3%

Other relative 0 0%

Responses 36

Child Health

The majority of HSC community members report the child’s health as being good or better, with

49% reporting zero days of poor or fair physical health.17% report the child being underweight

and 9% report the child being at least 10 pounds over the respondent’s desired weight for the

child.

55. Would you say that in general the child's health is:


Excellent 13 35%

Very Good 16 43%

Good 7 19%

Fair 1 3%

Poor 0 0%

Responses 37

56. For how many days during the past 30 days would you rate the child's physical health as

poor or fair?


0 days 18 49%

1-2 days 9 24%

30

3-5 days 5 14%

6-9 days 3 8%

10 or more days 2 5%

Responses 37

57. For how many days during the past 30 days would you rate the child’s mental health as

poor or fair?


0 days 22 59%

1-2 days 5 14%

3-5 days 4 11%

6-9 days 1 3%


Responses 37

68. How would you describe the child's weight?


Underweight 6 17%

At your desired weight 27 75%

10-25 pounds over desired weight 2 6%

More than 25 pounds over desired weight 1 3%

Responses 36

Access to Healthcare for Child

Less than 3% of HSC community members report the child as not having healthcare coverage

and just 2.8% as not having a personal physician. 94.6% report the child as having been able to

see a doctor when needed and 92% report the child having a checkup within the past 12 months.

58. Does the child have any kind of health care coverage, including health insurance, prepaid

plans such as HMOs, or government plans such as Medicare? 26

Answer

Options HSC Survey

Number

HSC Survey


No 5 2.8% 3.0% 6%

Yes 171 97.2%

Employer 62.0% 47%

26

http://kff.org/other/state-indicator/children-0-18/

31

Non-Group 4.0% 5%

Medicaid 29.0% 39%

Other Public n/a 2%

Responses 176

59. Do you have one person you think of as the child’s personal doctor or health care

provider?

Answer


No 1 2.8%

Yes, only one 27 75.0%

More than one 8 22.2%

Responses 36

60. Was there a time in the past 12 months when the child needed to see a doctor but could

not?

Answer


No 35 94.6%

Yes 2 5.4%

Responses 37

61. What was the reason? (please choose all that apply)

Answer Options HSC Survey Number Reason

Cost 0

Lack of transportation 0

Provider would not accept your insurance 1

Other 1 "Out of state"

Responses 2

62. What type of doctor?


Primary care physician 24 85.7%

Specialist 2 7.1%

Other (please specify) 2 7.1%

Responses 28

63. About how long has it been since the child last visited a doctor for a routine checkup?


Never 1 3%

0-12 month 34 92%

1-2 years 2 5%

2-5 years 0 0%

5 years or more 0 0%

Responses 37

32

Oral Health – Child

HSC respondents match the national figures for children visiting a dentist within the last 12

months, falling only slightly under the Northeast region’s figures with 81.1%. It is important to

note that the 8.1% that were cited as never having been to a dentist or dental clinic were reported

as being too young to receive the service. While the other 10.8%reported as having not received

care in over a year cite cost and the difficulty associated with obtaining care for a special needs

child as the reasoning.

64. How long has it been since the child last visited a dentist or dental clinic for any reason? 27


Number

HSC Survey

Percent

Northeast Region

% 2013 (within 12

months, No/Yes)

National % 2013

(within 12 months)

Never 3 8.1%

0-12 months 30 81.1% 86.9% 83.0%

1-2 years 4 10.8%

3-5 years 0 0.0%

5 years or more 0 0.0%

Responses 37

65. Does the child visit a dentist or dental clinic for regular check-ups?

Answer


No 3 8.1%

Yes 34 91.9%

Responses 37

66. Why doesn't the child visit a dentist or dental clinic for regular check-ups? (please choose

all that apply)


Cost 2 33.3%

Lack of transportation 0 0.0%

Provider would not accept

your insurance 0 0.0%

Other* 4 66.7%

Responses 6

*Other responses: "Having trouble with special care needs"

“child too young”

27

http://www.cdc.gov/nchs/data/hus/hus14.pdf#084 , http://www.cdc.gov/nchs/fastats/dental.html

http://www.cdc.gov/nchs/data/hus/hus14.pdf#084

33

Chronic Illnesses and Conditions – Child

HSC offers a wide range of inpatient and outpatient services and community programs for

children with chronic conditions. Questions posed in the survey will provide details on the

challenges these children experience within their community. Items of concern include the

number of children being reported as having chronic conditions, and the specific data on asthma

and autism spectrum disorders.

69. Has a doctor, nurse, or other health professional ever told you the child has a chronic

illness?


No 28 78%

Yes 8 22%

Responses 36

70. Regarding that chronic illness. Is the child:


Seeing a primary care/family doctor for

follow up treatment and monitoring 22 21%

Seeing a specialist for follow up treatment

and monitoring 23

22%

Seeing both your primary care/family

doctor and a specialist for follow up

treatment and monitoring

46

44%

Responses 104

71. About how many times in the past 12 months has the child seen a doctor, nurse, or other

health professional for the chronic illness?


0 days 15 56%

1-2 days 7 26%

3-5 days 2 7%

6-9 days 1 4%


Responses 27

72. Has a doctor, nurse, or other health professional ever said that the child has asthma? 28

28

http://www.lung.org/assets/documents/research/estimated-prevalence.pdf

34

Answer

Options

HSC Survey

Number

HSC Survey


No 29 83%

Yes 6 17% 3% 9%

Responses 35

73. Has a doctor, nurse, or other health professional ever said that the child has autism,

Asperger syndrome, or a related developmental disorder?

Answer


No 32 89%

Yes 4 11%

Responses 36

74. Has a doctor, nurse, or other health professional ever told you the child has diabetes?

Answer


No 36 100%

Yes 0 0%

Responses 36

Exercise / Activities – Child

94% of respondents reported the child as having participated in a fitness activity or exercise in

the past month; however, 6% reported that the child was limited in some way due to a physical

problem. Continuing or even expanding HSC’s programs that promote physical activity,

especially for those children with disabilities and chronic illnesses should be a priority.

67. During the past month, has the child participated in any fitness activities or exercises?

(Examples: running, walking, calisthenics, sports, games)

Answer


No 4 11%

Yes 32 89%

Responses 36

75. Is the child limited in any way in any activities because of physical problems? 29

Answer

Options

HSC Survey

Number

HSC Survey

Percent

CT % with

disability 2010

National % with

disability 2010

No 34 94%

29

https://www.census.gov/prod/2011pubs/acsbr10-12.pdf , https://www.census.gov/prod/2011pubs/acsbr10-12.pdf

https://www.census.gov/prod/2011pubs/acsbr10-12.pdf

https://www.census.gov/prod/2011pubs/acsbr10-12.pdf

35

Yes 2 6% 4.3-4.5% 5.2%

Responses 36

76. Does the child have any health problems that require use of special equipment?

Examples: cane, crutches, walker, wheelchair, special bed, special telephone.


No 1 3%

Yes 5 14%

Responses 36

Emotional Health – Child

While 60% of children are reported as having no days affected by mental health issues, 40% are

affected and the activities of 14% are impacted by the problem.

57. For how many days during the past 30 days would you rate the child’s mental health as

poor or fair?


0 days 22 59%

1-2 days 5 14%

3-5 days 4 11%

6-9 days 1 3%


Responses 37

77. Is the child limited in any way in any activities because of mental or emotional problems?


No 31 86%

Yes 5 14%

Responses 36

Demographics of Those Surveyed

Demographic details pertinent to identified health needs are discussed here. 153 of the 184

respondents completed the demographic section, including individuals from 51 towns.

A number of respondents do not drive as their primary means of transportation. 42% of

individuals who serve as caregivers provide transportation services. Downtown sections of most

state cities have readily available buses, but sections of these cities may not have an adequate

schedule and connection link to make public buses an efficient option for transportation.

36

Suburban towns in Connecticut may have a commuter bus that runs on “drive time” schedules, to

specific cities. Other towns offer no public transit options. Some public systems have limited

equipment to accommodate individuals living with disabilities. HSC’s “Amazing Journey”

demonstrates the challenges to travel within Connecticut. At this annual event, teams of

individuals living with disabilities are given destinations to which they must travel via public

transit.

88. What is your primary means of transportation?


Drive Myself 128 84%

Get a Ride with family or

friends 15 10%

Public Bus system 3 2%

Walk 1 1%

Bicycle 0 0%

Taxi 0 0%

Paratransit (wheelchair,

accessible van) 5 3%

Other (please specify) 1 1%

Responses 153

An interesting and helpful response shows that most survey respondents have internet access and

chose to complete the questions online. Support groups and other educational programs and

mailings may now be offered using technology to reach the majority of our patients, program

participants, and new contacts.

89. Which of these devices do you have? (please choose all that apply)


Computer or Tablet with

Internet Access

140 93%

Smartphone 105 70%

Cell phone with text and

calling (no internet)

44 29%

None of the above 3 2%

Response Count 151

Survey Completion Number Percent

Online 168 91%

Paper/phone 16 9%

Total surveys 184

37

38

Key Informant Survey

The key informants provided a range of health concerns in their community, with several issues

receiving more focus than others.

What are the top three health issues you see in your community? (CHOOSE 3)

0 5 10 15 20 25 30

Other

Uninsured/Underinsured

Tobacco

Suicide

Substance Abuse/Alcohol Abuse

Stroke

Obesity/Overweight

Mental health

Maternal/Infant/Child Health

Heart Disease

Diabetes

Dental Health

Cancer

Access to Care

Other:

Lack of physical activity

Dementia

MND/ ALS

Affordable care

Limb Loss

Housing

Access to affordable healthy food

Geriatrics/Aging Population

Disabilities

39

Of those mentioned, which one is the most significant? (CHOOSE 1)

0 5 10 15 20

Other (please specify)

Uninsured/Underinsured

Tobacco

Suicide

Substance Abuse/Alcohol…

Stroke

Obesity/Overweight

Mental health

Maternal/Infant/Child Health

Heart Disease

Diabetes

Dental Health

Cancer

Access to Care

Access to Care

The key informants reported having varying opinions on the availability and accessibility of

healthcare in their communities.

Answe r Op tio nsStro ng ly

D isa g re eDisa g re e Ag re e Stro ng ly Ag re e

Re sp o nse

Co unt

Number of Individuals 3 12 21 0 36

Percentage 8.33% 33.33% 58.33% 0.00%


Percentage 8.33% 38.89% 52.78% 0.00%


Percentage 8.33% 52.78% 33.33% 5.56%


Percentage 13.89% 58.33% 27.78% 0.00%

Number of Individuals 9 18 9 36

Percentage 25.00% 50.00% 25.00% 0.00%


Percentage 13.89% 61.11% 22.22% 0.00%


Percentage 33.33% 44.44% 22.22% 0.00%

9. T he re is a suffic ie nt numb e r o f me nta l/b e ha v io ra l he a lth p ro v id e rs in Co nne cticut.

3. Co mmunity me mb e rs a re a b le to a cce ss a p rima ry ca re p ro v id e r whe n ne e d e d .

(Fa mily Do cto r, Pe d ia tric ia n, Ge ne ra l Pra ctitio ne r)

4. Co mmunity me mb e rs a re a b le to a cce ss a me d ica l sp e c ia lis t whe n ne e d e d .

(Ca rd io lo g is t, De rma to lo g is t, Ne uro lo g is t, e tc .)

5. Co mmunity me mb e rs a re a b le to a cce ss a d e ntis t whe n ne e d e d .

6. T he re is a suffic ie nt numb e r o f b il ing ua l p ro v id e rs in Co nne cticut.

7. T he re is a suffic ie nt numb e r o f p ro v id e rs a cce p ting Me d ica id a nd Me d ica l

Ass is ta nce in Co nne cticut.

8. T ra nsp o rta tio n fo r me d ica l a p p o intme nts is a va ila b le whe n ne e d e d .

40

Significant Barriers to Access

According to the key informants, significant barriers affect the accessibility of healthcare in their

communities. These barriers affect health disparity rates among different populations.

Underserved Populations

41

Uninsured/Underinsured Programs

In the United States, the percentage of people with health insurance coverage has increased since

2013. Specifically, Connecticut’s uninsured rate fell from 12.3% in 2013 to 6.4% in 2015. This

5.9% change represents an increase in both private and government coverage. Furthermore, the

ACA will help many currently uninsured people from the state gain health coverage by providing

coverage options across the income spectrum for low and moderate-income people. The recent

Medicaid expansion established coverage provisions for low-income individuals, while premium

tax credits help individuals with moderate income purchase insurance directly through new

Health Insurance Marketplaces (Figure 1).

Due to Connecticut’s recent Medicaid expansion, over six in ten (63%) uninsured nonelderly

people in the state are eligible for financial assistance to gain coverage through either Medicaid

or the Marketplaces (Figure 2).30

As a result of these changes, the focus now shifts to outreach and enrollment efforts, as well as

education about navigating the new health care system in order to further decrease the state’s

uninsured rate, as well as help the underinsured gain access to better coverage.

Adults and Children Living with Disabilities

The health care system in the United States is complex, highly fragmented, and restrictive in

terms of program eligibility. As a result, people with disabilities are often left uninsured or with

cost-sharing obligations and limits on benefits. These barriers to care prevent adults and children

living with disabilities from obtaining health-preserving prescription medications, medical

equipment, specialty care, dental and vision care, long-term care, and care coordination, leading

to a significant increase in health disparities compared with people who do not have

disabilities.31

30

http://kff.org/health-reform/fact-sheet/state-profiles-uninsured-under-aca-connecticut/

31 https://www.ncd.gov/publications/2009/Sept302009#Health Coverage and Benefits

http://kff.org/health-reform/fact-sheet/state-profiles-uninsured-under-aca-connecticut/

42

Location for Healthcare Services

Emergency care departments serve as the safety net for the entire national health care system,

providing care to everyone, regardless of ability to pay or insurance status. As a result, newly

employed individuals and uninsured/underinsured individuals are turning to emergency

departments for primary care. Furthermore, one key informant cited the following as rational for

using emergency departments for primary care in her survey response:

“Simplicity. It’s a known location, big building, locally situated. It’s easy to get to and it

resembles retail services. It’s known and trusted because it is familiar.”

- Key Informant32

Needed Services and Resources

14. Related to health and quality of life, what services or

resources do you think are missing in the community?

Response

Free/Low Cost Medical Care 50.0%

Free/Low Cost Dental Care 58.3%

Primary Care Providers 22.2%

Medical Specialists 8.3%

Mental Health Services 61.1%

Substance Abuse Services 25.0%

Multilingual Services 22.2%

Transportation 44.4%

Prescription Assistance 19.4%

Health Education/Information/Outreach 38.9%

Health Screenings 13.9%

Other (see next page) 11.1%

32

http://kff.org/medicaid/issue-brief/safety-net-emergency-departments-a-look-at-current-experiences-and-

challenges

http://kff.org/medicaid/issue-brief/safety-net-emergency-departments-a-look-at-current-experiences-and-challenges

http://kff.org/medicaid/issue-brief/safety-net-emergency-departments-a-look-at-current-experiences-and-challenges

43

Other:

Long term services and supports - information on how to access is often difficult

Smoking Cessation Programming is absent in this Community.

Lack of capacity for free med. PCP could develop better capacity for Medicaid.

Providers specializing in disabled populations

Multilingual

Healthcare in the United States is currently one of the top industries in need of multilingual

workers. Recent studies have shown that a majority of hospitals lack multilingual physicians and

healthcare support staff, leading to increased miscommunication and malpractice. Moreover,

many non-English speakers have mistrust of the healthcare system, as well as difficulty

navigating the system. This leads to the misuse of emergency care departments and other

resources. 33

Dental

“Dental care now represents the number one health care issue among people with

neurodevelopmental disorders.” – Dr. Steve Perlman, Global Clinical Director for the US Special

Olympics/Special Smiles Program

Research links poor oral health with increased risks for systematic conditions such as heart

disease, diabetes and aspiration associated with chronic obstructive pulmonary disorder (COPD).

Furthermore, people with disabilities are at a greater risk for health issues related to the lack of

dental care. As such, “oral health and general health should not be interpreted as separate

entities,” according to Surgeon General David Satcher who noted, “You cannot be healthy

without oral health.” For this reason, it is imperative that dental providers increase the care they

provide to persons with disabilities and implement systems for care for those persons requiring

individualized care.34

Smoking Cessation

Tobacco related diseases are the nation’s single most preventable cause of death, yet according

to DPH statistics, tobacco use continues to kill more people in Connecticut annually than

alcohol, AIDS, car crashes, illegal drugs, accidents, murders and suicides combined. Fortunately,

70% of Connecticut’s smoker’s indicate they want to quit; however, only 40% attempt to quit

each year, and only 5% are successful. These statistics show the need for tobacco use prevention

and cessation programs. Not only would these programs cut annual tobacco related health care

costs, they would also decrease tobacco related deaths, including those due to second-hand

smoke. 35

33

http://www.jointcommission.org/assets/1/6/hlc_paper.pdf 34

https://www.achieva.info/files/PDFs/Access%20to%20dental%20care%20for%20people%20with%20disabilities

%20-%20challenges%20and%20solutions%20includes%20policy%20recommendations.pdf 35

https://www.cga.ct.gov/ph/related%5C20141222_Public%20Health%20and%20Appropriation%20Committees%2

0Public%20Hearing%20re%20THTF%20Board%202014%20Report/Testimony%20-

%20American%20Cancer%20Society.pdf

http://www.jointcommission.org/assets/1/6/hlc_paper.pdf

https://www.achieva.info/files/PDFs/Access%20to%20dental%20care%20for%20people%20with%20disabilities%20-%20challenges%20and%20solutions%20includes%20policy%20recommendations.pdf

https://www.achieva.info/files/PDFs/Access%20to%20dental%20care%20for%20people%20with%20disabilities%20-%20challenges%20and%20solutions%20includes%20policy%20recommendations.pdf

https://www.cga.ct.gov/ph/related%5C20141222_Public%20Health%20and%20Appropriation%20Committees%20Public%20Hearing%20re%20THTF%20Board%202014%20Report/Testimony%20-%20American%20Cancer%20Society.pdf



44

Providers for Disabled Population

According to the World Health Organization (WHO), people with disabilities have less access to

health care services and therefore experience unmet health care needs. This is because people

with disabilities encounter a range of barriers when they attempt to access health care, including

the following: prohibitive costs such as affordability of health services and transportation; a

limited availability of appropriate services; and physical barriers including uneven access to

buildings and inaccessible medical equipment. Moreover, many healthcare workers lack

adequate skills and knowledge to provide care to those living with disabilities. These barriers

cause people with disabilities to be particularly vulnerable to deficiencies in health care services.

Depending on the group and setting, persons with disabilities may therefore experience greater

vulnerability to secondary conditions, co-morbid conditions, age-related conditions, engaging in

health risk behaviors and higher rates of premature death. For these reasons, physicians need to

provide a broad range of modifications and adjustments (reasonable accommodation) to facilitate

access to health care services to disabled individuals, as well as ensure their staff possesses

adequate skills and knowledge for providing the necessary care. 36

Challenges to Maintaining Healthy Lifestyles

Maintaining a healthy lifestyle can be challenging in today’s environment, especially for those

individuals with acute or chronic illnesses or disabilities. The stress of being diagnosed with said

ailments can lead to an increase in dangerous life style behaviors such as smoking, unhealthy

diet, and physical inactivity. These behaviors increase the risk factors for developing additional

chronic diseases, specifically heart disease, stroke, diabetes, obesity, metabolic syndrome,

chronic obstructive pulmonary disease, and some types of cancer.37

What Is Being Done Well? (regarding health and quality of life)

According to our key informants who participated in the survey, Hospital for Special Care has

made strides in increasing health and quality of life, including having a strong understanding of

the needs of the community and the patients it serves. Great effort has been made to

communicate and fulfill said needs through new and continuing services and programming, such

as support groups, recreation services, advocacy for healthy lifestyles, and web based resources.

Outside HSC, there have also been several community initiatives to help improve health and

quality of life, such as MyPlate education, after school programming and recreational

programming for children and adults offered by the Park and Recreation Department, and free

flu shots at local pharmacies.

36

http://www.who.int/mediacentre/factsheets/fs352/en/ 37

http://www.cdc.gov/nationalhealthyworksite/docs/Issue-Brief-No-2-Mental-Health-and-Chronic-Disease.pdf

https://www.health.ny.gov/diseases/cardiovascular/heart_disease/risk_factors.htm

http://www.who.int/mediacentre/factsheets/fs352/en/

http://www.cdc.gov/nationalhealthyworksite/docs/Issue-Brief-No-2-Mental-Health-and-Chronic-Disease.pdf

https://www.health.ny.gov/diseases/cardiovascular/heart_disease/risk_factors.htm

45

Recommendations to Improve Health and Quality of Life (for persons living with chronic

conditions and physical disabilities)

According to our key informants who participated in the survey, there are several areas Hospital

for Special Care should focus on to improve the health and quality of life of individuals with

disabilities and chronic conditions. Those areas that key informants focused on most include:

improved transportation to medical services, increased mental health services, and increased

education about healthy lifestyle choices for the whole family.

Education about Services and Navigating Healthcare System

With the abundance of changes and additions being made to the state’s healthcare system, effort

needs to be made to increase education about available resources, as well as how to successfully

navigate the system as a whole. This includes helping individuals better understand the insurance

landscape in order to increase coverage across the state.

Transportation

Transportation serves as a prohibitive cost of healthcare and is therefore a barrier to care for

many adults and children living with disabilities and chronic illnesses. Increasing the availability

of free or low-cost transportation would increase the utilization of healthcare resources,

including those services that help decrease the health disparities experienced by individuals

living with disabilities.

Increase Awareness/Incentives Healthy Lifestyles and Public Health Initiatives

Increased awareness should be established about the importance of living a healthy lifestyle,

including: the impact of preventative care, the importance of maintaining a healthy diet and

exercise, eliminating dangerous life style behaviors, and increasing focus on the importance of

dental care. Similarly, programming should be implemented to make healthy lifestyle choices

easier. Developing ways to incentivize these behaviors would be especially valuable.

Key Informant Demographics

46

47

PRIORITIZED COMMUNITY HEALTH NEEDS

The health needs stated or implied by the community member survey—targeted groups like those

served by HSC—differ from the priorities measured by the key informant group. Most key

informants serve a much broader range of the general population than our LTACH facility, which

impacts their priorities. Our hospital does not provide all of the types of services requested, but

we do have the ability to impact several important needs. When comparing our community

member survey to state and national statistics differences are noticeable. Many of those currently

served by HSC’s programs demonstrate good choices (healthcare coverage, not smoking, regular

medical checkups and treatment of chronic conditions), but increased needs for assistance and

education in special areas (frequency of falls, and transportation challenges).

Needs documented in the 2013 CHNA have been successfully addressed by new or expanded

HSC programs, but more work can be done in most of these areas. The data collected in the 2016

assessment provides details on our community that will allow us to better design program

content to meet needs.

The HSC community health needs team and clinical operations leadership examined the data,

selected needs, and prioritized the projects to meet those needs using a simple but effective tool

employed regularly by our Lean process teams to rank projects by the level of impact (high or

low) and the ability of HSC to implement the project (hard or easy).

Prioritization Matrix Source: Rocky Hill, CT www.connstep.org

Using this method, HSC prioritized the following identified needs:

1. Reduce obesity and overweight by increasing physical activity levels of persons with

chronic conditions and physical disabilities. Continue to promote community

membership in the Aquatic Rehabilitation and Fitness Center, targeting special

populations. Expand services of Special Care Equipment Exchange.

Rated as high impact, easy to implement

48

2. Enhancing the ability of like groups to communicate and share aspects of their conditions

Promote existing support groups and new groups, with an emphasis on new venues.

Improve access to resources for caregivers; explore opportunities to help caregivers

communicate as a group. Rated as high impact, easy to implement

3. Offer education on prevention of slips, trips and fall to individuals who report falls and

challenges with ambulation. Rated as high impact, easy to implement

4. Improve access to primary care for persons with chronic conditions and physical

disabilities. Continue working to establish medical homes for specific groups and

coordinate care for persons with chronic conditions. Programs will include our

Neuromuscular Center, Autism Center, and Dental Services.

Rated as high impact, hard to implement

5. Issues from transportation to medical services, are identified as a challenge by

individuals, caregivers, and key informants. Public transportation, especially accessible

vehicles, is a statewide challenge could benefit from a collaborative effort.

Rated as high impact, hard to implement

6. Provide education and support to encourage people to make healthy lifestyle choices.

HSC’s smoking cessation program has demonstrated effectiveness and should be

continued. Many community members rely on HSC for reliable healthcare information

and resources. Rated as low impact, hard to implement

7. HSC does not offer services in the areas of mental health, substance abuse, or weight loss

and healthy food choice programs, but will explore collaborative options to promote

existing community services. Rated as low impact, hard to implement

Existing Community Resources

Connecticut has many acute care hospitals that work to meet the healthcare needs of their

community members. HSC is part of the continuum of care for these hospitals statewide:

The William W. Backus Hospital, Norwich

Bridgeport Hospital, Bridgeport

Bristol Hospital, Bristol

The Hospital of Central Connecticut, New

Britain

Connecticut Children's Medical Center,

Hartford

Danbury Hospital, Danbury

Day Kimball Hospital, Putnam

Greenwich Hospital, Greenwich

Griffin Hospital, Derby

Hartford Hospital, Hartford

The Charlotte Hungerford Hospital,

Torrington

Johnson Memorial Hospital, Stafford

Springs

Lawrence + Memorial Hospital, New

London

Manchester Memorial Hospital, Manchester

Middlesex Hospital, Middletown

MidState Medical Center, Meriden

Milford Hospital, Milford

New Milford Hospital, New Milford

Norwalk Hospital, Norwalk

Rockville General Hospital, Vernon

49

Saint Francis Hospital and Medical Center,

Hartford

Saint Mary's Hospital, Waterbury

St. Vincent's Medical Center, Bridgeport

Stamford Hospital, Stamford

UConn John Dempsey Hospital, Farmington

Waterbury Hospital, Waterbury

Windham Hospital, Willimantic

Yale-New Haven Hospital, New Haven

The state of Connecticut has a number of departments and programs that address specific needs

of special populations. HSC often refers patients and program participants to programs that can

help them to access services:

Department of Public Health

Department of Mental Health and Addiction

Services

Department of Children and Families

Department of Developmental Services

Department of Housing

Department of Rehabilitation Services

Department of Social Services

Money Follows the Person

Department on Aging

Council of Developmental Disabilities

Office of Early Childhood

Office of the Healthcare Advocate

Office of Protection and Advocacy for

Persons with Disabilities

A number of valuable not-for-profit organizations advocate for special groups and provide

services. Those working with members of HSC’s community include:

ALS Association – CT (Amyotrophic lateral

sclerosis)

American Heart Association, CT Affiliate

American Lung Association in CT

Autism Speaks

Autism Families CONNECTicut

Brain Injury Alliance – CT

Food Share (CT)

Muscular Dystrophy Association, CT office

National Stroke Association

Spinal Cord Injury Association – CT

Community Health Needs Not Addressed

All of the needs demonstrated in the assessment are genuine. However, based on the variety of

those needs and HSC’s core competencies in certain specialized areas, HSC will continue to

focus on the needs of individuals living with chronic conditions or physical disabilities.

Therefore, HSC is not in a position to address all of the needs. Identified needs that will not be

directly addressed are explained here.

Healthcare coverage / Access to care / Navigation of healthcare systems

The reasons individuals do not seek care or are unable to obtain care are many and varied. The

survey responses indicate that these reasons are often intertwined.

In the United States, the percentage of people with health insurance coverage has increased since

2013. Specifically, Connecticut’s uninsured rate fell from 12.3% in 2013 to 6.4% in 2015. This

5.9% change represents an increase in both private and government coverage. While there are

48

some individuals who remain uninsured, this number also includes those individuals who have

chosen to pay the annual fine rather than pay for insurance.

All of HSC’s inpatient and outpatient services access a wide variety of coverage products

including Medicare and Medicaid. Some services specifically target uninsured and underinsured

individuals.

Some of the exchanges offered to individuals without other health coverage options may actually

complicate access to care. Some products have few approved providers which may limit access.

Most plans require co-pay or have high deductibles that may be unaffordable for some people.

HSC supports and encourages patients and program participants to enroll in programs that will

best meet their needs. Advice and education on navigating healthcare systems is offered to

patients and to program participants. Clinicians at HSC often function as advocates for our

community members.

Mental health services / Substance abuse treatment

As an LTACH, HSC’s programs address physical rehabilitation and respiratory care; we are not

a provider of mental health services or substance abuse treatment as primary diagnoses. Staff

psychologists and psychiatrists address such issues with our inpatients and outpatients when the

issues are secondary to a patient’s medical diagnoses.

49

NEXT STEPS

Approval of CHNA Report by the Governing Body

The Hospital for Special Care Board of Directors met on March 24, 2016 to review the findings

of the CHNA. The report was approved.

Public Access to the 2016 CHNA

This report can be found on the HSC website at: http://hfsc.org/about-us/community-health-needs-

assessment . A paper copy is available in the HSC Health Sciences Library.

Implementation Strategy

Data collection will be ongoing throughout the three-year cycle of this CHNA.

Design Implantation Strategy to address prioritized needs, with participation of the HSC

program managers

Meetings with key informants and service providers to discuss implementation strategy

and collaborative efforts.

Board of Directors will adopt the Implementation Strategy before August 15, 2016.

Implementation from the month of adoption through 2019.

http://hfsc.org/about-us/community-health-needs-assessment

http://hfsc.org/about-us/community-health-needs-assessment

50

ATTACHMENT SECTION FOLLOWS

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Attachment 1

Documents

COMMUNITY HEALTH NEEDS ASSESSMENT(CHNA) Triennial …...The main focus of this report is the results of our 2016 CHNA. The data collected will impact HSC’s decisions on programs