EDITION - University of Kentucky

SPRING 2021EDITION

PAW POWERPet therapy programs

provide comfort, joy

ON THE STAGEFarmers teach farmers

about health and safety

MOBILE NURSESouthern Kentucky clinic treats patients on the road

The Bridge KENTUCKY’S CONNECTION TO RURAL HEALTH ISSUES2

For most of my life, no one would have mistaken me for a “pet person.”

Sure, when I was young, there were always animals around our house. Frisky was a mixed breed dog. My first pet. I liked him from a distance.

There was a parakeet named Pepper.

A rabbit whose name I don’t remember.

Several outside cats. Smokey. Oscar. And others.

But, I didn’t have much of a desire to be around animals of any kind. In fact, I was pretty fearful of most animals.

When my wife and I got married, we had a pup named Sparky for a brief period of time. It didn’t last long.

All of that changed in 2017.

I was attending the annual conference of the National Rural Health Association, in San Diego, when I received a text from my wife. It was a photo of a beagle sitting on our front porch.

I dismissed the message.

Another text followed. Bing. This time, it was a snapshot of my daughter and the beagle. Together. My heart began to melt.

A third text arrived. Bing. This one included a photo of a shopping cart filled with dog toys, a collar, dog shampoo, a dog bed and just about any other item you could imagine being sold to new dog owners.

I cautioned my wife and daughter that they needed to do what they could to find the dog’s owner. Beagles don’t just grow on trees after all.

I was optimistic that, by the time I returned from my trip, the dog would be back to its rightful owners.

Boy was I wrong.

When I did make it home from the conference, no one had yet come forth to claim the dog. And, in fact, she

finding in our four-legged friends

A WORD FROM

DIRECTOR, KENTUCKY OFFICE OF RURAL HEALTH

had already been named (Bailey) and received a clean bill of health from the local vet.

She had found a new home. Our home.

So, I did what I never would have done in years past: I immediately went out and purchased everything else that Bailey might possibly need and probably a few things that she didn’t need.

I also began work on building her a dog house in the yard. Its use was, it turns out, short lived. Bailey soon was spending the daytime hours outside and retreating indoors — into our house — in the evenings and nights.

Flash forward to the spring of 2020.

I began working remotely. My wife began working remotely. Our daughter began attending school virtually. We were home together each and every day, all day long.

And, Bailey was right there with us.

She joined us on walks to the creek, drives to town and lazy evenings hanging out on the porch.

She became an even bigger part of our daily routines.

Her mere presence comforted us. Life slowed down just a bit when she was around.

Her constant companionship meant we felt a little less alone in an unpredictable world, a little less anxious about what might happen next.

It’s no surprise then that health care facilities across rural Kentucky — hospitals and long-term care facilities among them — have turned to using pets with their patients. (See our story on Page 4.) The research suggests that animal-assisted interventions — visits from pets as well as animal-assisted therapy — can have tangible effects on patients’ health and well-being.

Our Bailey may not be a certified therapy dog, but even this “I’m not a pet person” will confess: She’s just the kind of dog that we needed to help make it through this past year. ■

Comfort

The Bridge KENTUCKY’S CONNECTION TO RURAL HEALTH ISSUES 3

The Louisville & Nashville Railroad Bridge, built in 1926, crosses the Green River in Munfordville, in Hart County. Two earlier bridges — one completed in 1859, the other in 1898 — also sat on the same site. The bridge is still in regular use.

The Bridge is published on a quarterly basis through a joint effort of the UK Center of Excellence in Rural Health and the Kentucky Office of Rural Health. The magazine highlights best practices and innovative solutions to rural health challenges in the Commonwealth. This edition is funded in part by federal Health Resources and Services Administration Primary Care Office grant funds.

The UK Center of Excellence in Rural Health was established in 1990 to address health disparities in rural Kentucky, including a chronic shortage of health professionals and residents’ poor health status. The Center accomplishes this through health professionals’ education, health policy research, health care service and community engagement. The Center serves as the federally-designated Kentucky Office of Rural Health.

The Kentucky Office of Rural Health (KORH), established in 1991, is a federal-state partnership authorized by federal legislation. The mission of the KORH is to support the health and well-being of Kentuckians by promoting access to rural health services. The KORH assists clinicians, administrators and consumers find ways to improve communications, finances and access to quality health care while ensuring that funding agencies and policymakers are made aware of the needs of rural communities. The KORH receives support from the Federal Office of Rural Health Policy in the Health Resources and Services Administration of the U.S. Department of Health and Human Services.

The statements and opinions contained in the articles published in The Bridge are solely those of the individual authors and contributors and not of the UK Center of Excellence in Rural Health, the Kentucky Office of Rural Health, its affiliates or funding agencies.

contentsOn the CoverRailside in Hart CountyPhotographer | Wayne Garmon

04Animals as Healers:Pet therapy programs provide comfort, joy

10Out of the Fields, On to the StageFarmers Teach Farmers

Departments

16

18

17

22

Clinic SpotlightOn the Road: Clinic meets need with home visits

National Health Service Corps SpotlightMeet Julie Percefull

Rural Health ChampionARH CEO works to spark growth, revitalization

National Health Service Corps SpotlightMeet Sara Durham

For additional information, questions or comments, contact:Kentucky Office of Rural HealthAttn: Michael McGill750 Morton Blvd.Hazard, Kentucky [email protected]

To receive The Bridge electronically, visithttp://thebridge.kyruralhealth.org

14HELP, Not HandcuffsKSP helps residents seeking treatment

http://thebridge.kyruralhealth.org

mailto:michael.mcgill%40uky.edu?subject=

http://thebridge.kyruralhealth.org


By Jackie Hollenkamp Bentley

Animals

Lucy Peterson and Belle regularly visit residents in the long-term care unit at Owensboro Health Muhlenberg Community Hospital in Greenville.

During those visits, Peterson, one of the unit’s certified nursing assistants, helps move residents to the lobby and then begins “playtime”: Residents start rolling a dog toy and Belle chases after it.

Belle is Peterson’s Chihuahua-Yorkie mix.“They’re just so intrigued with having a little puppy

running around,” she says. “They ask me all the time, ‘When are you bringing Belle?’”

And, Peterson’s not the only one bringing a pet to the workplace. Since 2019, three other employees and their dogs have made similar visits with residents.

Marty Carver, the hospital’s long-term care director, says the result of these human-animal interactions has been a greatly improved mental health among residents.

“It relaxes them, it decreases anxiety and they just look so forward to seeing these little dogs — even the residents who have a lot of anxiety. It just calms them down,” Carver says. “They feel that love that the pet gives and they give that love back. Mentally, love just helps everybody’s mental health.

“They don’t have their family here, and, of course they see us every day, and they get tired of seeing us. So when you bring a pet in, that’s new and everybody loves

Rural Kentucky health care facilities use pets to aid in treating patients and residents

animals and they just feel connected to that animal.” Many health care facilities throughout rural

Kentucky have been experimenting with forms of animal-assisted interventions for several years now. Some have established formal therapy-based programs. Others have incorporated animal visits into their schedules.

What they’ve all found out is that it seems to help.

Not a New IdeaUsing animals in a therapeutic role — to improve

patients’ cognitive, emotional, physical or social functioning — isn’t a particularly new idea.

In the late 1700s, patients being treated for mental illness at the York Retreat in England cared for chickens, rabbits and other farm animals on the facility’s grounds in an effort to help increase patient self-control.

A little more than 100 years later, in 1919, dogs were being used at a Washington, D.C. hospital to help treat psychiatric patients.

And, even famed nurse Florence Nightingale once observed the benefits of pets to patients, writing, “A small pet animal is often an excellent companion for the sick, for long chronic cases especially.”

Beginning in the 1960s, researchers started documenting the effects of these kinds of animal-

as


Shirley Hancock, a resident in the long-term care unit at Owensboro Health Muhlenberg Community Hospital in Greenville, cuddles Willow, a Yorkie Poo belonging to one of the hospital’s registered nurses. Since 2019, four hospital staff members have regularly brought their dogs to the unit for visits with residents. The hospital’s long-term care director says the visits have had a noticeable impact on residents’ mental health.


assisted interventions. The number of studies has grown since then, pointing to a wide range of health and wellness benefits: reducing loneliness in long-term care residents; improving mood and decreasing anxiety among psychiatric patients; decreasing stress and improving patient morale in pediatric patients; promoting increased communication with health care professionals during counseling sessions; and more.

Integral Part of Patient CareThe pet therapy program at Bourbon Community

Hospital in Paris is now in its eighth year of operation. It’s become an integral part of the hospital’s patient care.

But, its start wasn’t a given.“Research and science don’t lie, [but] it’s a leap of

faith to get a program started,” says Alan Teegarden, the hospital’s senior director and one of the program’s first participants, alongside his Burmese mountain dog Kismet (now retired). “I’m a risk manager and I went through all the scenarios a million times — ‘What if this happens?’ and ‘What if that happens?’ But once you see

“We’re very passionate about our pet therapy program because we see the benefit that it brings to our patients. Even in the adult behavioral health unit, you always get a smile … [the dog] really gets that patient’s mind off why they’re there … and really have some relaxation time.”

Cindy WesleyChief Nursing Officer,

Bourbon Community Hospitalwith Natalie,

her Russian Doodle

the value and you see the patient experience, none of that matters anymore.

“You have a grandma in her room and she’s got her dog at home that she’s missing terribly. For five or 10 minutes that day [as a participant in the pet therapy program], she doesn’t have to think about pneumonia or whatever health condition is going on. The way their eyes light up, it’s so rewarding.”

Cindy Wesley, the hospital’s chief nursing officer, is also a member of the pet therapy team. She and her black Russian Doodle, Natalie, are regular visitors to patients’ rooms — including in the hospital’s behavioral health unit which treats both adults and children.

“We’re very passionate about our pet therapy program because we see the benefit that it brings to our patients,” Wesley says. “Even in the adult behavioral health unit, you always get a smile … [the dog] really gets that patient’s mind off why they’re there … and really have some relaxation time.”

And, Wesley says, it’s the same for the unit’s youngest patients — children.


Animal-assisted interventions — a broad term that refers to a goal-oriented and structured use of animals in a variety of settings (education, health care, human services) in order to achieve therapeutic goals and improved health and wellness — can take a number of different forms, including:

Pet Therapy, Explained

Animal-assisted activities, which provide opportunities for motivational, educational and/or recreational benefits to enhance quality of life. While more informal in nature, these activities are delivered by a specially trained professional, paraprofessional and/or volunteer, in partnership with an animal that meets specific criteria for suitability.

Animal-assisted therapy, which provides goal-oriented, planned, structured and documented therapeutic interventions directed by health and human service providers as part of their profession. A wide variety of disciplines may incorporate animal-assisted therapy. Possible practitioners include physicians, occupational therapists, physical therapists, certified therapeutic recreation specialists, nurses, social workers, speech therapists and mental health professionals. (Animal-assisted therapy is commonly called “pet therapy.”)

- From Pet Partners, a nonprofit that registers handlers as volunteer teams

“They have very structured time in the unit so we visit during our designated times with the kids and the kids just spend time with the dogs — lots of talking and interaction, and really just downtime for the kids to spend [with Natalie],” she says. “They just sit down and hug her and they’ll talk to her and they talk about their pets at home … it’s very therapeutic.”

Bright SpotOne of the bright spots on the residents’ schedule at

Kenton Pointe Assisted Living Community in Maysville is the arrival of Koda and Molly.

It’s especially a treat for resident Margaret Ann Gorey. She’s grown attached to the two Border Collies. She likes to give Koda tummy rubs.

“I enjoy them,” she says. “It’s like being in your own home.”

Any time that she can spend with the dogs is special, Gorey says.

“For those of us who like dogs, it’s very important to have them around,” she says. “I wish they could come and stay with us permanently.”

Mary Anna Best, Kenton Pointe’s activities director, said the dogs started visiting the facility about five years ago. They’ve since become a mainstay.

“I think it’s awesome for us when the dogs come to visit because it brings back childhood memories,” Best says. “That’s always a good thing to remember — those good times we had as youngsters with our animals.”

Koda and Molly’s handler is Rhonda Sims, a nursing


professor at Maysville Community and Technical College, who, when she’s not in the classroom, doubles as a pet therapy volunteer. Sims also serves as a tester and observer for the Alliance of Therapy Dogs, Inc., a Wyoming-based international registry of certified therapy dog teams.

The trio visit dozens of locations across northern and eastern Kentucky — hospitals, assisted living centers, hospice and long-term care facilities. They also visit area schools to work with special needs students.

And, it’s a service she’ll provide until she’s physically unable, Sims says.

“I consider it part of holistic care as a nurse, as a professor and as a forensic nurse,” she says. “I consider it the best part of care we can give.”

Sims says working with patients is a humbling experience.

“Many times [patients are] so weak, they couldn’t raise up or touch the dog, so I would hold Koda or Molly on my lap right next to the bed so they could reach over. Even in their debilitative state they would smile or they would say the dog’s name,” she says.

She adds, “We’re paying it forward and sharing the love.”

Jackie Hollenkamp Bentley is a Louisville-based freelance writer who covers all things Kentucky.

An Outlet, a Coping SkillStaff at Baptist Health Hardin have been using

animal-assisted therapy since November 2018, after the hospital’s foundation provided a grant to begin the program. That grant covered starup costs for the program — a salary for Courtney Buis, the hospital’s pet therapy coordinator, as well as other expenses (dog vests, cleaning materials). The program is now funded by the hospital.

“There are so many reasons to have this program,” Buis says. “We’re able to go in and really give those patients an outlet and, for some patients, a coping skill to be able to calm down and reset. We are able to go in and help families and give them a break from their loved ones being sick or passing away and provide that emotional support.”

For Buis, the real payoff is seeing a patient’s reaction when she and her golden retriever, Maggie, walk into a room.

“We went in to see a lady who had a stroke and wasn’t communicating with anyone. She was a dog lover, but lost all motivation to do anything. The family asked for a pet therapist,” she says. “We brought Maggie in and automatically she lit up and she said the first words since she had had her stroke. Her family afterwards came to me and they were crying. They said that’s the first time that she said anything … or had a will to even sit up in the bed.”

An Unintended BenefitOne added benefit of animal-assisted interventions

is the unintended demographic — health care facilities’ own staff — they can also help.

Teegarden, the Bourbon Community Hospital administrator, says some of the most rewarding interactions he’s seen with the hospital’s therapy animals are those between the animals and the hospital staff.

“Let’s face it, we’re in a horrible time in health care right now [due to the coronavirus public health emergency] and the dog is going to the nurses' station and the nurses are getting on the floor with them just speaks volumes,” he says. “I can’t imagine working at a place that didn’t have therapy animals.”

Buis says she also regularly sees the direct impact therapy animals have on staff at Baptist Health Hardin.

“There’s just a huge sense of calm and happiness that comes on the unit. You can tell everybody’s stress level decreases,” she says. “Everybody is so excited and forget for a second all the horrible things going on. They’re able to focus on something positive. It gives people a positive experience in a hospital setting that they may not get otherwise.” ■

“We went in to see a lady who had a stroke and wasn’t communicating with anyone. She was a dog lover, but lost all motivation to do anything. The family asked for a pet therapist. We brought Maggie in and automatically she lit up and she said the first words since she had her stroke. Her family afterwards came to me and they were crying. They said that’s the first time that she said anything … or had a will to even sit up in the bed.”

Courtney Buis, Pet Therapy Coordinator, Baptist Health Hardin


One added benefit of animal-assisted interventions at health care facilities: Staff members can also visit with the animals.


Farmers feed the world. But today they face increasing pressures to produce

more and more with less and less. Profit margins are thin. Families are shrinking in size, and many farmers’

children go on to pursue careers outside of agriculture. Farming is also among America’s most dangerous

professions, yet many farmers plan to never retire. Taken together, it’s a potentially perilous mix of risk

factors and generations-old culture that can lead to an increased risk of injury and possibly death.

Enter: Deborah Reed. A nurse by training and a faculty member in the

University of Kentucky’s College of Nursing, Reed sought a way to help aging farmers and their families recognize the risks involved with their work and take steps to reduce or eliminate those risks, so that they could continue farming in the healthiest and safest ways possible. The result: a farm dinner theater program that weaves real-life stories

into short plays, with farmers serving as both actors and audience. It’s based on the premise that “[t]he way people act is greatly influenced by what they know about the actions of others in their community,” Reed and co-author Deborah Claunch note in a Journal of Safety Research study detailing the program.

“Some farmers think they are the only one to have gone through something, but when they start talking across the table [in the audience of dinner theater programs], they realize it’s happening to the whole community,” Reed said recently. “You move the social norm and what was usual in that community gets nudged toward a healthier and safer environment on the farm.”

How it StartedReed is no stranger to the world of agriculture. She

calls herself “a farm girl with a farm family.” She grew up on a 200-acre beef cattle and tobacco farm in Woodford County, where she saw the risk of farm injuries firsthand.

By Katheran Wasson

Out of the FieldsON TO THE STAGE

Dinner theater program uses farmers to educate their peers about health and safety issues


Live theater has long been accepted as a medium that seeks to entertain, instruct or both. One important use of the theater is to help audiences recognize the importance of certain behaviors and beliefs. This form of theater, called didactic theater, includes discussion of the performance’s themes with the audience following the presentation. Open discussion allows the audience to reflect on the content and incorporate the information into their own lived experiences and within the social norms of the group. Through these discussions, new information becomes available and the audience is empowered to make changes. The theater becomes a medium for information sharing and processing.

Readers theater refers to a performance style in which actors read directly from a script, rather than reciting lines from memory. Performers use their voice and gestures to help bring their characters and their characters’ words to life. Costumes and sets are limited or optional. The words in the script of a readers theater performance are most important, not elaborate sets, costumes or the physical action of an actor. The approach became popular during World War II when resources to produce plays were scarce.

Didactic readers theater has been used to highlight a range of health or social problems, including smoking, obesity, vehicle safety, bullying and palliative care.

—Adapted from the Farm Theater Toolkit

What is didactic readers theater?


While her four older siblings went into farming, Reed chose, instead, a career in nursing. But the dangers of farm life remained top of mind: One of the first injured patients she treated as a nurse was a farmer who had had a chainsaw accident.

After working more than 20 years in clinical settings, Reed began what has now been a 30-year career conducting community-based research on farms in Kentucky and across the U.S. That research led her to the realization that farmers know the risks and reasons for on-the-job injuries, but they don’t often make the changes that are necessary to protect themselves. It’s particularly true among older farmers, who are, by the numbers, injured less often, but when those injuries do occur, they tend to be more serious.

“Coming from a farm family, I know that old dogs can learn new tricks,” she said, “but sometimes they don’t like to.”

The development of the dinner theater program was based on years of research and three years of focus groups and interviews with farmers and their families in Iowa, Kentucky, Nebraska, Tennessee and Virginia. In those discussions, Reed and her research team learned about the health and safety concerns of those they spoke with and discovered that farmers were more receptive to messaging presented through humor and stories, rather than messages communicated in a top-down approach by health experts. A brochure isn’t enough to move the needle, Reed said — farmers already know the risks, but are still resistant to change their behaviors.

“Through our research, farmers told us they listen to each other and watch each other — that’s the culture of agriculture,” Reed said. “What can we do then? We realized they need to learn from themselves.”

Reed and her team considered staging a play with professional actors, an approach that had been tried before by public health departments. It was cost prohibitive and hadn’t really caught on. But what if they used local farmers as the actors? And what if they pitched the performance to the community as a free date night for farmers and their wives? It was worth a shot.

In 2014, Reed’s team secured a multi-year grant from the National Institute for Occupational Safety and Health, part of the Centers for Disease Control and Prevention, to test the concept. They wanted to see if staging plays using humor and content that was relevant to farmers’ lives could prompt farmers in the audience to change their high-risk behaviors. Farmers from the community would serve as actors in these readers theater-style performances, which required them only to read from scripts, not memorize lines or stage directions. Sets would be simple — a table and chairs, for example — to reduce costs and add to the relaxed atmosphere of the night. It would be a laid back, non-threatening environment in which to share health and safety messages.

The eight dinner theaters held in Kentucky, Tennessee and Virginia with assistance from county extension offices sold out. And Reed and her team got the results they were hoping to see.

The ResultsThe dinner theater events were found to be highly

effective in changing the work behavior of farmers: More than 50 percent of participants had made safety-related changes — from minor changes like wearing sunscreen to major investments, like purchasing new cab tractors, which are safer than open station tractors — within two weeks of attending a theater event. And nearly 60 percent had made changes within two months of their attendance.

After one play that addressed the dangers of fatigue, audience members talked about how such weariness affected their work. One even admitted to napping midday — a bold statement in a culture marked by sunup to sundown work. But others said they did the same, and by the end of the night, participants left feeling better about taking a break without feeling they were “being lazy,” Reed wrote in a study summarizing her work.

“Realizing that the non-risky behavior (e.g., taking a nap or break during the day) was socially acceptable was liberating and empowered the individuals to form a new mental model of their own behavior,” the study noted. “This, in effect, moved the social norm for performing farm work.”

Attendees have reported a wide range of behavioral changes following the dinner theater events: from wearing ear plugs, drinking more water and changing the shoes they wear, to wearing a seat belt more often, getting an annual checkup with a physician, taking a vacation and communicating better with a spouse about the work they’re doing in the field and just where on the farm they’ll be doing it.

One critical part of the dinner theater programs is a quick group discussion after each play to help solidify the information shared.

“While the actors are on stage it feels like pure entertainment, so the discussion allows the people to think about what they saw on the stage and guide them a bit in that thought process,” Reed said. “That’s the time when you can say, ‘Did you know farmers have one of the highest suicide rates of any occupation? That’s why vacations are really important and you should take one.’”

Another key to the success of the farm dinner theater is inviting couples. Reed said it’s important that spouses hear the information together. Wives have historically played the role of “gatekeeper of health” on farms and their presence in the audience at the performances helps spur discussion in the moment, she said.

More recent research by Reed and her team concluded the theater approach was more effective


in eliciting behavioral change among farmers than distributing traditional educational materials.

“If you present people information in a way that's realistic and applicable to them, it becomes very meaningful and the thought processes begin to click as they solve their own problems,” she said.

Many farmers have also reported that they shared information gained at the events with others in their community, spreading the effects even further.

In addition, Reed said the dinner theater events caused an unexpected change among the extension staff who partnered with her research team: They began to rethink their own approach to programming directed at local farmers. Many extension staff said they would now include more health- and safety-oriented information in any program they host for farmers.

A Program SpreadsReed has since developed a toolkit to help other

organizations and communities host their own farm dinner theater events, including tips on setting up a planning committee, finding a location, selecting catering and funding considerations.

Farm Theater ToolkitThe Farm Theater Toolkit, developed by Deborah Reed and available free of charge online, provides a step-by-step guide to planning and performing farm dinner theater-style events.

The toolkit includes an overview of using readers theater to deliver farm health and safety messages; key points to consider during the planning of a performance; suggestions on how to handle post-performance discussions and generate audience engagement; sample scripts, event evaluation forms and promotional materials; and farm health and safety informational resources.

The toolkit can be accessed at: https://psd.ca.uky.edu/webinarshandouts

The toolkit also includes sample scripts, developed to cover topics generic enough to apply to any farming community — hearing loss, tractor overturns, arthritis. Local organizers can customize the dialogue, weave in local concerns and avoid anything that might be considered inappropriate in their particular community.

The farm dinner theater concept has since reached 20 states, including Nebraska and North Carolina. It’s even being used with dairy farmers in Ireland and in non-farm settings, among mental health educators and in elementary schools. Reed sees opportunities for the dinner theater concept to grow beyond farming communities.

“I'd love for anyone interested to look over the toolkit and then sit down with some of their peers and think about how they could use this concept, not necessarily just with farmers but thinking of other people who learn by the oral tradition,” she said.

Reed added: “If a community wants to do this, you don't need much if any money to do this. You don’t have to have a lot of fancy choreography. You can use the Ruritan Club or a church fellowship hall. It's the stories that really are meaningful, not the setting.” ■

Katheran Wasson is a Northern Kentucky-based writer and editor who covers business, health, agriculture and life in Kentucky.


Its promise is to offer “help, not handcuffs.”And, since 2016, the Angel Initiative, offered

at Kentucky State Police posts statewide, has helped about 200 residents facing substance use disorders enter treatment.

The program — first piloted in rural Eastern Kentucky and operating across the state beginning in 2018 — takes a proactive approach: Any Kentucky resident facing addiction can come to any Kentucky State Police post and get help finding a treatment center.

KSP works with partnering organizations to help the program’s participants access treatment quickly — often the same day — rather than being placed on a waiting list, being asked to return later or facing the prospect of having to seek out

help on their own, said Capt. Jennifer Sandlin, the Hazard Post commander.

Treatment Without Fear of Prosecution

The Angel Initiative is treatment without the fear of prosecution.

It’s not a way to complete court-ordered treatment. And, it’s not a way to fulfill sentencing obligations.

Instead, it’s completely voluntary.When they arrive at a KSP post, those

seeking to participate in the program are asked to provide a form of identification and a copy of their insurance information, if they have insurance.

Kentucky State Police initiative helps residents seeking treatment

By Shannon Clinton


They’re asked to sign a form granting permission to conduct a records check and submit to being searched. (Individuals who have an outstanding warrant or a non-extraditable arrest warrant in another jurisdiction are disqualified from participation. Also disqualified are unaccompanied minors, registered sex offenders and individuals who are deemed to be a danger to others.) Any drugs or drug paraphernalia found during the search will not lead to an investigation, charges or jail time.

They will also be asked to provide information during the intake screening to help determine their best treatment options.

‘It Was Just So Brand New’Five years ago, Sandlin oversaw

the Pikeville KSP Post when the Angel Initiative was piloted there. It’s modeled after a program operating in Gloucester, Massachusetts.

At first, Sandlin said, she wasn’t sold on the idea. She wondered whether it could succeed or if progress could be accurately gauged. She also knew that, historically, law enforcement has been trained to conduct drug investigations and jail lawbreakers.

“Early on I was more intimidated,” Sandlin said. “Not that I didn’t want to do it, it was just so brand new. It was something I knew nothing about.”

But, after working alongside other community partners — including treatment centers; Operation UNITE, the Somerset-based nonprofit focused on drug prevention, community education and treatment for those impacted by substance use disorders; and, residents seeking help for their own addictions — her views changed. She realized that substance use disorders are a public health problem and that everyone in the community has a role to play in ending the addiction crisis.

First ParticipantsIn August 2017, the Pikeville Post

received its first Angel Initiative participant.

And, in its first year, the program helped about 50 residents seek treatment, topping out at around 130 in 2019, once the initiative spread to all 16 posts statewide.

In 2020, participation remained strong until the coronavirus pandemic hit. In-person requests to the program were suspended for nearly a year and opened up again in early 2021, with assistance during the shutdown remaining available by phone.

‘Treatment is Much Better’

Partnering treatment facilities pledge to have a bed open when needs arise and to not turn participants away due to an inability to pay.

Prestonsburg-based Hope in the Mountains accepted the Angel Initiative’s first participant from the Pikeville area and has continued to work with troopers and victim’s advocates to coordinate treatment for those who have followed, said Renee McCoy, the organization’s executive director. The nonprofit offers adult residential and transitional services for women and outpatient services for both men and women for 30- or 90-day stays or longer, if necessary.

“It’s a wonderful program,” McCoy said of the Angel Initiative. “For all the people who are in jail, if you took away issues with drugs and alcohol, you probably wouldn’t have very many people left in jail. Treatment is much better.”

Far-Reaching ImpactSandlin said the program’s impact

is far-reaching, extending beyond just the participant numbers: There are the children and family members of those who are in recovery. There are the participants themselves who are able to re-enter the workforce, pay taxes and become productive members of the communities where they live.

“You can’t measure that — it’s hundreds of people that can be affected by one person getting into recovery,” Sandlin said. ■

Shannon Clinton is a Lawrenceburg, Kentucky-based freelance writer who for the past 25 years has written feature and business articles for publications across the southeastern U.S.


When did your service begin?September 2019

What are your job responsibilities at your NHSC practice site?

I am an outpatient therapist providing individual, family and group counseling for children, adolescents and young adults. I also provide services to those who may experience developmental and intellectual disorders. In 2019, I began serving as CAFCA’s group coordinator. We provide group services to elementary and middle school-aged children through a program we refer to as Character Quest. I have led one of our Character Quest groups since I started working at CAFCA in 2016.

How did you first learn about NHSC programs?

I learned about the NHSC program through my workplace and other colleagues.

What does it mean to you to be a NHSC participant?

I am very grateful to have been selected as a NHSC participant. While being free of student loan debt is a relief and benefit, I am honored to be able to provide services to underserved, rural communities. I grew up in a small, country town and witnessed the poor accessibility to mental health and behavioral services. Knowing I can make a difference in these children’s and families’ lives, even if it’s a small difference, is very rewarding.

NATIONALHEALTH SERVICECORPS

LIGHT

LPCC, Group CoordinatorChildren and Family Counseling Associates (CFCA)

Harrodsburg, Kentucky

Meet

What is the most important thing/lesson that you've learned during your NHSC service?

Mental health services can be difficult to access in the areas that we serve. And the pandemic has not made it any easier. As accessibility has improved over the last several years, there is still a significant need for mental health professionals in this area. We are seeing a rise in depression and anxiety in children, adolescents and teens, and they need the adequate support in order to thrive in today’s environment.

What advice would you offer to someone who is considering participating in NHSC programs?

What are you waiting for? This program has been rewarding in more ways than one. Being an NHSC participant can help relieve financial stress and allow you to focus on other areas of growth while also providing services to those in underserved populations. As mental health professionals in this region, we can come together in order to make services more accessible to those in need. ■


If you have participated in a National Health Service Corps program or know of someone who has, please let us know. We’re looking for participants to feature in future issues of The Bridge.

When did your service begin? September 2020

What are your job responsibilities at your NHSC practice site?

I provide care to primarily pediatric patients in a rural health care setting. That includes diagnosing and treating acute and chronic illness; providing preventive health care; administering physical exams; monitoring diagnostic laboratory results; evaluating radiographs; and prescribing and monitoring medications. I collaborate with providers and ancillary staff daily as we work together to improve patient and community health through quality improvement processes. I also enjoy the opportunity to give back to other students by serving as a preceptor for doctor of nursing practice and family nurse practitioner students.

How did you first learn about NHSC programs?

I learned of the NHSC program once I started at Family Medical Center of Hart County; previous providers had participated in the program. Upon researching the opportunity further, I decided to apply once our clinic was accepted as a site.

NATIONALHEALTH SERVICECORPS

LIGHT

Nurse PractitionerFamily Medical Center of Hart County

Munfordville, Kentucky

Meet

What does it mean to you to be a NHSC participant?

In addition to receiving assistance in paying off my loans, being a NHSC participant means I am able to remain in a health care shortage area and provide much needed care to an underserved population. Providing services locally allows me the opportunity to improve the health of my community.

What is the most important thing/lesson that you've learned during your NHSC service?

I have learned how important the NHSC program is to maintaining qualified health professionals in rural and underserved areas to meet the needs of those communities.

What advice would you offer to someone who is considering participating in NHSC programs?

A sense of pride comes from helping those most in need and the NHSC programs help participants to achieve that goal through their assistance. I encourage everyone who is eligible to apply and become the next NHSC participant and make a difference in the community you serve. ■


CLINIC

LIGHT

Lakeside Primary Care

fills community need through

home visits

ON THE ROAD

By Michael McGill



When sisters Thuresa Cash and Alisha Cooley, both nurse practitioners, opened Lakeside Primary Care in early 2019, they hadn’t planned on making at-home visits.

That all changed one day when a woman brought her mother, a stroke survivor who was completely paralyzed on her right side, to the rural health clinic (RHC) in Somerset. The daughter came inside the clinic and asked for a wheelchair for her mother. The staff took one outside.

The daughter, a small woman, couldn’t easily get her mother out of the car and into the wheelchair. So, the clinic’s staff did the lifting.

And, figuring that life might be much easier on the daughter if she didn’t have to transport her mother to the clinic for appointments, Cooley made the offer.

“I said, ‘Why don’t I start coming and seeing her at home?’” she remembers saying.

That, it turns out, was the first of many such offers.

The home visits have since snowballed for the Pulaski County clinic — especially since the COVID-19 public health emergency, when many of the clinic’s immunocompromised patients were also added to the at-home visit list. What initially began as a two or three day-a-week service offered by the clinic and Cooley, who, along with her sister has years of experience in the home health field, has now morphed into, essentially, her full-time job.

Since the fall of 2019, she’s been on the road four days a week, visiting, on the low end, five or six patients a day, and, up to as many as 15 or 16. She’s regularly seen patients on holidays, weekends and nights. And she’s also been known to visit patients on her days off. Cooley now sees around 150 patients at their own homes. (She also sees patients one day a week, on Saturdays, at the clinic.)

“We try to take care of our patients … we just do what we can,” Cash says. “You know, we don’t have a lot because we’re kind of struggling here as well. But we do what we can to help take care of our patients. They’re like family and that’s what our motto has been. You know, we want them to be like family to us.”

‘Pretty Much Everything’Cooley’s patients on the road — in McCreary,

Pulaski, Wayne and Whitley counties — are a mix. Many are bed-bound or wheelchair-bound. Some are referrals from hospice. Many are on the sicker end of the spectrum.

There’s also the patients who lack the transportation

to get to the clinic. They’re likely on a fixed income. They may or may not own a car. And they probably can’t afford the gas or the cost of paying someone to drive them to an appointment.

A majority of the home visit patients are covered by Medicare or Medicaid.

Cooley heads out early and goes all day on Tuesdays, Wednesdays, Thursdays and Fridays — the days set aside for her home visits. When she can, she tries to schedule appointments by county: She’ll have “McCreary days” when she only visits patients in McCreary County, “Pulaski days” and so forth.

On those visits, she’ll conduct initial assessments. She checks patients’ vitals. She may draw labs. She often refills medications. She might change feeding tubes or catheters. She offers wound care. She may arrange for home health to come and visit the patient.

“Pretty much everything,” she says.And while she used to take her

own car on the road — she “put a ton of miles on it,” she admits — the clinic has since purchased an SUV for her travels. She calls it her “rolling medical clinic.” Inside, she has anything and everything that she might need while tending to patients: vital sign equipment, blood pressure equipment, medicine samples, injectables, oxygen, lab kits, wound supplies, catheters, IV-related supplies.

Cash jokes, “A lot of times we’ll go to the drawer [in the clinic] to get something out and it will be gone and we’ll be like, ‘She’s been here again.’”

The SUV is also equipped with a centrifuge, which allows Cooley to spin down blood samples until she can get back to the clinic.

‘You Coming Just Means Everything to Us’It’s likely an understatement to say that Cooley’s

patients — and their family members — are thankful for the service she provides.

There’s the patient she just saw the other day who’s been out of her blood pressure medicine for nine months. She didn’t have a way to get to the doctor.

There’s the man in Whitley County who somehow got Cooley’s number, called her in tears and told her about his bed-bound wife who has a severe case of rheumatoid arthritis. A house calls service used to visit the couple but quit because their home was too far to travel to.

The husband was panicked. “I don’t know what I’m going to do,” he told Cooley.

She agreed to visit the wife. (“I have a hard time telling people ‘no,’ she explains.) She warned him that it

“We try to take care of our patients … we just do what we can. You know, we don’t have a lot because we’re kind of struggling here as well. But we do what we can to help take care of our patients. They’re like family and that’s what our motto has been. You know, we want them to be like family to us.”

- Thuresa Cash


Michael McGill is a Rural Project Manager in the Kentucky Office of Rural Health.

might not be until nine o’clock that night.He replied, “I don’t care if it’s midnight.”When Cooley did arrive at the home, the husband

was on the porch. And he cried. They were tears of joy.“Doesn’t matter what time you come, day or night,”

Cooley remembers him saying. “You coming just means everything to us.”

Home visits, though, may not be for every provider and clinic, Cooley says. They take time.

“So, a lot of people probably don’t do this service because … I can see 10 patients and it can take me 14 hours. You know what I mean?” Cooley says. “When you can see 10 patients in the clinic in two hours or two-and-a-half hours. But those patients [at their homes] need to be taken care of as well. And we would want the same if we were in that situation.”

Cash points to the way she and her sister were raised and the lessons they learned growing up in McCreary County to help explain the clinic’s adoption of home visits as a regular service.

“You know, we were grown up with a really close family that took care of one another and we’ve always just been taught to take care of people,” Cash says. “And to care about people. And to love people. And to treat them as if we would want to be treated that way.

“And our parents grew up with nothing and they taught us more about love than they did material things. We don’t do this for the money. We do it for people.”

‘Free Her Up’Cooley’s high patient load for home visits means

that appointments for new patients aren’t quite as

immediate as they once were. (They’ve never advertised the home visit service. Details of it have spread mostly by word of mouth and through some recent television news coverage.)

“People can’t just call me and say, ‘I need a visit,’” Cooley says. “It used to be they would call me, and I’d say, ‘OK, I’ll be right on over there’ or ‘I’ll be over there today.’ So now when they call me, I’m getting a new patient [ for an initial appointment] on the next week or the following week, depending how sick they are.”

The clinic’s other full-time nurse practitioner, who lives in McCreary County, also helps out with home visits when she can. If a patient calls from her home county, she offers to stop by on her way home and check in.

Cooley does sometimes have to say “no.” She once got a call about a hospice patient who lives in Russell County. It was too far to drive to care for just a single patient.

“[I]f there was more there … I’d be willing to do it,” she says.

By early 2022, the sisters hope to add another full-time provider to the clinic’s staff, which will allow Cash to join Cooley on the road and help take some of the burden for home visits off her sister.

“I’m hoping to help her out because she’s killing herself seeing so many patients,” Cash says. “And I thought that once the COVID was on the decline and patients were starting to trickle back in here [into the clinic], I thought, well, maybe that will free her up. But she gets referrals every day.” ■

VIEW FROM THE NATIONAL ASSOCIATION OF RURAL HEALTH CLINICS

Nathan Baugh, the director of government affairs for the National Association of Rural Health Clinics, says home visits shouldn’t be neglected as a way to potentially connect with RHC patients. Providers can see their RHC patients in the clinic, at the patients’ home, in a skilled nursing facility and at the scene of an accident. Sometimes RHCs can be too focused on bringing patients in, to generate face-to-face visits in their clinic,” he says. “But the regulation and guidance are both very clear that a patient’s home is an appropriate setting for an RHC encounter.”


Joe Grossman isn’t originally from Kentucky. He grew up just across the Ohio River, in Lawrenceburg, Indiana, west of Cincinnati.

And, he didn’t initially set out to work in the health care field. He started out in public accounting.

Those two facts haven’t stopped him from making an impact on the health and economic wellbeing of Eastern Kentucky.

As president and CEO of Appalachian Regional Healthcare (ARH) over the last eight years, Grossman has embraced the idea that hospitals can and should play a proactive role in improving not just the physical and mental health of the communities they serve, but also the social and economic health of those communities. Hospitals — as the largest employer in so many small

communities and one of the largest, if not the largest, land owner in those same communities — can be agents of change.

For Grossman, that’s meant betting on the future of the communities that lie outside the walls of each of ARH’s 13 hospitals in Southeast Kentucky and southern West Virginia. It’s meant moving beyond the more traditional role of a health system CEO and taking a hands-on approach to helping jumpstart economic growth and revitalization at the local level.

“You know, if we’re going to continue to have thriving communities and thriving hospitals, we have to have a thriving economy,” Grossman says. “So we have a decision to make: Either we participate in making the economy thriving or we wither.”

By Michael McGill

Charting the Course

Appalachian Regional

Healthcare CEO works

to spark economic

growth and revitalization

in Eastern Kentucky


‘Learn Every Day’Grossman’s entry to the health care field came in his

mid-20s and on the finance side, after he began a career in accounting. (Although his mother worked as a nurse, Grossman says that likely had no influence on his future plans. His father worked as an operating engineer for electric utilities.)

After studying to be an accountant at Purdue University (he actually majored in industrial management there; they didn’t have an accounting program then), he joined Ernst & Whinney (now known as Ernst & Young) in Indianapolis. At the time, it was the largest accounting firm in the state and represented most of Indiana’s major health care organizations. It’s where Grossman got a taste for working in health

care: He was assigned to work with a number of the firm’s health care clients and grew to like not just the accounting side of his work, but also the consulting side — working with state agencies on rate approvals and certificate of need issues, and also working on Medicare cost reports.

“I enjoyed that kind of stuff,” he says.After a co-worker moved on to become the

chief financial officer at Good Samaritan Hospital in Lexington, Grossman got a call inviting him to join the hospital as its controller — to help strengthen the accounting department, to do some of the consulting work that was being outsourced and to work on the budgeting process. He and his wife Leigh “waffled back and forth on it,” he remembers. They eventually decided


to make the move. That was back in early 1987. And ever since then, Grossman’s been working in

the health care world. He spent more than 11 years at Good Samaritan (under three different owners) before he was enticed to become the CFO at Ephraim McDowell Regional Medical Center in Danville. He later joined ARH in 2002. He rose from controller to vice president of operations and chief operating officer, then to vice president for fiscal affairs and chief financial officer at the health system. In May 2013 he was named the president and CEO.

“I’ve been very blessed throughout my entire career to be put into situations where I learn. And my philosophy is learn every day,” Grossman says. “I can remember sitting around the dinner table with my kids and talking about how their day was and somebody would say, ‘Did you have a good day?’ And I said, ‘You know what, I learned something new today. It was a good day.’”

‘It is Happening’With an accounting and finance background, it’s

probably no surprise that many of the bigger projects that Grossman’s tackled as CEO at ARH have focused on economics — specifically, community economic

development with a mix of both workforce development activities and traditional economic development activities (creating jobs, building infrastructure and the like).

In early 2017, in response to the growing shortage of nurses in Eastern Kentucky, ARH and Louisville-based Galen College of Nursing partnered to start a new associate degree nursing program based at the ARH System Center in Hazard. Grossman led the partnership. They converted unused space in the administrative building — the former Hazard hospital — into a 40-seat classroom, a clinical learning lab, a student lounge and office space.

The first students enrolled in March 2017.And, the campus has since added a licensed

practical nurse to associate degree in nursing bridge program. Students are also able to enroll in an online program for registered nurses seeking a bachelor’s degree in nursing.

“Galen is a big one,” Grossman says, reflecting on some of what’s been accomplished at ARH while he has been CEO. “To me, it’s a couple of things. It’s an opportunity for people in our area to gain a skill that will offer them gainful employment as long as they want it. Two, it helps our organization and the other


organizations by providing a workforce.”Two years later, in 2019, ARH welcomed the

inaugural class of medical school residents to the ARH Internal Medicine Residency Program. Based at Harlan ARH Hospital and Whitesburg ARH Hospital, the program — the first internal medicine residency program operating in Eastern Kentucky — seeks to train and keep physicians in the region.

The residency program currently has 12 residents. Six more will be added in July.

Eastern Kentucky’s economy — long dependent on coal — is another challenge that Grossman’s tried to help tackle.

Coal jobs have disappeared. And with them, the income that came from those high-paying jobs. There’s also been some population loss. But, hospitals, Grossman says, can play a vital role in helping to transform communities; they have a vested interest in the economic health of the communities they serve. Their futures are linked.

In 2015, Grossman was one of the original partners that formed One East Kentucky, a nine-county regional economic development organization which seeks to recruit industry, jobs and investment to Eastern Kentucky. The privately-funded nonprofit’s members

include local governments, chambers of commerce, industrial development authorities, area development districts and private industry located in Floyd, Johnson, Knott, Lawrence, Letcher, Magoffin, Martin, Perry and Pike counties.

He currently serves as the group’s chairman.Most recently, One East Kentucky was instrumental

in attracting Ontario, Canada-based Dajcor Aluminum to locate its first U.S. manufacturing plant in Perry County. The project is expected to create nearly 300 jobs.

Grossman also helped start two more locally-focused economic development organizations: what’s now called the Hazard-Perry County Economic Development Alliance and One Harlan County. Both seek to do, at a county level, what One East Kentucky is working on at the regional level.

“Hopefully we’ll see the loss of coal jobs turn around,” Grossman says. “It’s not going to happen overnight, but it is happening. And I think that’s important for our communities.”

‘I Don’t Need the Spotlight’There have been other changes in the ARH system

since Grossman took the top job.ARH added three hospitals — Barbourville ARH

During Joe Grossman’s tenure as president and CEO of Appalachian Regional Healthcare (ARH), the hospital system has grown — adding three hospitals (Barbourville ARH Hospital in 2015, ARH Our Lady of the Way Hospital in 2018 and Highlands ARH Regional Medical Center in 2019) and nearly 30 clinics.


Hospital in 2015; ARH Our Lady of the Way Hospital in Martin in 2018; and Highlands ARH Regional Medical Center in Prestonsburg in 2019 — to become a 13-hospital system. In addition, nearly 30 clinics have been added.

“They were all struggling,” Grossman says of the three hospitals. “We brought stability to those hospitals and those communities and, in most cases, improved the care that’s provided in those communities.”

He says working to keep hospitals open in small communities is a case of both economics and access: there’s the local and regional economic impact felt by keeping hospital doors open and growing their services, and there’s the everyday reality that open hospitals mean health care gets delivered closer to home.

“I hope that it’s two very impactful positives in the lives of the people in the mountains,” he says.

There have been upgrades to existing facilities — like the construction of the nearly $50 million Joe Craft Tower in 2014 at Hazard ARH Regional Medical Center. The three-story, 100,00 square foot addition included a new emergency department (ED), doubling the capacity of the original ED; a critical care unit; an acute care cardiac nursing unit; and a roof-mounted helipad.

And, at a time when rural hospitals are struggling financially — 136 rural hospitals have closed since 2010 and a recent report from the Chartis Center for Rural Health identified 453 hospitals as being vulnerable to closure — there’s also been Grossman’s efforts to maintain the health system’s overall financial stability.

The secret to the success at ARH: “We control our expenses,” he says.

Grossman’s tried to do all of this work — and more — outside of the spotlight, while doing his best to adhere to the Golden Rule.

He doesn’t have a history of chatting up reporters or mugging for the cameras. He’s modest, humble, unselfish. He doesn’t like to draw attention to himself or his work.

And, if he does eventually get cornered, he’s more likely to credit the team effort than anything he did on his own.

“I don’t need the spotlight,” he says. “I had a guy I worked for one time describe me, and I took it as a very big compliment, he said, ‘You know, Joe, you’re the kind of person that when leadership is needed, you step in. And, when somebody else steps up, you’re willing to step back.’”

He adds: “I just tried to keep my head down and do what I thought was right at the time, and I don’t want to attract attention or anything. The hard part of this job, I guess, is knowing that there’s over 6,000 families [of employees] that depend on you and your team

making the right decision.” (“What if I made the wrong decision?” is the question that’s kept him up at night, he says.)

‘Probably One of the Smartest People I Know’

Dan Stone calls Grossman “probably one of the smartest people I know.” Especially in the area of finance, he says.

“I learned many years ago, if Joe asked you a financial question, he already knew the answer. Don’t make something up. Cause he already knew it,” says Stone, who serves as the community CEO at Hazard ARH Regional Medical Center and who has worked with Grossman for nearly three decades in Lexington and Danville, and at ARH since 2008.

Stone, who says he views Grossman as a mentor of sorts, has regularly used the ARH CEO as a bit of a sounding board.

“If I have something that I’m really struggling with, I’ll call him up and say, ‘Hey, Joe, I need a Monday morning quarterback here. I need you to kind of listen to me and say, ‘You’re off base’ or ‘You’re headed in the right direction,’” he says. “He doesn’t tell you what to do. He kind of guides you in a direction that he thinks is right. And, you know, I’ve always appreciated that versus someone who says, ‘Just do this.’ That’s not his style. He’s not going to do that. He’s going to listen to you. He’s going to think thoughtfully. And then he’s going to give you some advice.”

Stone also credits Grossman with a “pretty amazing” work ethic. He says the CEO has regularly traveled from Lexington to Hazard for late-in-the-day medical staff meetings that end after nine o’clock. And, after those meetings, Grossman would still sit down and talk with Stone, one-on-one, for a half hour or more. When Stone would eventually ask “Where you headed?” Grossman would respond, “Well, I’m headed back home.” Grossman still had a two-hour drive, back to Lexington, ahead of him. (During his tenure, Grossman has regularly traveled the nearly five-hour drive between all of the ARH hospitals — from Middlesboro in the far southeastern part of Kentucky to two facilities in southern West Virginia — more times than he can count.)

“But he never rushed himself to hurry and get home,” Stone says. “He always took his time to sit down and address or help you address issues.”

That’s the same Joe Grossman that Nancy Galvagni has encountered in her role as president and CEO of the Kentucky Hospital Association (KHA).

“The entire KHA team and I have been very lucky to work with Joe Grossman for many years. He has been


an outstanding leader and has worked hard to improve health care for Kentuckians,” she says.

Galvagni points to Grossman’s role with the Kentucky Statewide Opioid Stewardship program as an indicator of his commitment to communities beyond just the ARH service regions. The program is a KHA and Cabinet for Health and Family Services initiative which focuses on reducing opioid overprescribing and improving safe opioid use at the hospital level. Grossman serves on the program’s advisory committee, representing hospital CEOs across the Commonwealth.

“He sets an example for other hospitals throughout the state in tackling the Commonwealth’s opioid epidemic,” she says.

‘Some of These Other Things Are Calling Me’

When he was in his 30s, Grossman says he was already plotting out his retirement plans. He figured he’d quit working by the time he hit 55 — just like many of his older friends had done by that age. It was, as he calls it, a life goal.

That moment came and went five years ago. Grossman wasn’t yet ready to step away.

“I still felt there was a lot of good being done and that I could participate,” he says.

The recent addition of two new grandchildren to the

two he already had, however, has complicated things. They’re now competing for his attention. And, while “spending more time with my family” is often a phrase used by executives to hide the real reason for their departure, for Grossman, it’s the truth. He announced earlier this year that he will step down as president and CEO in June, after spending nearly two decades at ARH — quite a bit more than the five years he thought he’d stay when he first joined the health system. (His wife, retired from the education field, is already helping to take care of their grandchildren.)

In retirement, he says he’ll continue to stay involved with the economic development organizations that he helped start. He’ll also do some volunteer work. He’ll stay connected to his church. And there will be time too for some of his hobbies — golfing, fishing, woodworking and “home destruction” projects, as his wife calls them. He may even get back into coaching youth sports, as he did for nearly two decades when his now adult children were younger. (His kids — two teachers, an occupational therapist and a physician — all live within a 15-minute drive of their childhood home in Lexington, where Grossman and his wife still reside after more than three decades.)

“I love the people. I love the organization. And I enjoy the job,” Grossman says. “It’s just, I’m at a point in life where I think some of these other things are calling me.” ■

Michael McGill is a Rural Project Manager in the Kentucky Office of Rural Health.

Grossman will step down from ARH in June after nearly two decades with the hospital system.

Since the 1970s, National Health Service Corps programs — like the Loan Repayment Program for primary care providers and the Scholarship Program for students pursuing primary care careers — have helped organizations to recruit and retain health professionals in underserved communities.

Learn more about National Health Service Corps programs at nhsc.hrsa.gov or by contacting the Kentucky Office of Rural Health.

Helping others.Making a difference.

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