Author: hultgrea

End of life is a difficult subject to tackle.

For the most part, people don’t like to entertain conversations regarding death and dying. There is an overwhelming feeling of sadness and discomfort that accompanies these conversations. Although, it does not have to be this way. There is a particular establishment in the Schenectady community that provides end of life care however, the Joan Nicole Prince Home goes about this process a little differently. This facility will be the main focus of this post because of their unique approach to end of life care. If I were a terminally ill patient or a family member seeking care for my loved one, the JNP Home would be an option for me to consider, if I did not require round the clock medical care such as dialysis and was willing to sign a DNR. Their mission is to provide comfort and compassionate care to those who are terminally ill and to help to make them feel at home during their final days, the feel strongly about continuing to treat their residents . They have both staff and volunteers that spend quality time with the residents; from reminiscing good memories to simply sitting by their bedside, those who work at the home establish meaningful relationships residents. This sets the Jon Nicole Prince Home apart from a hospice facility or a hospital where the staff might not be dedicated to making the patient feel comforted. Moreover, ‘home’ is not a figure of speech. The Joan Nicole Prince Home has bedrooms, a kitchen, a living room and a backyard providing a genuine home experience for the residents.

#stillhuman https://www.instagram.com/jnp.comfort.home/

Those who wish to be chosen to become a resident must have a prognosis of three months or less, they must already be under hospice care, and they additionally must sign a DNR. The last requirement might be striking yet, the Joan Nicole Prince Home is not a medical facility. They do not have physicians or nurses on staff thus, there would not be qualified medical personnel to perform a resuscitation or any life-saving measures. The reasoning behind this is something that was discussed with Amanda Neveu, the Executive Director at the JNP Home. She explained that being a medical facility would be difficult because the Home is a non-profit, and it would be difficult to fund; but, also it goes against the home-like feeling and could take away from the overall experience of feeling safe and at home for the residents. Those who come to the home do not pay for their time there, it is completely free of charge, which broadens access for residents who don’t have insurance or the money to pay for expensive end of life services.

As aforesaid, the requirements for the JNP Home are fairly strict so, if a patient does not qualify there are other options within the community available. Ellis Medicine offers a Palliative Care program for terminally ill patients, whether they have cancer or other illnesses. However, these services are not free, it is likely that a patient would need insurance, Medicare or Medicaid or other funds to be able to pay for palliative care which would include hospice in end of life. Cost restricts access to end of life care because it is expensive, and people cannot afford it. In addition, there is a facility in Niskayuna called Brookdale Senior Living that also offers Hospice care. Their services can be covered by Medicare, Medicaid or private insurance. Hospice care at Brookdale includes services for not only the patient but also the family, that includes grief counseling and emotional or spiritual support. This type of care differs from the JNP Home in that Brookdale is a medical facility with physicians and nurses on staff. Thus, this would be an option for someone who needed round the clock medical care.

Paying for Hospice Care, the breakdown

https://www.brookdale.com/en/hospice/understanding-hospice/paying-for-hospice.html

Hometown Health Care & Wicker Wellness Center will be the focus of this week

Check out Hometown Health Center on Instagram!

http://www.instagram.com/p/CFPzWv-pXqw/?utm_source=ig_web_button_share_sheet

There are a few different communities within the local vicinity that are quite separate.There is a population of people who might have lower access to healthcare because of their lower socioeconomic status, these people inhabit the neighborhoods near Van Vranken Avenue as well as Hamilton Hill and Vale and Eastern Avenue. Then there is the community of students at Union College in the middle of those neighborhoods. These communities mostly access healthcare through different mediums.

Hometown Health Center is a local healthcare facility with locations in Schenectady and Amsterdam. The facilities mission statement outlines that their primary goal is to provide quality and preventative care to “anyone seeking care, regardless of income,” (Hometown Health Centers). The facilities provide both medical and dental care thus, patients seeking care for their physical, mental or dental health will be treated. Offering a wide scope of care makes for greater accessibility for the community members who are uninsured or underserved. This one facility that provides many different treatment options has the ability to make a large difference for a community where there are likely a lot of uninsured and underserved individuals and families. Additionally, the Schenectady location is on State Street, in between Hamilton Hill and Vale/Eastern Avenue neighborhoods. Those two neighborhoods are the lowest income areas in Schenectady. Hometown Health is within walking distance of these neighborhoods, making the facility much more accessible to patients who might not have a car or enough money for bus or cab fare. Additionally, during the covid-19 pandemic Hometown Health has been offering telehealth appointments. However, due to the fact that some of their patients do not have access to a computer or are unable to access Zoom, they are sending computers with nurses on house calls so that the patients can speak with the physicians. The outreach of Hometown Health seems very promising, but there are still people who don’t have health insurance and cannot afford it.

The students of Union College seek care at the Wellness Center on campus for the most part. Students are required to have health insurance in order to attend, if they do not have health insurance on their own, the school provides health insurance for them and the fee is included in their tuition. The Wicker Wellness Center offers services for all students and is highly accessible, appointments are easy to schedule, or students can walk in if they need to. During covid-19, the counseling center is offering services over Zoom or the phone, any student can set up an appointment easily. Healthcare for students at the college is not difficult to access, anything they need, they are able to get via the health center or they can be referred through the health center.

These are vastly different situations for one community. The college is required to provide health care for students, which brings to light how privilege and education has an effect on access to healthcare. Public school systems are unable to offer health care to students, there is not appropriate funding for that. Nor is it a public government duty at this point in time to provide a community with health care services yet, on a smaller scale at a college this is achievable because students who have the means are able to pay for it.

Project targets root causes of poor health in poorer areas of Capital Region

Clearly, the health of the community is not as good as it could be, the attached article highlights a few issues such as waiting until manageable health problems like asthma, are severe and ending up in the Emergency Department.

In the previous post, it was discussed that parts of the Schenectady community are at or under the poverty line, that parts of the community receive or qualify for food stamps, that a significant portion of the community has an overall low socioeconomic standing. These factors make paying for health care difficult. There are many other essential expenses that come before healthcare, such as food and housing. It is also important to note that Schenectady is a neighborhood that is “high-risk cost burdened,” meaning that members of the community spend 30% or more of their income on housing (Health Equity Report). Thus, seeing a doctor on a regular basis, or at all, is probably not something that people are able to do. It is unlikely that someone struggling to make ends meet would be able to use their income to buy health insurance rather than food to put on the table.

This suggests, that income plays a large factor in access to healthcare. In 2014, 9.4% of the community from ages 18-64 did not have health insurance. This statistic is dated, and may not be as useful today yet, it does give an indication as to where Schenectady has been with regard to insurance coverage. This statistic suggests that a portion of the community could not afford health insurance. According to the New York State Health Insurance website, there are 9,334 uninsured members of the community in Schenectady. Additionally, the average monthly cost of health insurance is $519. As it happens, rent in Schenectady is roughly the same amount per person, per month. So, if given the option between paying rent or health insurance, it is more likely that a person would choose to pay rent.

Thus, without insurance that leaves people to pay for any expenses out of pocket. This may deter people from establishing a primary care physician and seeing that doctor on a regular basis. The Department of Health released a strategies list for many local areas to help provide better health care. One of the strategies listed includes “encouraging patients to establish medical homes for primary/preventive care to reduce emergency services for non-urgent care needs” (Department of Health). This suggests that people might be over using emergency department services because they are unable to pay for regular primary care visits. Overall, it seems like the crux of the system, no matter how effective the medicine may be, is finding the money to pay for it. There are free clinic options in Schenectady, see the below link to find the different locations.

Works Cited:

https://www.health.ny.gov/prevention/prevention_agenda/strategies/access_to_health_care.htm

http://www.hcdiny.org

https://www.opendatanetwork.com/entity/0500000US36093/Schenectady_County_NY/health.health_insurance.pctui?ref=entity-question&year=2014&age=18%20to%2064&race=All%20races&sex=Both%20sexes&income=All%20income%20levels

https://www.freeclinics.com/cit/ny-schenectady

https://www.nyhealthinsurer.com/insurance/quote/result/?_af=WwMcYCgAAicXAAEIaCE

https://cbs6albany.com/news/coronavirus/schenectady-county-provides-first-live-video-update-on-covid-19-crisis

The focus of this post will be to outline important determinants of health specific to Schenectady, New York.

Roughly 23% of the population in New York State’s capital region were at or below the Federal Poverty Line according to the Health Equity Report procured by the Healthy Capital District Initiative. Low socioeconomic status can lead to decreased health access; more specifically, those who have low income more than likely will encounter greater difficulties when seeking to make decisions with regard to their health. For instance, it is difficult to find affordable healthy food, it is difficult to see a doctor if you cannot afford the visit, it is difficult to find a safe and stable home for long periods of time.

Moreover, the aforementioned report outlined many of the social determinants of health in the capital region. This Health Equity Report focused specifically on factors having to do with access to food and housing as these are two large indicators of health. There were high percentages of people in the area that had limited access to these two factors. 22.9% of the population in Schenectady were low income residents with low healthy food access, 13.3% qualified for SNAP food stamps, and 47% of Schenectady’s school children were eligible for free or reduced lunch – all of which were highest in the capital region. Moreover, Schenectady had an 1.44% overcrowding rate, Schenectady was dubbed a high-risk cost burdened neighborhood- meaning that residents were spending 30% or more of their income on housing. Lastly, older houses built prior to 1960, with lead in the paint and plumbing systems put residents at risk for lead exposure. 33.9% of homes in Schenectady were built before 1960.

Additionally, according to New York State health records Schenectady counties obesity rate, adult smoking rate, adult asthma prevalence rate, diabetes mortality rate, and heart attack hospitalization rate were all higher than New York State rates. This evidence coupled with the aforesaid data suggest that low socioeconomic status, leading to limited access to healthy food and safe, stable housing may influence the overall health of the community.

Due to COVID-19 Hometown Health Center has taken the initiative to provide house calls to residents who are unable to access a computer. An article written by the Daily Gazette noted that most of the residents utilizing this option were of Schenectady. Moreover, at the beginning of the COVID-19 outbreak in March the Schenectady County Manager Rory Fluman said that a question people were coming to him with was, “how am I going to get my food stamps?” These statements both underline the limited access in this community, which seems to be heightened due to the COVID-19 outbreak.