community healthcare needs assessment.indd

Community Healthcare Needs Assessment

Cheyenne County August 2011

In partial fulfi llment of requirements related to the Patient Protection and Affordable Care Act

In cooperation with:

Funding provided by:

Cheyenne County Rural Health Works Summary Meeting

July 13, 2011 The meeting was convened at 12:00 p.m. Approximately 40-50 people in attendance. Following a summary by John Leatherman, Tom Keller facilitated a group discussion of potential action strategies that might follow on from the formal Rural Health Works meetings. Three major issues were identified and would serve as the focus for additional discussion and future action: (1) the future of the Good Samaritan long-term care facility in St. Francis; (2) hospital, clinic, and community services; and (3) general community health and wellness initiatives. (1) Long-term Care Facility Taskforce Members Janet Carman, [email protected], 785 332-3569; 1625 Rd G, St Francis, KS, 67756 Glenn Isernhagen, [email protected], 785 332-3634; 1515 Rd 9, St Francis, KS 67756 Rod Klepper, [email protected], 785 734-2003; PO Box 369, Bird City, KS, 67731 Chuck Kribs, [email protected], 785 734-7126; PO Box 333, Bird City, KS, 67731 Dr. Mary Beth Miller, [email protected], 785 332-2682; PO Box 1053, St Francis, KS 67756 Linda Rogers, [email protected], 785 332-2051; 528 E Jackson, St Francis, KS 67756 Eddy and Sherry Schultz, [email protected], 785 332-2860; 1564 US 36, St Francis, KS 67756 Barbara Waters, [email protected], 785 734-2635: 2285 Rd P, Bird City, KS 67731 With a ballot referendum to approve up to 6 mils for Good Samaritan Society - St. Francis Village operational support scheduled for August 2, much of the discussion focused on this issue. An associated proposal of potential county takeover of the facility added additional questions. A county commissioner indicated that the county currently had no intention of assuming ownership of the facility and that the ballot would put the issue of financial support to the voters. He did express reservations related to the overall cost of county operations given the multiple needs to sustain services. He invited the public to the next county commission meeting to further discuss the ballot initiative. Additional public information meetings would be scheduled in advance of the ballot, and people were encouraged to attend and become fully informed prior to the vote. (2) Hospital, Clinic, and Community Services Taskforce Members Tyler Raile, [email protected], 785 332-2682; PO Box 1075, St Francis, KS 67756 Tom Smull, [email protected], 785 332-3939; 118 E Jackson, St Francis, KS, 67756 Rita Stephens, [email protected], 785 332-2667; 630 Rd 15, St Francis, KS, 67756 Jerry Toler, 785 332-2225; PO Box 601, St Francis, KS, 67756

mailto:[email protected]

Velda Wright, [email protected], 785 734-2447; 475 Rd 31, Bird City, KS, 67731 Erika Zimbelman, [email protected], 785 332-3219; PO Box 261, St Francis, KS, 67756 Les Lacey provided a report on behalf of a group that were discussing hospital services. He identified several discrete issues that were currently underway. A) Currently, there is no eye doctor practicing in Cheyenne County. The community survey indicated both the need and a high level of support for local service provision. Action would follow to attempt to bring an eye doctor to the county. B) The hospital intended to review and attempt to improve service provision available through the Bird City Clinic. C) In response to the challenges faced by residents relating to transportation to receive non-local treatment, the hospital intends to explore greater use of telecommunication technologies for medical applications. D) The hospital intends to expand its leadership and support of community wellness initiatives. E) The hospital will review existing staffing and services, including the feasibility of establishing an obstetrics unit. F) The hospital will continue to focus on use of technology and the Internet to make additional services locally accessible. (3) General Community Health and Wellness Taskforce Members Mila Bandel, [email protected], 785 332-2149; 1302 RS 877, St Francis, KS, 67756 Penny Gienger, [email protected], 785 332-3949; 1570 Rd Y, St Francis, KS, 67756 Shara Johnson, [email protected], 785 332-3540; PO Box 734, St Francis, KS, 67756 Rod Klepper, [email protected], 785 734-2003; PO Box 369, Bird City, KS, 67731 Natalie Knodel, [email protected], 785 332-3129; PO Box 446, St Francis, KS, 67756 Jeff and Becca Landers, [email protected], 785 332-2956; 535 E Spencer, St Francis, KS, 67756 Margaret Poling, 785 332-3103. PO Box 867, St Francis, KS, 67756 A committee had met prior to the final Rural Health Works meeting to discuss general community health and wellness initiatives. They offered three general suggestions: (1) marketing; (2) community information/education; and (3) information gathering. (A) The committee recognized that to encourage broader community participation in exercise, fitness, healthy nutrition, etc. would require a strong marketing effort. To that end, they offered a

theme around which to build a broader promotional effort. The theme suggested was "Pre-habilitation." The theme recognizes and emphasizes the need for proactive efforts to avoid the need for healthcare treatment. (B) There will be a ongoing need for community engagement and dialogue relating to health care topics. This will need to be a "give and take" process whereby there is outreach to community groups and organizations to both deliver health-related messages and to gather information about what can effectively motivate widespread community support and involvement in health and wellness programs. (C) Further investigation is needed into the potential feasibility of a community health and wellness center. The community survey suggested broad community support for the establishment of such a facility. Additional community input is required to flesh out the types of activities, programs and services such a center may offer. This effort will move toward the development of a coherent wellness center proposal for community discussion and consideration. The meeting adjourned at 1:20 p.m.

1. What are the major health‐related concerns in Cheyenne County? Number Responses

Getting the nursing home (LTC), assisted living back to capacity 35

Keeping doctors and facilities available locally 10

Access to local specialists 9

Healthcare and Healthcare providers 4

Maintaining quality hospital and clinic services and providers 4

Nursing Home beds 4

Paying for all of these improvements (Tax dollars) 4

Population is growing older and smaller 4

Providing the scope of services we now have that is sustainable financially 3

Recruitment/Retention 3

What burdens can/will the community support for various services 3

Being sensitive to low incomes 2

Cost of local population 2

Matching the certainty of a declining population with the more practical

health needs 2

Mental Health Services 2

Prevention Areas 2

Sustain a critical access hospital 2

Transportation 2

Addition services need for our demographic 1

Alzheimer's wing in LTC 1

Alternative Health 1

Being sensitive to health care of aging 1

Community emphasis on health and nutrition 1

Cutting Hospital/Healthcare Losses 1

Educated workers in healthcare industry 1

Emergency Services 1

Exercise and fitness options for middle aged and elderly 1

Keeping and growing out total capabilities for health care 1

Keeping good health care for our citizens 1

Lack of meeting community need 1

Lower costs of health procedures 1

Meals on Wheels 1

Other county subsidizing comparison tax dollars in other counties 1

Poor billing system 1

Progressive care facilities 1

Repair and expansion of Good Samaritan Village 1

Retaining what we have 1

Senior Care Facility 1

Special needs facility 1

State and Federal oppression of providers through demands 1

Traveling long distances 1

Sustainability of local hospital/nursing care given the market 1

Cheyenne County Rural Health Works

Local Healthcare Issues 4‐28‐11

2. What needs to be done to improve the local healthcare system? Number Responses

Develop and expand Long Term Care/Assisted Living facility 18

Expand and maintain services 5

Increased home health assistance 4

Transportation services 4

Making sure we are offering what people want ‐ if not, how to improve that 3

Specialists coming into local system 3

Better back‐up personnel for special services (technical) 2

Continued education for employees to retrain high quality staff "top to

bottom" 2

County‐owned LTC to have control over its future 2

Education of good nutrition, exercise, and personal responsibility for

individual health 2

Expand nursing home facilities 2

Maintain and update local facilities 2

Maintain emergency services 2

More support and cooperation between the hospital and the nursing home

administrations 2

Nursing home back up to speed 2

Special needs (Alzheimer's and Seredemtia care) 2

A more broad based specialty services venue to meet our aging community 1

Assessment of consensus of needs of community 1

Being made aware of services that are available (list in the paper) 1

Better access to Denver specialists 1

Education of the community of the importance and benefit of current

system 1

Grow out own healthcare workers 1

Have less be referred to specialists 1

Increase support for public health 1

Keep current on technology 1

Keep the great doctors in the county 1

Level the sale barn site and build a new facility 1

Local control 1

Lower leakage 1

New industry to stimulate population and economics 1

Overcome the impact of distance 1

Provide healthcare services to LTC and community members (education,

preparation) 1

Public relations/communication 1

See what other rural communities are doing 1

Skilling nursing 1

Talk to people that go to Wray, CO instead of stay local 1

Trust in our current healthcare providers to make knowledgeable diagnosis 1

Understand and listen to what residents of the county want retaining to

healthcare 1

3. What should be the over‐arching health care goals of the community? Number Responses

Assisted Living Facility and nursing home construction and expansion 15

Being able to meet the needs from birth to death 14

Medical facilities for long term 6

Affordable, accessible, available healthcare providers and services without

long waits 5

Keep all medical services in county 4

Use health care to increase jobs, students in school, etc 4

Maintain Good Samaritan Village at a competitive and competent facility 3

People being educated about shopping in our community vs. shopping at

home 3

Best bangs for our bucks 2

Having enough people and jobs for our community 2

Matching services with local population 2

Medical specialists 2

Preventative medicine 2

Programs to engage persons of all ages in fitness and health education

issues 2

Reverse population and econommic decline 2

Broad spectrum of services 1

Create expanded facilities to attract more outside personnel, especially

older people from cities 1

I agree with all the goals mentioned at the meeting 1

Life‐long service access 1

Keep our population intact 1

Larger facility 1

Long Term Care Facility 1

LTC and hospital must work together 1

Nursing facility owner and operated by county 1

Provide basic health services for a reasonable cost 1

Public relations services available 1

Quit shipping so many patients out of this hospital 1

Services required for retirement of community 1

Services should range from preventative to critical care 1

Show people what we can do 1

To keep services to care for aging‐up community 1

Transportation area "specialist" 1

Work together with neighboring hospitals to offer complimentary services 1

4. What are the greatest barrier to achieving health care goals? Number Responses

Cost/Finances 43

Low population 22

Older population who are "takers", not "givers" 10

Work Form/Competent Employees 9

Location 7

Taxes required 6

Stubborn citizens who don't like change 4

Lack of "progressive attitudes" on the part of the community 3

Long distance to specialists 3

Location ‐ recruitment and retention of health care providersd 3

Unity/Agreement 3

Lack of exercise facilities and programs/Unhealthy lifestyles 2

Medicare reimbursement and Medicaid 2

Retaining local businesses 2

Retaining the population 2

Shopping locally 2

Transportation 2

Demographics 1

Few health resources stretched too thin 1

Fragmented system of particulars in frontier areas 1

Get bond issue before voters and passed 1

Get the machinery running 1

Getting people to realize the need 1

Health insurance costs and cost of clinic visits 1

Healthcare services or providers that treat their customers badly 1

Housing 1

Lack of knowledge in Topeka of what is in Western Kansas 1

Management 1

People seeking to utilize local services and providers 1

Personnel touch from LTC 1

Political interests 1

Pride 1

State lines hinder licensing from state to state 1

The right personnel to get things going 1

The highly personal nature of long‐term care 1

1. What are the major health‐related concerns in Cheyenne County? Number Responses

Getting the nursing home (LTC), assisted living back to capacity 46

Keeping doctors and facilities available locally 10

Access to local specialists 9

Quality of local healthcare and healthcare providers 9

Paying for all of these improvements (Tax dollars) 5

Population is growing older and smaller 6

Providing the scope of services we now have that is sustainable financially 3

Recruitment/Retention 3

What burdens can/will the community support for various services 3

Being sensitive to low incomes 2

Matching the certainty of a declining population with the more practical health

needs 2

Mental Health Services 2

Focus on Prevention 2

Sustain a critical access hospital 2

Transportation 2

Addition services need for our demographic 1

Alzheimer's wing in LTC 1

Alternative Health 1

Being sensitive to health care of aging 1

Community emphasis on health and nutrition 1

Cutting hospital/healthcare losses 1

Educated workers in healthcare industry 1

Emergency Services 1

Exercise and fitness options for middle aged and elderly 1

Keeping and growing out total capabilities for health care 1

Keeping good health care for our citizens 1

Lack of meeting community need 1

Lower costs of health procedures 1

Meals on Wheels 1

Other county subsidizing comparison tax dollars in other counties 1

Poor billing system 1

Progressive care facilities 1

Retaining what we have 1

Senior Care Facility 1

Special needs facility 1

State and Federal oppression of providers through demands 1

Traveling long distances 1

Sustainability of local hospital/nursing care given the market 1

Support quality of life services in the community 1

Emphasize community‐based care and home health care 1


Local Healthcare Issues 4‐28‐11 / 5‐5‐11

2. What needs to be done to improve the local healthcare system? Number Responses

Develop and expand Long Term Care/Assisted Living facility 25

Expand, improve and maintain services 7

Increased home health assistance 4

Transportation services 5

Making sure we are offering what people want ‐ if not, how to improve that 3

Specialists coming into local system 4

Better back‐up personnel for special services (technical) 2

Continued education for employees to retrain high quality staff "top to bottom" 2

County‐owned LTC to have control over its future 3

Education of good nutrition, exercise, and personal responsibility for individual

health 3

Maintain and update local hospital facilities 4

Maintain emergency services 2

More support and cooperation between the hospital and the nursing home

administrations 2

Special needs (Alzheimer's and Seredemtia care) 2

A more broad based specialty services venue to meet our aging community 1

Assessment of consensus of needs of community 1

Being made aware of services that are available (list in the paper) 1

Better access to Denver specialists 1

Education of the community of the importance and benefit of current system 2

Grow our own healthcare workers 1

Have less be referred to specialists 1

Increase support for public health 1

Keep current on technology 1

Keep the great doctors in the county 1

Level the sale barn site and build a new facility 1

Local control 1

Lower leakage 1

New industry to stimulate population and economics 1

Overcome the impact of distance 1

Provide healthcare services to LTC and community members (education,

prevention) 1

Public relations/communication 1

See what other rural communities are doing 1

Skilled nursing 1

Talk to people that go to Wray, CO instead of stay local 1

Trust in our current healthcare providers to make knowledgeable diagnosis 1

Understand and listen to what residents want pertaining to healthcare 1

Provide specialy services unavailable in the region 1

Better attitudes by care‐givers at the LTC facility 1

3. What should be the over‐arching health care goals of the community? Number Responses

Assisted Living Facility and nursing home construction and expansion 22

Being able to meet the needs from birth to death 17

Maintaining local medical facilities and services 7

Affordable, accessible, available healthcare providers and services 6

Keep all medical services in county 4

Use health care to increase jobs, students in school, etc 4

People being educated about shopping locally vs. non‐locally 3

Best bang for our bucks 2

Having enough people and jobs for our community 2

Matching services with local population 2

Medical specialists 2

Prevention and preventative medicine 3

Programs to engage persons of all ages in fitness and health education 2

Reverse population and econommic decline 2

Broad spectrum of services 1

Create expanded facilities to attract more outside personnel, especially older

people from cities 1

I agree with all the goals mentioned at the meeting 1

Keep our population intact 1

LTC and hospital must work together 1

Provide basic health services for a reasonable cost 1

Public relations services available 1

Quit shipping so many patients out of this hospital 1

Services required for retirement in the community 1

Services should range from preventative to critical care 1

Show people what we can do 1

To keep services to care for aging‐up community 1

Transportation area "specialist" 1

Work together with neighboring hospitals to offer complimentary services 1

Community‐based services and home health care for the elderly 1

4. What are the greatest barrier to achieving health care goals? Number Responses

Cost/Finances 47

Low population 22

Older population who are "takers", not "givers" 10

Work Form/Competent Employees 9

Location 7

Taxes required 8

Stubborn citizens who don't like change 4

Lack of "progressive attitudes" on the part of the community 5

Long distance to specialists 3

Location ‐ recruitment and retention of health care providersd 3

Unity/Agreement 3

Lack of exercise facilities and programs/Unhealthy lifestyles 2

Medicare reimbursement and Medicaid 2

Retaining local businesses 2

Retaining the population 2

Shopping locally 2

Transportation 2

Demographics 2

Few health resources stretched too thin 1

Fragmented system of particulars in frontier areas 1

Get bond issue before voters and passed 1

Get the machinery running 1

Getting people to realize the need 1

Health insurance costs and cost of clinic visits 1

Healthcare services or providers that treat their customers badly 1

Housing 1

Lack of knowledge in Topeka of what is in Western Kansas 1

Management 1

People seeking to utilize local services and providers 1

Personnel touch from LTC 1

Political interests 1

Pride 1

State lines hinder licensing from state to state 1

The right personnel to get things going 1

The highly personal nature of long‐term care 1

Federal expenditure priorities 1

Community quality of life is more than economics 1

DRAFT – June 23, 2011

Cheyenne County Rural Health Works Community Healthcare Concerns: Emerging Themes

Future of Long-term Care Facilities. With active consideration of county takeover of the St. Francis Village nursing care facility currently owned be the Good Samaritan Society, this seems the single greatest concern among program participants. There are questions relating to the adequacy of the existing facilities, its financial viability, the role of county government in assuming ownership, and the potential need and scale of public subsidies to maintain the facility. Determining Priority: Several questions related to issue were included in the community survey. The results should provide a preliminary indication of awareness and support for pursuing the option of public ownership and involvement to maintain or enhance local nursing care. To the extent there is consideration of additional investment in facilities and services, professional market and financial analysis assistance would be prudent. Potential Action Strategies: _________________________________________________ ________________________________________________________________________________________________________________________________________________ Shared Community Goals and Aspirations. Underlying much of the concern relating to the nursing care facility issue is the broader concern regarding community divisiveness over public issues. Among the sources of conflict are differences in views over costs and the need for investment, the extent to which certain demographic segments of the local population are sufficiently progressive, and fundamental differences in values regarding the appropriate role of local government in maintaining local institutions and services. Determining Priority: The collective community attitude and spirit is a very important factor that can either help catalyze the community in achieving collective goals or hinder the community on almost any initiative. To the extent such a situation exists in the community, it is simultaneously both very easy and very difficult to rectify. Among all of the challenges rural communities face, the collective community spirit is entirely within local control. However, it requires individuals to let go of animosity and move forward with a shared sense of purpose and collaboration regardless of the outcome. Potential Action Strategies: _________________________________________________ ________________________________________________________________________________________________________________________________________________ Health-related Services and Facilities. A number of comments reflected concerns related to maintaining and enhancing existing local facilities and services. Among the concerns identified was the desire for a broader range of visiting specialists, the quality of existing services and providers, and the recruitment and retention of additional service providers.


Determining Priority: The community survey results should provide some indication of local market demand and the level of leakage of spending for health care services. The county health services and provider directory is intended to help address this concern. The community survey should help communicate the quality of available local healthcare services. For their part, local providers need to invite local customers, make them feel welcome when they arrive, and give them a reason to come back by providing excellent service and high levels of satisfaction. Potential Action Strategies: _________________________________________________ ________________________________________________________________________________________________________________________________________________ Exercise, Health and Wellness. Taken together, a number of different comments and suggestions spoke to the general notion of broad health and wellness goals. Several identified the need for fitness facilities and equipment and other health and wellness programs. Determining Priority: Access to exercise, recreation and fitness opportunities is essential to maintaining physical wellbeing, particularly during winter months. Likewise, access to information related to nutrition and healthy lifestyles is equally important. And, attending to emotional and spiritual needs is essential to a meaningful and fulfilling existence. Here, a variety of partnerships and initiatives may be feasible. Bringing together public and private institutions to discuss community health fairs, recreation programs, and other ideas may improve the situation. The community survey will also provide insight into support for new community wellness center. Potential Action Strategies: _________________________________________________ ________________________________________________________________________________________________________________________________________________ Broad Community and Institutional Involvement and Collaboration on Healthcare Issues. A common lament is the lack of resources for addressing health-related concerns. In part, this stems from a lack of interest and involvement in health-related initiatives (such as the Rural Health Works program) by local government, school board, etc. Determining Priority: The Economic Contribution of Health Care report, together with associated public relations materials is intended to help communicate the relative importance of the local healthcare sector. The community survey should provide some additional opportunities to enhance awareness. While pursuit of any external financial resources should be investigated, additional dialogue among local leaders, policy makers, and health care providers may be warranted. Potential Action Strategies: _________________________________________________ ________________________________________________________________________________________________________________________________________________


Public Education for Prevention and Wellness. There were a range of issues identified for which people believed there was need for more outreach and education. These included tobacco usage, obesity, teen pregnancy, alcohol and illicit drug use, nutrition, and physical fitness. Determining Priority: Any and all of these issues are potentially worthy of greater attention and effort. All are well-established and could attract broad-based coalitions to work collaboratively to improve the relative situation. It starts with the leadership of a few to initiate public information/education programs. Contacting the county Extension office may be a logical starting point. Potential Action Strategies: _________________________________________________ ________________________________________________________________________________________________________________________________________________ Accessing Adequate Eldercare Assistance. There is concern services targeting the elderly could be expanded and enhanced. This includes community-based and home healthcare assistance, transportation assistance, the need for special mental health treatment for certain elders, and accessing public assistance programs for which they are eligible. Determining Priority: The community survey will provide an indication of whether area residents believe there is need for at least certain types of assistance. A range of local institutions including health care providers, local government, civic and service organizations, the local school system, local religious organizations, and regional health services providers all can make contributions toward expanding and enhancing local eldercare services. Potential Action Strategies: _________________________________________________ ________________________________________________________________________________________________________________________________________________

Name Position Affiliation Community Email Phone

Ruth Milliken Homemaker/Secretary

42 year member/Club

Leadership Community Builder [email protected] 785‐332‐3421

Glenn Isernhagen Retired Lutheran Pastor

Member Good

Samaritan Advisory St. Francis [email protected] 785‐332‐3634

Les Lacy Administrator

Cheyenne County

Hospital Cheyenne County [email protected] 785‐332‐2104

Jeffrey Paulsen Campus Administrator

St. Francis Good

Samaritan Village St. Francis [email protected] 785‐332‐2531

Troy Hilt Banking Center President Western State Bank St. Francis [email protected]

785‐332‐0040 or

2940

Rodney Klepper Retired Bird City [email protected]

785‐734‐2003 or

785‐736‐7369

Tom Keller Facilitator

Community Builders,

LTC Task Force St. Francis [email protected]

785‐332‐3991 or

785‐332‐8516

Jeff Landers

Pastor First Christian

Church

St. Francis Ministerial

Association St. Francis [email protected] 785‐772‐7309

Kody Krien Pharmacist

Krien Pharmacy,

Cheyenne County

Hospital, Good

Samaritan Village St. Francis 785‐332‐2177

MARCH 31st, 2011

Cheyenne County Rural Health Works Program

Initiating Committee Participants

Catherine Domsch

Executive Director Bird

City Century II

Development Foundation

Cheyenne County

Long Term Care Task

Force Bird City [email protected] 785‐734‐2556

Sherry Schultz

Farm Wife, Community

Builders, Volunteer St. Francis [email protected] 785‐332‐2860

Norman Morrow Minister

Church of Christ,

Community Builder St. Francis [email protected]

785‐332‐3424 or

785‐772‐7409

Stacy Kaup Manager

Cheyenne County

Clinic St. Francis [email protected]

785‐772‐5077 or

785‐332‐2682

Dale Patton

Cheyenne County

Commission Cheyenne County Cheyenne County [email protected]

785‐332‐2153 or

785‐332‐4867

Mike Bandel

Bankwest of Kansas Vice

President

Cheyenne County

Hospital Board Cheyenne County [email protected]

785‐332‐4577 or

785‐332‐3333


Marsha Zimbelman Semi‐Retired Community Builders St. Francis [email protected] 785‐332‐2076

Charlotte Hilt Self Employed St. Francis [email protected] 785‐332‐3200

Rodney Keepper Retired Bird City [email protected]

Mila Bandel County Health Nurse St. Francis [email protected]

Rebecca L. Allard Medical Doctor

Cheyenne County

Hospital St. Francis [email protected] 785‐332‐4833

Erika Zimbelman Board Member

Cheyenne County

Hospital and St.

Francis Community

Foundation St. Francis [email protected] 785‐332‐6195

Floyd and Elaine Retired St. Francis f‐[email protected]

Ernie Ketzner County Commissioner Bird City 785‐734‐2755

Nathan Boyer Veterinarian St. Francis [email protected] 785‐332‐4355

Robyn Raile Farmer, Business Owner St. Francis [email protected]

Sherry Carmichael Farmer, Retiree Bird City [email protected]

Casey McCormick

Agent Farm Bureau

Financial Services

Community Builders,

Farm Bureau St. Francis [email protected]

Dr. Judy Baxter Veterinarian

Republican Valley Vet


Kelly and Penny

Gienger

Farmer, Substitute

Teacher

Former Hospital

Board, Community

Builder St. Francis [email protected]

Shawna Blanka Director of Quality, CCN

Community Builders‐

Hospital St. Francis [email protected]

Lee Nichols Retired St. Francis [email protected]

Ren and Beth Maifeld Veterinarian/Ranch St. Francis 785‐332‐3133

Karen Krein Herald/Jienes St. Francis [email protected]

Kelly Frawer St. Francis [email protected] 785‐332‐2108

Economics, Overview and Issue Identification

APRIL 28th, 2011

Jeff Paulsen Administrator

Good Samaritan

Society: SNF, SL

Apartments, Home

Health Cheyenne County jpaulse1@good‐sam.com

Karol Lohman

General Manager St.

Francis Equity Coop St. Francis [email protected] 785‐332‐2113

Ken Krien Resident [email protected]

Glenn Isernhager Resident [email protected]

Chuck and Diane

Kribs

Co‐Director Economic

Development Corp CCDD Bird City [email protected]

Kay Shay Part‐time Office Work St. Francis [email protected]

Rhonda Born Receptionist/Secretary St. Francis [email protected]

Fred Klie St. Francis [email protected]

Althea R Lebow Banker Community Builders St. Francis [email protected]

Clifford Raile Farmer/Rancher St. Francis [email protected]

Betty M Louden

United Methodist

Thrift Store St. Francis [email protected] 785‐332‐2347

Ron Louden Retired St. Francis [email protected] 785‐332‐6034

Troy Burr Mayor/Farmer Bird City‐City Bird City [email protected]

Don Love Retired St. Francis 785‐332‐2737

Sharon Hendricks Farmer/Wife, Retired Bird City [email protected] 785‐734‐2760

Velda Wright Retired Nurse/Farmer Bird City [email protected] 785‐734‐2447

Kary Jo Meyer St. Francis [email protected] 785‐332‐5371

Linda Rogers St. Francis [email protected] 785‐332‐2051

Rick Rogers St. Francis [email protected]

Jeff Landers

Pastor First Christian

Church

St. Francis Ministrial

Association St. Francis [email protected] 785‐772‐7309

Michael Grover Owner, Manager NAPA ‐ Nex‐Tech St. Francis 785‐332‐2138

Barbara Grover Treasurer NAPA ‐ Nex‐Tech St. Francis [email protected]

Ken & Gloria Bracelin St. Francis [email protected] or [email protected]

Neala Carmichael St. Francis [email protected] 785‐332‐8996

Dara Carmichael Loan Officer Bankwest of Kansas [email protected]

Bob Bixler [email protected]

Noel and Tabetha Agronomy, Student St. Francis [email protected]

Lyle Knebel Pastor St. Francis [email protected] 970‐630‐9960

Carol Ross Manufacturing Company St. Francis nc‐[email protected]

Harold Onolan St. Francis

Ruth E Milliken Community Builder St. Francis [email protected] 785‐332‐3421

Rob Schiltz USD 297 SUP'T St. Francis [email protected] 785‐332‐8182

Elton Keller St. Francis 785‐332‐3025

Kody Knun Pharmacy St. Francis 785‐332‐2173


Cheyenne County


Steve Jenkins Teacher USD 297 St. Francis [email protected]

Tom Smull Farmer St. Francis

Matt Smull Farmer St. Francis [email protected]

Brenda Nelson Laborer

Riverside and USD

297 St. Francis [email protected]

Betty Petersen

Community Builder,

Resident, Businessman St. Francis [email protected]

Mary Bier Bier's Hometown St. Francis [email protected]

Coleen Applegate Self Employed Community Builder St. Francis [email protected]

Rita Stephens St. Francis [email protected] 785‐332‐2667

Sparky and Eilene St. Francis

Rodney and Sondra

Bracelin

Past Hospital Board

Member St. Francis [email protected]

Norman Morrow Minister, Community Church of Christ St. Francis nm‐[email protected] 785‐772‐7409



St. Francis Good




Troy Burr Mayor/Farmer City of Bird City Bird City [email protected]

Mike McCarty Dairy Manager Birdy City Dairy Bird City [email protected] 785‐443‐3145

Ken Krien Retired Bird City [email protected]

Diane Kribs Co‐Director

Cheyenne County

Development Corp Bird City [email protected]

Chuck Kribs Co‐Director

Cheyenne County


Roger Jensen City Council St. Francis [email protected]

Tina Sager FNB‐Bird City Bird City [email protected]

Pat Brunow St. Francis [email protected]

Kay Shay Part‐time office work St. Francis [email protected]

Mila Bandel County Health Nurse Health/Farming St. Francis [email protected] 785‐332‐2381

Althew R. Lebon Banker Community Builders St. Francis [email protected] 785‐332‐3377

Donna Wright Insurance Agent

Health & LTC

Insurance Agent Bird City [email protected]

Betty Petersen

Community Builder,

Resident, Businessman St. Francis [email protected]


Lee Amsberry

Doris Amsberry


785‐734‐2003 or

785‐736‐7369

Data and Informtion Analysis

MAY 12th, 2011


Community Builders,


785‐332‐3991 or

785‐332‐8516

Floyd and Elaine Retired f‐[email protected] 785‐332‐8948

Rita Stephens St. Francis [email protected]

Mary & Norman Retired Bird City 785‐734‐2713

Phyllis Wright Bird City 785‐734‐2502

Beth Klepper Cheyenne County [email protected] 785‐734‐2003

Sharon Hendricks Farmer/Wife, Retired Bird City [email protected] 785‐734‐2760

Laurie A Leonard Bird City/McDonald

785‐734‐2505 or

785‐538‐2370

Brett Poling Chiropractor

Cheyenne

/Sherman County 785‐332‐3105

Cynthia Poling

Office Mgr of Poling

Chiropractic

Cheyenne/Sherman

County 785‐332‐3105



785‐332‐0040 or

2940




Stacy Kaup Manager

Cheyenne County


785‐772‐5077 or

785‐332‐2682

Dara Carmichael Loan Officer Bankwest of Kansas [email protected]

Mike Bandel Loan Officer Bankwest of Kansas [email protected]

785‐332‐4577 or

785‐332‐3333


Jerry Toler Chairman

Cheyenne Co.

Hospital Board St. Francis

785‐332‐2225 or

785‐332‐2104

Mike Bandel

Cheyenne Co.

Hospital Board St. Francis [email protected] 785‐332‐2502

Carl M. Werner Retired Superintendent St. Francis [email protected] 785‐332‐3418

Helene Landenberger St. Francis [email protected]

Lyle Knebel Retired Pastor St. Francis [email protected] 970‐630‐9960

Raedell Winston Massage Therapist St. Francis [email protected] 785‐332‐4391


Community Builders,


785‐332‐3991 or

785‐332‐8516

Kyle Schultz St. Francis

785‐332‐8343

(cell) or 785‐332‐

3641

Mike Day St. Francis

Tom Smull Farmer St. Francis

Cynthia Poling

Office Mgr of Poling

Chiropractic

Cheyenne/Sherman

County 785‐332‐3105


Cheyenne County


Kody Krien St. Francis

Ken Quigley St. Francis [email protected]

Fred & Shelley Klie St. Francis [email protected]

Joan Gienger St. Francis [email protected] 785‐332‐2649

Sherry Schultz

Farm Wife, Community

Builders, Volunteer St. Francis [email protected] 785‐332‐2860

Rita Stephens St. Francis [email protected] 785‐332‐2667

Michael Grover Owner, Manager NAPA ‐ Nex‐Tech St. Francis 785‐332‐2138

Barbara Grover Treasurer NAPA ‐ Nex‐Tech St. Francis [email protected]

Community Survey Development

MAY 26th, 2011


Church of Christ,


785‐332‐3424 or

785‐772‐7409


Stacy Kaup Manager

Cheyenne County


785‐772‐5077 or

785‐332‐2682

Sally Priest Rancher [email protected]

Karen Flemming Deputy Appraiser

Cheyenny Co.

Courthouse Bird City [email protected] 785‐734‐2463


Betty M. Louden Retired

United Meth. Thrift

Shop St. Francis 785‐332‐2347


785‐734‐2003 or

785‐736‐7369


Norman Dorsch Retired Bird City 785‐734‐2713

Barbara Waters Bird City 785‐734‐2635

Ruth Milliken Homemaker/Secretary Community Builders St. Francis [email protected] 785‐332‐3421

Beth Maifeld St. Francis 785‐332‐3133


785‐332‐0040 or

2940

Becky Allard Physician

Cheyenne Co.

Clinic/Hospital St. Francis [email protected]

Shawna Blanka Director of Quality CCH St. Francis [email protected]

Erika Zimbelman Board Member, EMT CCH, CH Co. EMS St. Francis [email protected]


Carla Lampe City Council‐Bank FNB [email protected]

Jo Rogers SrVP FNB St. Francis [email protected]

Jeffrey Paulsen Administrator

Lutheren Good

Samaritan Society St. Francis jpaulse1@good‐sam.com

Casey McCormick Insurance Agent

Farm Bureau

Financial Services St. Francis [email protected]

Chuck Kribs Director

Cheyenne County


Diane Kribs Director

Cheyenne County


Elmer Kellner St. Francis [email protected] 785‐332‐2950

Glenn Isernhagen [email protected]

Art Krueger St. Francis 785‐332‐2933



John Knodel St. Francis

Twila Kramer 785‐332‐2840

Floyd and Elaine Retired St. Francis f‐[email protected]


Mary Bier Bier's Hometown St. Francis [email protected]

Ward Cassidy State Rep 120th District St. Francis [email protected]

Name Position Affiliation Community Email PhoneNancy Semler


Donna Wright Insurance Agent

Health & LTC

Insurance Agent Bird City [email protected]

Sharon Hendricks

Phyllis Wright Bird City 785‐734‐2502

Cathy Loop

Lea Keller

Ruth Milliken Homemaker/Secretary

42 year member/Club

Leadership Community Builder [email protected] 785‐332‐3421

Bruce A. Swihert City Council


Althea R Lebow Banker Community Builders St. Francis [email protected]

Mike Bandel

Bankwest of Kansas Vice

President

Cheyenne County

Hospital Board Cheyenne County [email protected]

785‐332‐4577 or

785‐332‐3333

Elmer Kellner St. Francis [email protected] 785‐332‐2950

Dorothy Kellner

Sondra Bracelin Past Hospital Board St. Francis [email protected]

Marvin J. Zimbelman

Donna Zimbelman


Tim Burr

Bonnie Burr



Cheyenne County


Survey Results and Community Healthcare Asset Directory

JUNE 23rd, 2011

Sara Roberts Office of Rural Health

Casey McCormick

Agent Farm Bureau

Financial Services

Community Builders,




St. Francis Good







Erika Zimbelman Board Member

Cheyenne County

Hospital and St.

Francis Community

Foundation St. Francis [email protected] 785‐332‐6195

Dale Patton

Cheyenne County

Commission Cheyenne County Cheyenne County [email protected]

785‐332‐2153 or

785‐332‐4867

Chuck Kribs

Co‐Director Economic

Development Corp CCDD Bird City [email protected]

Lyle Knebel Pastor St. Francis [email protected] 970‐630‐9960


Church of Christ,


785‐332‐3424 or

785‐772‐7409

Raedell Winston Massage Therapist St. Francis [email protected] 785‐332‐4391

Helene Landenberger St. Francis [email protected]

Name Position Affiliation Community Email PhoneKen Quigley St. Francis [email protected]


Carl M. Werner Retired Superintendent St. Francis [email protected] 785‐332‐3418



Betty M Louden

United Methodist

Thrift Store St. Francis [email protected] 785‐332‐2347


John Knodel St. Francis


Cathy Domsch Executive Director

Bird City Century II

Development

Foundation Bird City [email protected] 785‐734‐2556

Penny Gienger Substitute Teacher Community Builder St. Francis [email protected]

Natalie Knodel St. Francis [email protected] 785‐332‐3129

Glenn Isernhagen Retired Lutheran Pastor

Member Good

Samaritan Advisory St. Francis [email protected] 785‐332‐3634


785‐332‐0040 or

2940

Diane Kribs Co‐Director

Cheyenne County


Kay Shay Part‐time Office Work St. Francis [email protected]

Casey McCormick

Agent Farm Bureau

Financial Services

Community Builders,


JULY 13th, 2011

Summary Meeting and Action Planning


Carla Lampe City Council‐Bank FNB [email protected]

Bruce A. Swihert City Council


St. Francis Good






Leslie Lacy Administrator

Cheyenne County

Hospital Cheyenne County [email protected]


785‐734‐2003 or

785‐736‐7369




Janet Carman Resident Cheyenne County [email protected]

Marvin J. Zimbelman

Donna Zimbelman


Church of Christ,


785‐332‐3424 or

785‐772‐7409

Bonnie Burr

Mary & Norman Retired Bird City 785‐734‐2713

Karen Flemming Deputy Appraiser

Cheyenny Co.

Courthouse Bird City [email protected] 785‐734‐2463

Sondra Bracelin Past Hospital Board St. Francis [email protected]


and

The Importance of the Health Care Sector to the Economy ofCheyenne County Kansas Rural Health Options Project April 2011

Jill Patry, Research AssistantKatie Morris, Extension AssistantJohn Leatherman, Director

Funding for this report provided by: Health Resources and Services Administration

The Economics of Rural Health Care The organization and delivery of health care services have undergone rapid evolution in recent years. For many Americans, the cost of services and access to care are important issues. This certainly is true in many rural areas where communities have struggled to maintain affordable, quality health care systems. As economic forces and technical advances continue to change health care, it is more important than ever for rural community leaders and health care providers to work together to ensure affordable, sustainable health care systems. In an effort to provide useful information resources to rural community and health care leaders, the Kansas Rural Health Options Project (KRHOP) has teamed with the Office of Local Government, a unit of the Department of Agricultural Economics and K-State Research and Extension, to develop this report as a component of the Kansas Rural Health Works program. KRHOP is a partnership of the Office of Local and Rural Health at the Kansas Department of Health and Environment, the Kansas Hospital Association, the Kansas Board of Emergency Medical Services and the Kansas Medical Society. KRHOP is dedicated to assuring quality health care delivery in rural Kansas through the promotion of collaborative systems of care. Kansas Rural Health Works is supported by a federal grant to KRHOP (No. 5 H54 RH 00009-03) from the Health Resources and Services Administration, Office of Rural Health Policy. The purpose of this report is to provide information resources that may be used to communicate to community leaders and concerned citizens the relative importance of health care to the local economy. Much of this information draws on the national Rural Health Works program sponsored by the Office of Rural Health Policy, an initiative led by Cooperative Extension Service specialists at Oklahoma State University. Many persons knowledgeable about the Kansas health care system also contributed to this report, including specialists at the Kansas Hospital Association, the Office of Local and Rural Health, and hospital administrators from across the state who cooperated in the development of these resources. The Office of Local Government welcomes any questions, comments or suggestions about this report or any of their other services. Contact your county Extension office or: Dr. John Leatherman

Office of Local Government Phone: 785-532-2643 Department of Agricultural Economics 10E Umberger Hall K-State Research and Extension Fax: 785-532-3093 Manhattan, KS 66506-3415 E-mail: [email protected]

i

mailto:[email protected]

ii

Table of Contents

Introduction....................................................................................................................... 1

Health Care Changes and Their Effects on Rural Communities ................................. 2

Health Services and Rural Development ........................................................................ 5

Health Services and Community Industry ................................................................. 5

Health Services and Retirees........................................................................................ 5

Health Services and Job Growth ................................................................................. 6

Understanding Today’s Health Care Impacts and Tomorrow’s Health Care

Needs .............................................................................................................................. 6

The Economic Impact of the Health Care Sector .......................................................... 7

An Overview of the Stafford County Economy, Highlighting Health Care ............ 7

Health Sector Impact and Economic Multipliers .................................................... 10

Summary and Conclusions............................................................................................. 13

Selected References ......................................................................................................... 15

Glossary of Terms ........................................................................................................... 16

The Economic Contribution of the Health Care Sector In Cheyenne County, Kansas

Introduction The rapidly changing delivery of health services in rural counties has the potential to greatly impact the availability of health care services in the future. These changes include:

Insufficient Medicare and Medicaid payments to hospitals and providers may force a reduction in the provision of health care services.

Although Kansas rural health networks are already fairly strong, creation of provider networks may substantially change the delivery of, and access to, local health care services.

Use of telemedicine could increase access to primary, consultative and specialty health care services at the county level.

Development of critical access hospitals could help health care services remain in rural counties. Kansas currently has over 80 critical access hospitals.

As a result, the health care sector can have a large impact on the local economy. All of these changes make it imperative that decision makers in Cheyenne County become proactive in maintaining high quality local health care services. Health care facilities such as hospitals and nursing homes provide jobs and income to people in the community. As these employees spend their income in the community, a ripple spreads throughout the economy, creating additional jobs and income in other economic sectors. To help understand this important connection between the health sector and the local economy, this report will:

Discuss the role of the health sector in rural development. Measure the employment, income, and retail sales impact of the health sector on

the Cheyenne County economy. This report will not make any recommendations.

1

Health Care Changes and Their Effects on Rural Communities The changes occurring in the health care sector have had a substantial impact on many rural communities. Many people have found it more difficult to get health care coverage, insurance premiums have increased, and rural health care providers have been reimbursed at rates less than their urban counterparts for doing the same work. Concurrently, changes in urban health systems have had impact on rural health care delivery with the result that some rural communities have lost their ability to make decisions about their local health care. Rapid increases in health care costs have driven these changes. In 1990, a person spent an average of $2,239 (2008$) on health care expenditures. By 2008, health care expenditures rose to $3,486 per person. Additionally, the average person spent $1,415 (2008$) for insurance premiums and $824 on out-of-pocket expenses such as deductibles and co-payments in 1990. In 2008, those figures rose to $2,573 for insurance premiums and $913 for out-of-pocket expenses. Table 1 shows the trend of increasing health care expenses from 1970 through 2008. Because of the increases in the demand for and cost of health care, the major purchasers of health care services – employers and government (through Medicare, Medicaid and other programs) – must search for ways to slow the rapid growth in health care expenditures. Table 1. United States Per Capita Health Expenditures

Year Per Capita

Consumer Spending(2008$)

Per Capita Insurance Premiums

(2008$)

Per Capita Out-of-Pocket Costs

(2008$) 1970 $913 $350 $563 1980 $1,307 $708 $598 1990 $2,239 $1,415 $824 2000 $2,786 $1,957 $829 2001 $2,915 $2,081 $834 2002 $3,114 $2,251 $863 2003 $3,291 $2,400 $892 2004 $3,376 $2,476 $900 2005 $3,460 $2,547 $912 2006 $3,492 $2,586 $906 2007 $3,530 $2,603 $926 2008 $3,486 $2,573 $913

Centers for Medicare & Medicaid Services; data are inflation adjusted to 2008 dollars

2

Typically, rural community residents pay little attention to their local health care system until it is needed. Consequently, many rural people have little idea of the overall importance of the health care sector to their community’s economy, such as the number of jobs it currently provides and its potential to provide more jobs. To ensure that health care services remain available locally, rural communities need to understand these economic relationships. First, rural communities need to learn about their own local health care needs and take stock of their local health care system. While the emphasis at the national level is on controlling costs and eliminating duplication and overcapacity in the system (de-licensing unused hospital beds, for example), the issues are very different in rural communities. One of the issues that underlies differences between health care systems in rural and urban areas is demographics. In rural areas, there are proportionately more elderly, more children living in poverty, higher unemployment and lower incomes. Rural people report poorer health and have more chronic health conditions. Rural people are more likely to be uninsured and have fewer health services available in the town where they live. Finally, people in rural communities are more likely to derive part of their income from the health care industry (either directly or indirectly). Another issue that underlies the differences between urban and rural health care is the structure of the systems. In general, there are fewer providers and hospitals in rural areas, and they operate on very thin profit margins. In fact, many rural hospitals operate at a loss, with too few patients to cover daily costs. Also, until recently, most rural health care systems had been locally operated and controlled. Pressures outside of the health care system also come into play in rural communities, creating stresses not applicable to urban systems. Cyclical commodity prices cause a periodic farm financial crisis, undermining the financial viability of family farms and business, such as farm implement manufacturers and dealers. Businesses located in rural areas tend to be small, often do not provide health insurance, and are highly vulnerable to changing economic conditions. Although these stresses can lead to mental and physical health problems, many people do not seek help for their health problems. Some will say they have too little time to seek out health care services, especially if they are working two jobs to make ends meet. For others, the strong sense of pride and self-reliance inherent among rural people may preclude many from seeking care, especially if they cannot afford it. What is the ultimate impact of these changes and stresses on rural communities? Will it be a net gain or net loss, or will it all balance out in the end? On the positive side, urban-based specialists may set up periodic office hours in rural clinics, health centers and hospitals; an urgent care center may open; and air medivac helicopters and other emergency medical services may be strategically located in a rural community. These services, while provided by many urban health systems, are convenient for rural residents, and otherwise would not be available to rural communities.

3

On the negative side, ties with financially strong urban health care providers can be detrimental to rural providers if the rural providers lose decision-making ability. Rural providers may also find themselves aligned with an organization that does not share their mission and values, or the rural provider may be unable to meet the expectations of the larger provider. Anecdotal evidence suggests that the downsides can be significant and potentially devastating for a rural community. In some instances, urban or other outside interests have purchased rural clinics and hospitals and then closed them because they did not provide sufficient profit. Employers have signed contracts with insurance plans that push patients to the city for their health care, bypassing local, more convenient services. Emergency medical service providers have changed their service areas or closed their doors. When urban health organizations encourage insured rural residents to spend their health care dollars in the city rather than to purchase equivalent services locally, it can have a significant negative economic impact and result in a loss of health dollars within the local community. In addition, out of town trips to obtain health care naturally offer opportunities to spend dollars out of town that may have been spent locally. These out-migrated dollars are missed opportunities and can significantly impact the local economic base. Rural communities need to overcome inertia and take stock of local health care. Rural providers should be challenged to organize, whether through formal or informal mechanisms, so that they can compete with urban systems. In general, regional strategies will probably work better than local ones. Providers must be willing to take risks and coordinate services. Well-positioned rural health systems can meet these challenges. Fragmentation is a big problem in health systems, but smaller, independent rural systems have more opportunity to create linkages. The scarce resources available to rural health services have engendered innovation and efficiencies as a matter of survival. Strong local leadership helps sustain these systems. Many rural health organizations are committed to fiscal accountability, expressed as quality health care at low cost. It should not be too difficult to remind rural residents of the long-term commitment these rural providers have made in the communities they serve. In time, rural providers need to offer sustainable health care services that best meet community need. Success in meeting these challenges can be measured in terms of increased local services, more spending on locally-available health care, local control of health resources, negotiation of good reimbursement rates for providers, and high levels of community satisfaction with local health care. If rural health providers do not act, they will face the prospect of losing jobs; rural communities could lose health care services; and everybody may lose local control of their health care.

4

Health Services and Rural Development Though the connections between health care services and rural development are often overlooked, at least three primary areas of commonality exist. A strong health care system can help attract and maintain business and industry growth, attract and retain retirees, and also create jobs in the local area. Health Services and Community Industry Studies have found that quality of life factors play a dramatic role in business and industry location decisions. Health care services represent some of the most significant quality of life factors for at least three reasons. First, good health and education services are imperative to industrial and business leaders as they select a community for location. Employees and participating management may offer strong resistance if they are asked to move into a community with substandard or inconvenient health services. Secondly, when a business or industry makes a location decision, it wants to ensure that the local labor force will be productive, and a key productivity factor is good health. Thus, investments in health care services can be expected to yield dividends in the form of increased labor productivity. The third factor that business and industry consider in location decisions is cost of health care services. A 1990 site selection survey concluded that corporations looked carefully at health care costs, and sites that provided health care services at a low cost sometimes received priority. In fact, 17 percent of the respondents indicated that their companies used health care costs as a tie-breaking factor between comparable sites (Lyne, 1990). Health Services and Retirees A strong and convenient health care system is important to retirees, a special group of residents whose spending and purchasing can provide a significant source of income for the local economy. Many rural areas have environments (for example, moderate climate and outdoor activities) that enable them to attract and retain retirees. Retirees represent a substantial amount of spending, including the purchasing power associated with pensions, investments, Social Security, Medicare and other transfer payments. Additionally, middle and upper income retirees often have substantial net worth. Although the data are limited, several studies suggest health services may be a critical variable that influences the location decision of retirees. For example, one study found that four items were the best predictors of retirement locations: safety, recreational facilities, dwelling units, and health care. Another study found that nearly 60 percent of potential retirees said health services were in the “must have” category when considering a retirement community. Only protective services were mentioned more often than health services as a “must have” service.

5

Health Services and Job Growth Job creation represents an important goal for most rural economic development programs. National employment in health care services increased 70 percent from 1990 to 2008. In rural areas, employment in health-related services often accounts for 10 to 15 percent of total employment. This reflects the fact that the hospital is often the second largest employer in a rural community (local government including schools typically being the largest employer). Another important factor is the growth of the health sector. Health services, as a share of gross domestic product (GDP), has increased over time. In 1990, Americans spent $1.1 trillion on health care (2008$), which accounted for 12.3 percent of the GDP. In 2005, health care costs increased to $2.0 trillion, or 15.7 percent of the GDP. If current trends continue, projections indicate that Americans will spend 19.3 percent of GDP on health care by 2019. Capturing a share of this economic growth can only help a rural community. Understanding Today’s Health Care Impacts and Tomorrow’s Health Care Needs A strong health care system represents an important part of a community’s vitality and sustainability. Thus, a good understanding of the community’s health care system can help leaders and citizens fully appreciate the role and contributions of the health care system in maintaining community economic viability. In addition, a community should also examine the future health care needs of its residents in order to position itself so that it can respond to those needs. This report is designed to provide the kind of information that a community can use to understand its health care system and some possible indicators of current and future health care needs of its residents. The report begins with an examination of demographic, economic and health indicators and culminates with an illustration of the full economic impact of the health care sector in the county’s economy.

6

The Economic Impact of the Health Care Sector An Overview of the Cheyenne County Economy, Highlighting Health Care Table 2 presents employment, income and sales data for Cheyenne County for 2009. Health services employment is from a local census reflecting current 2011 employment. Health care income and sales data were estimated using state average data. Data for all other economic sectors come from various government statistics and published data sources. The table aggregates the economic sectors into broad categories, and the employment numbers indicate “average” jobs in each sector, including full- and part-time employment. Labor income represents local wages and proprietary income. Total income is the broadest measure of income generated within the local economy, and includes labor income plus dividend, interest, rents, corporate profits, etc. Table 2 Direct Employment, Income and Sales by Economic Sector and Health Services Relative Shares Compared to the State and U.S., 2009 ($thousands)

Sector

Employment

Labor Income

Total Income

Total Sales

Agriculture 970 $34,151 $54,795 $150,364 Mining 1 $61 $89 $168 Construction 277 $12,531 $14,671 $32,052 Manufacturing 765 $37,558 $49,592 $231,895 Transportation, Information, Public Utilities

484 $35,227 $58,046 $1,475,584

Trade 1,044 $29,611 $47,858 $64,448 Services 1,945 $61,308 $1,112,805 $204,499 Health Services1 (2011) 626 $20,399 $22,409 $45,084 Health and Personal Care Stores 17 $626 $9,810 $1,159 Veterinary Services 24 $391 $418 $919 Home Health Care Services 16 $367 $389 $635 Doctors and Dentists 46 $2,942 $3,137 $5,196 Other Ambulatory Health Care 31 $857 $1,101 $2,745 Hospitals 212 $9,175 $9,795 $23,615 Nursing/Residential Care Facilities 191 $4,808 $5,190 $9,278 Health and Fitness Centers 10 $54 $61 $198 Local Government Health Care 79 $1,178 $1,339 $1,339 Government 917 $31,919 $36,034 $51,731 Total 6,481 $243,546 $375,229 $882,098 Health Services as a Percent of Total County 9.7 8.4 6.0 5.1 State 8.7 8.1 6.0 4.4 Nation 8.1 8.4 6.4 5.3

Minnesota IMPLAN Group; Due to rounding error, numbers may not sum to match total. 1In some Kansas counties, various health services are consolidated within a single entity in the classification system shown here. In such cases, it may not be possible to break apart employment, income or sales information. If you have questions regarding the organization of health care services in your county, contact your local hospital administrator.

7

Health services are separated from the service and retail trade sectors but not double counted in the totals. The numbers for each sector include not only the professionals in the sector (the doctors, dentists, etc.) but also support staff (assistants, clerks, receptionists, etc.) employed by the business. In the health sector, the Health and Personal Care stores category includes pharmacies, while the Doctors and Dentists category includes chiropractors, optometrists, and other health care practitioners. Other Ambulatory Health Care Services includes services such as medical and diagnostic labs and outpatient care centers. Health Services employs 177 people, 9.6 percent of all job holders in the county. Health Services for the state of Kansas employs 8.7 percent of all job holders, while 8.1 percent of all job holders in the United States work in Health Services. Health Services in the county has a number 5 ranking in terms of employment (Figure 1). Health Services is number 5 among payers of wages to employees (Figure 2) and number 5 in terms of total income (Figure 3). As with most rural areas, the health sector plays an important role in the economy.

Figure 1. Total Employment by Sector

Agriculture27%

Services30%

Government15%

Health Services9%

Construction3%

Manufacturing2%

TIPU3%Trade

10%

Mining1%

Minnesota IMPLAN Group

8

Figure 2. Labor Income by Sector

Agriculture28%

Services26%

Government15%

Mining1%

Trade10%

TIPU4%

Manufacturing2%

Construction3%

Health Services11%


Figure 3. Total Income by Sector

Agriculture32%

Services29%

Government11%

Mining1%

Trade10%

TIPU6%

Manufacturing2%

Construction2%

Health Services7%


9

Health Sector Impact and Economic Multipliers The previous section detailed the direct contributions of the Health Services sector within the Cheyenne County economy, but the full impact of the sector goes beyond the number of people employed and the wages they receive. The employment and income levels in the health sector have a significant impact on employment and income throughout other industries in the market area. This secondary impact or “ripple effect” comes from local businesses buying and selling to each other and from area workers spending their income for household goods and services; the ripple effect spreads the economic impact of the health sector throughout the community economy. As dollars are spent locally, they are, in turn, re-spent for other goods and services. Some of these goods are produced locally while others are imports (the portion of the dollar spent on imports leaves the community as leakage). This spending and re-spending occurs over multiple rounds until it is finally exhausted. Graphically, we can illustrate the round-by-round relationships modeled as shown in Figure 4. The direct effect of spending is shown in the far left-hand side of the figure (the first bar (a)). For simplification, the direct effects of a $1.00 change in the level of spending plus the indirect effects spillover into other sectors and create an additional 66 cents of activity. In this example, the multiplier is 1.66. A variety of multipliers can be calculated using these analysis techniques. Figure 4. Multipliers and the round-by-round impacts

(a) (b) (c) (d) (e) (f)

Initial $1.00 of spending

$0.60 leakage

$0. nt

$0. nt

$0. nt $0. nt $0. nt

40 respelocally

$0.24 leakage

16 respelocally

$0.10 leakage

06 respe 03 respe

$0.03 leakage

01 respe$0.02 leakage

Initial Impact: $1.00 .40 .16 .06 .03 .01 --------- Full Impact: $1.66

10

Tables 3 and 4 illustrate the ripple effect in the county. As an example, Table 3 shows that the hospital sector employs 65 people and has an employment multiplier of 1.33. This means that for each job created in the hospital sector, another 0.33 jobs are created in other businesses and industries in the county’s economy. The direct impact of the 65 hospital employees results in an indirect impact of 22 jobs (65 x 0.33 = 22) throughout all businesses and industries in the market area. Thus, the hospital sector employment had a total impact on area employment of 87 jobs (65 x 1.33 = 87). Table 3. Health Sector Impact on Employment, 2011

Health Sectors Direct

Employment Economic Multiplier

Total Impact

Health and Personal Care Stores 5 1.10 6 Veterinary Services 7 1.12 8 Home Health Care Services 4 1.18 5 Doctors and Dentists 38 1.23 47 Other Ambulatory Health Care 0 0.00 0 Hospitals 65 1.33 87 Nursing and Residential Care Facilities 40 1.16 46 Health and Fitness Centers 3 1.05 3 Local Government Health Care 15 1.08 16 Total 177 217

Note: Most data obtained from secondary sources; some data unavailable or extrapolated Minnesota IMPLAN Group Similarly, multiplier analysis can estimate the total impact of the estimated $4,287,000 direct income for hospital employees shown in Table 4. The hospital sector had an income multiplier of 1.26, which indicates that for every one dollar of income generated in the hospital sector, another $0.26 is generated in other businesses and industries in the county’s economy. Thus, the hospital sector had an estimated total impact on income throughout all businesses and industries of $5,405,000 ($4,287,000 x 1.26 = $5,405,000). Table 4. Health Sector Impact on Income and Retail Sales, 2011 (thousands)

Health Sectors Direct Income

Economic Multiplier

Total Impact

Retail Sales

Health and Personal Care Stores $193 1.14 $219 $56 Veterinary Services $149 1.29 $191 $49 Home Health Care Services $177 1.20 $212 $54 Doctors and Dentists $1,421 1.29 $1,830 $465 Other Ambulatory Health Care $0 0.00 $0 $0 Hospitals $4,287 1.26 $5,405 $1,372 Nursing/Residential Care Facilities $1,361 1.23 $1,675 $425 Health and Fitness Centers $14 1.58 $22 $5 Local Government Health Care $214 1.15 $246 $63 Total $7,814 $9,800 $2,488

Note: Most data obtained from secondary sources; some data unavailable or extrapolated. Minnesota IMPLAN Group

11

In this manner, the total employment and income impacts of all the health services sectors can be estimated. In Table 3, the total employment impact of the health services sector results in an estimated 217 jobs in the local economy. In Table 4, the total income impact of health services results in an estimated $9,800,000 for the economy. The last column in Table 8 shows the retail sales that the health sector helps to generate. To estimate this, this study incorporates a retail sales capture ratio (retail sales to total personal income). Cheyenne County had retail sales of $24,857,636 and $97,909,000 in total personal income. Thus, the estimated retail sales capture ratio equals 25.4 percent. Using this as the retail sales capture ratio for the county, this says that people spent 25.4 percent of their income on retail goods and services within the market. By taking all the household income associated with health sector activities and multiplying by the retail sales capture ratio, we can estimate the impacts of the health sector on area retail sales. Thus, the total retail sales generated by the retail sector equals $2,488,000 ($9,800,000 x 25.4% = $2,488,000). This is a conservative estimate, as this method does not consider the impact of any local purchases made by the health services businesses.

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Summary and Conclusions The Health Services sector of Cheyenne County, Kansas, plays a large role in the area’s economy. Health Services represents one of the largest employers in the area and also serves as one of the largest contributors to income. Additionally, the health sector has indirect impacts on the local economy, creating additional jobs and income in other sectors. The health sector also contributes substantially to retail sales in the region. All of this demonstrates the importance of the health care sector to the local economy. While the estimates of economic impact are themselves substantial, they are only a partial accounting of the benefits to the county. Health care industries in rural counties help to preserve the population base, invigorating the communities and school systems. Similarly, many hospitals and nursing care facilities have active community outreach programs that enhance community services and the quality of life for community residents. A vigorous and sustainable health care system is essential not only for the health and welfare of community residents, but to enhance economic opportunity as well. Health-related sectors are among the fastest growing in economy. Given demographic trends, this growth is likely to continue. The attraction and retention of new business and retirees also depends on access to adequate health care services. While industry trends related to health care are positive overall, many rural communities have significant challenges. The economics of health care are rapidly changing. As health care costs escalate and government funding becomes tighter, rural markets may become less attractive to many providers. This will lead to the continued restructuring of rural health care services in many areas. If a community wants to maintain the benefits associated with accessible and affordable health care, it must actively work to meet these challenges. The challenges cannot be met by those directly responsible for health care administration alone. They require a community-wide response involving government, business and civic leaders, and they frequently incorporate outside assistance from professional resources providers, such as the Kansas Hospital Association, the Office of Local and Rural Health, the Kansas Department of Health and Environment, and others. In meeting current and future challenges, health care and community leaders can engage in an ongoing process of strategic health planning. This is continuous effort to maintain and enhance the community’s health care situation. The strategic health planning process helps local communities identify their health care needs; examine the social, economic, and political realities affecting the local delivery of health care; determine what is wanted and what realistically can be achieved to meet their identified health care needs; and develop and mobilize an action plan based on their analysis and planning.

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Strategic health planning involves cooperation among people and organizations to pursue common goals. The process is designed to answer three questions:

(1) Where is the community now? (2) Where does the community want to go? (3) How will the community get there?

For the strategic health planning process to be most effective, it must be based in the community and driven by the community. Local residents and their leaders must participate; a current knowledge of the health care industry is not necessary. This process is about local people solving local problems. The local hospital and health care providers should have input into the decision-making and should support and trust the outcomes, but, the community must provide the energy and commitment.

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Selected References

Chirilos, Thomas N. and Gilbert Nostel (1985). “Further Evidence on the Economic Effects of Poor Health.” Review of Economics and Statistics. 67(1), 61-69.

Deller, Steven (2004). “Basics of Input-Output Modeling.” Department of Applied and

Agricultural Economics, University of Wisconsin-Madison. Doeksen, Gerald A., Tom Johnson, Diane Biard-Holmes and Val Schott (1988). “A

Healthy Health Sector is Crucial for Community Economic Development.” Journal of Rural Health. Vol. 14, No. 1, pp. 66-72.

Lyne, Jack (1988). “Quality-of-Life Factors Dominate Many Facility Location

Decision.” Site Selection Handbook. (33), 868-870. Lyne, Jack (1990). “Health Care and Education: Important QOL Factors, But Who’s

Accurately Measuring Them?” Site Selection Handbook. 35(5), 832-838. McGuire T. (1986). On the Relationship Between Infrastructure and Economic

Development. Stoney Brook: State University of New York. Reginer, V. and L.E. Gelwicks (1981). “Preferred Supportive Services for Middle to

Higher Income Retirement Housing.” The Gerontologist. 21(1), 54-58. Scott, Loren C., Lewis H. Smith, and Brian Rungeling (1997). “Labor Force

Participation in Southern Rural Labor Markets.” American Journal of Agricultural Economics. 59(2), 266-274.

Toseland, R., and J. Rasch (1978). “Factors Contributing to Older Persons’ Satisfaction

with Their Communities.” The Gerontologist. 18(4), 395-402.

15

Glossary of Terms

Doctors and Dentists Sector: includes physicians, dentists, chiropractors, optometrists, other health care professionals, and all support staff employed by these professionals. Employment: annual average number of full and part-time jobs, including self-employed for a given economic sector. Employment Economic Multiplier: indicates the total jobs in the economy closely tied, in this case, to one job in the health sector. Employee Compensation: total payroll (wages, salaries and certain benefits) paid by local employers. Government Sector: includes all federal, state and local government enterprises; federal, state and local electric utilities; state and local government passenger transit; state and local government education and non-education; and federal military and non-military. Gross Domestic Product (GDP): the total value of output of goods and services produced by labor and capital investment in the United States. Health and Personal Care Stores: pharmacies. Income Economic Multiplier: indicates total income generated in the economy due to one dollar of income, in this case, in the health sector. Indirect Business Taxes: sales, excise fees, licenses and other taxes paid during normal operation. All payments to the government except for income taxes. Multipliers: Its calculation is based on the structure of the local economy. All of the buying and selling relationships between businesses and consumers are charted in an economic transactions table. When a dollar is spent in one area of the economy, all of the economic interconnections are stimulated as the effect “ripples” to other areas of the economy. The effect is caused by businesses buying and selling goods or services to each other and by local labor who use their income to purchase household goods and services. Over successive rounds of spending and re-spending, the effect of the original dollar is multiplied to some new, larger level of activity. Eventually, the economic “leakages” associated with the purchase of imported goods and non-local taxes and investments causes the ripple effect to finally run out. Multipliers are derived through algebraic calculations of the economic transactions table of the local economy. Other Ambulatory Health Care Services: medical and diagnostic labs and other outpatient care services and all of their employees. Other Property Income: corporate income, rental income, interest and corporate transfer payments.

16

17

Proprietor Income: income from self-employment (farmers and business proprietors, for example). Personal Income: income received by individuals from all sources (employment, Social Security, et cetera). Total Income: employee compensation plus proprietor income plus other property income plus indirect business taxes. Total Sales: total industry production for a given year (industry output).

Kansas State University Agricultural Experiment Station and Cooperative Extension Service, Manhattan, Kansas.

It is the policy of Kansas State University Agricultural Experiment Station and Cooperative Extension Service that all persons shall have equal opportunity and access to its educational programs, services, activites, and materials without regard to race, color, religion, national origin, sex, age or disability. Kansas State University is an equal opportunity organization.

Issued in furtherance of Cooperative Extension Work, Acts of May 8 and June 30, 1914, as amended. Kansas State Univer-sity, County Extension Cuncils, Extension Districts, and United States Department of Agriculture Cooperating, Gary Pierzyn-ski, Interim Dean, College of Agriculture.


Demographic, Economic and Health Indicator Data

Introduction

Kansas Rural Health Works (KRHW) is dedicated to helping rural communities build affordable and sustainable local health care systems. Health care is important to seniors, young families and companies. But rural health care systems are facing many challenges: hospitals are closing; services have been cut; doctors won't come to the area or they don't stay; Medicare and Medicaid payments are too low. Rural residents can revitalize their local health care system. KRHW provides the tools. Local visionary leadership puts these tools to work. KRHW helps communities keep health care dollars at home. Sponsored by the Kansas Rural Health Options Project with funding from the Office of Rural Health Policy, Health Resources and Services Administration.

Background Data Summary Following are a variety of data and statistics about background demographic, economic and health conditions in Cheyenne County that may have implications related to local health care needs. Most of the data only is available at a county scale and reflects the Cheyenne County boundaries.

Cheyenne County Primary Health Market Area

ZIP codes within the Cheyenne County Health Market Area. Source: Claritas, Inc. 2011.

1

- Between 1990 and 2010, the population decreased 15.3 percent in Cheyenne County, but is projected to remain fairly stable at about 2,700. - People aged 65 and older made up the largest portion of the population, with 26.7 percent. - In general, the county has less per capita personal income that the state and nation, and is more dependent of transfer income such Social Security and other retirement benefits, disability, medical payments like Medicare and Medicaid, unemployment insurance, and veterans’ benefits. - Medicare users make up 28.3 percent of the county’s total population and 3.0 percent of the county’s population receive food stamp benefits. - Within the county, 19.4 percent of children live in poverty, while 14.6 percent of children statewide live in poverty.


Table 1 presents population trends for Cheyenne County. In 2010, an estimated 2,734 people live in the county. Between 1990 and 2010, the population decreased 15.3 percent and also decreased 13.4 percent between 2000 and 2010. Population projections indicate that 2,716 people will live in the county by 2015. The state of Kansas population increased 8.5 percent between 1990 and 2000 and an additional 5.5 percent through 2010. Table 1. Current Population, Population Change and Projections Current Population Percent Change in Population Population Projections

Year Count Years County State Year Count 1990 3,226 1990-2000 -2.2 8.5 2015 2,716 2000 3,156 2000-2010 -13.4 5.5 2020 2,704 2010 2,734 1990-2010 -15.3 14.5 2025 2,694

U.S. Census Bureau; population projections from Woods and Poole Economics, Inc.

Figure 1. Population by Age and Gender

0 50 100 150 200 250

Zero to 9

10-19 20-24

25-34 35-44

45-54

55-59 60-64

65-74 75-84

85 and older

Population CountMale Female

U.S. Census Bureau Figure 1 shows a breakdown of the population by age and by gender. Here, people aged 65 and older made up the largest portion of the population, with 26.7 percent. Of those 65 and older, 41.4 percent were male and 58.6 percent were female. Age range can indicate the future health care needs of a county’s population. A growing population of older adults has a different set of health care needs than a population with more young people.

2


Race can also play a role in assessing the health needs of the community. In the case of Hispanic immigrants, lack of English speaking skills may prevent them from using health care services within the county or from using health care services at all. Figure 2 shows the racial and ethnic composition of the county. Whites made up 94.3 percent of the county’s population, while Native Americans represented 0.1 percent, African Americans made up 0.0 percent, Asians were 0.4 percent and Hispanics were 5.0 percent of the population. In Kansas, whites make up 80.5 percent of the population, Native Americans represent one percent, African Americans 6.3 percent, Asians 2.5 percent and Hispanics 9.6 percent.

Figure 2. Population by Race (2010)

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Race

Hispanic

Asian or Pacific Islander

Native American

Black

White

Woods and Poole Economics, Inc. Native American includes American Indians and Alaska Natives; Asian or Pacific Islander includes Asian Americans, Native Hawaiians, Pacific Islanders; Hispanic population is persons of Hispanic origin regardless of race. Economic Indicators An important question for health care providers is how people will pay for services. In rural areas, the likelihood of poverty, lack of insurance and chronic health conditions increases. Additionally, rural areas tend to have higher numbers of elderly, for whom supplemental income becomes a proportionally larger source of income. Such supplemental income comes in the form of transfer payments such as Social Security and other retirement benefits, disability, medical payments like Medicare and Medicaid, unemployment insurance, and veterans’ benefits. The elderly, major consumers of health care services, receive much of this income, and a large portion of this assistance is available only to those who make the effort to apply. In order to maximize the income resources available in the county, one strategy is to ensure that every person receives all of the financial assistance from broader levels of government for which they are eligible.

3


Figure 3. Total Per Capita Personal Income (2008$)

$20,000

$25,000

$30,000

$35,000

$40,000

$45,000

2005 2006 2007 2008

County State U.S.

Bureau of Economic Analysis; data are inflation adjusted to 2008 dollars. Figure 3 shows the change in total per capita personal income, adjusted for inflation from 2005 through 2008. Per capita personal income has increased in Kansas and the United States. In Cheyenne County, personal income has increased from $25,682 in 2005 to $36,950 in 2008.

Figure 4. Transfer Income as a Percent of Total Income (2008$)

10.0

15.0

20.0

25.0

30.0

35.0

2005 2006 2007 2008

Perc

ent

County State U.S.

Bureau of Economic Analysis; data are inflation adjusted to 2008. Figure 4 shows how the relative proportion of transfer income to total income has changed during the same four years. In the U.S., transfer payments have increased as a percentage of total income by 6.6 percent, while transfer payments in Kansas have increased by 2.5 percent. In the county, the proportion of income stemming from transfer payments has decreased from 27.0 percent in 2005 to 22.2 in 2008.

4


Table 2 shows personal income data by source for Cheyenne County, Kansas and the nation. Within the county, 39.7 percent of all earnings come from wages and salaries, compared to 69.4 percent in Kansas and 71.6 percent for the entire United States. Retirement and disability make up 43.7 percent of transfer payments in the county, with another 45.5 percent coming from medical payments. In Kansas, 39.0 percent of all transfers come from retirement and disability, while medical payments represent 42.2 percent. For the U.S., medical payments make up the largest portion of transfers at 44.0 percent. Table 2. 2008 Personal Income Data

Source County Total

County Per

Capita County Percent

State Percent

U.S. Percent

Earnings Wages and Salaries $25,816,000 $9,415 39.7 69.4 71.6 Other Labor Income $6,459,000 $2,356 9.9 17.0 16.3 Proprietor’s Income $32,810,000 $11,966 50.4 13.6 12.1 Total Earnings $65,085,000 $23,736 100.0 100.0 100.0 Transfer Payments Retirement and Disability $9,831,000 $3,585 43.7 39.0 34.2 Medical Payments $10,234,000 $3,732 45.5 42.2 44.0 Other $2,429,000 $886 10.8 18.7 21.9 Total Transfer Payments $22,494,000 $8,204 100.0 100.0 100.0 Personal Income Earnings by Place of Residence $61,976,000 $22,602 61.5 68.8 66.6 Dividends, Interest, and Rent $16,329,000 $5,955 16.2 17.0 18.0 Transfer Payments $22,494,000 $8,204 22.3 14.3 15.3 Total Personal Income $100,799,000 $36,761 100.0 100.0 100.0

Bureau of Economic Analysis Per capita estimates based on 2009 Woods and Poole Economics, Inc. estimates. Due to rounding error, numbers may not sum to match total.

5


Health Indicators and Health Sector Statistics The following health indicators and statistics provide information from which communities may infer several things about local health care needs. While some items provide an indication of need by type of service, other items suggest the amount and source of resources available to pay for health services. Health care planners can use this information to arrange for necessary services and anticipate the administrative requirements needed to support such services. Table 3. Health Services, Medicare, and Medicaid Funded Programs

County Number

County Percent/

Rate

State Percent/

Rate Hospitals (2009) Number1 1 0.4 0.1 Number of beds1 25 9.3 4.1 Admissions per bed1 14 5.1 0.01 Adult Care Homes (2009) Number2 1 1.4 0.8 Number of beds2 50 69.4 56.2 Assisted Living Facilities (2009) Number2 0 0.0 0.7 Number of beds2 0 0.0 29.6 Medicare (2007) Elligibles3,4 784 28.3 14.8 Medicaid Funded Programs Food Stamp Beneficiaries (2009)4 81 3.0 7.4 Temporary Assistance for Families (FY 2009)4 14 0.5 1.1 Kansas Hospital Association; Kansas Department on Aging; Kansas Department of Social and Rehabilitative Services; Center for Medicare and Medicaid Services 1Rate per 1,000 population. 2Number of beds per 1,000 people 65 years and older. 3Annual average number of original Medicare eligibles---individuals who are either currently or formerly entitled or enrolled in either part A or part B original Medicare. 4 Percent of total 2007 estimated population. Table 3 shows the availability of certain types of health services in Cheyenne County as well as usage of some health care-related government programs. The county has 25 available hospital beds, with a rate of 5.1 admissions per bed per 1,000 people. Additionally, the county has 50 adult care home beds, or 69.4 beds per 1,000 older adults, and 0 assisted living beds. Medicare users make up 28.3 percent of the county’s total population and 3.0 percent of the county’s population receive food stamp benefits.

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Table 4. Maternity and Children’s Health Statistics

County Number

County Percent/

Rate

State Percent/

Rate Poverty (2008) Total Persons in Poverty1 280 10.4 11.3 Children in Poverty2 98 19.4 14.6 Total Births3 (2008) 22 8.0 14.9 Births to Mothers without High-School Diploma4

(2007) N/A 15.0 18.2

Births with Adequate Prenatal Care3 (2008) 18 85.7 77.6 Low Weight Births5 (2007) N/A 10.0 7.1 Immunization6 (2007) N/A 71.0 58.0 Infant Mortality7 (2008) 0 9.4 7.4 Child Deaths8 (2008) 0 0.0 1.7 Child Care Subsidies9 (2008) 6 N/A N/A

U.S. Census Bureau; 2008 Kansas Kids Count Data Book, Kansas Department of Health and Environment 1 Percent of total population. 2 Percent of children younger than 18 years in families below poverty level. 3 Percent of live births to all mothers who received adequate or better prenatal care. 4 Rate of live births per thousand females. 5 Percent of live births in a calendar year. 6 Percent of total kindergarteners who received all immunizations by age two. 7 Number of infant deaths younger than one year per thousand live births. 8 Number of deaths from all causes per 100,000 children ages 1-14. 9 Average monthly number of children participating in the Kansas Child Care Assistance program. Table 4 gives information which can indicate the situation for young children and mothers. Within the county, 19.4 percent of children live in poverty, while 14.6 percent of children statewide live in poverty. Births to school age mothers occurred at a rate of 15.0 births per thousand teenage females, while school age mothers gave birth at a rate of 18.2 births per thousand teens statewide. Low weight births occurred in 10.0 percent of all live births in the county, while statewide low weight births occurred in 7.1 percent of all live births. This information was prepared by the Office of Local Government, K-State Research and Extension. For questions or other information, call 785-532-2643.


Economic & Demographic Data

Introduction Economic Data Summary Following are data and statistics about the economic and demographic characteristics of Cheyenne County that may have implications related to local health care needs. Some of the data only is available at a county scale and reflects the Cheyenne County boundaries.



1


- Continuing a long-term trend, the total population of Cheyenne County has declined by 18% since 1990. - The proportion of the population over 65 years is growing, and the female population over 85 years is growing fastest among the elderly group. - 37% of the population lives alone, making individual acute and chronic care management challenging. - Over 15% of households live on less than $15,000 income per year. - Transfer income to persons is among the fastest growing sources of income. In 2010, nearly $20 million in transfer income was paid to county residents, about 30% of total personal income. - Within transfer income, government assistance such as Medicare, income maintenance, and veterans pension and disability benefits are growing most strongly. - The county poverty rate decreased according to the most recent available data, but likely has increased in 2009 along with the unemployment rate.


Typical of many rural counties in Kansas, county population has been in long-term decline, about 18 percent since 1990. The trend is expected to continue into the near-term future. The implications of this trend are that there are fewer people to make up local economic markets, fewer people to support local public services, and a thinner local labor market. All of these create greater challenges for businesses, local governments and communities.

Figure 1. Total Population Projection in the Cheyenne County Health Area

0

500

1,000

1,500

2,000

2,500

3,000

3,500

2000 2011 2015

Popu

latio

n

Claritas, Inc. (2009) The proportion of the population 65 years and older is among the fastest growing demographic groups even as the overall population declines. The oldest of the old, persons 85 years and older, are increasing to the greatest degree among the elderly, with women commonly outliving men. The implications of these trends are several: without a source of renewal from economic growth, the community will increasingly rely on an elderly, fixed income population base to support local services. Further, the proportion of the population with special health care needs, especially community and home health care assistance, will increase. Table 1. Percent of Aging Population in the Cheyenne County Health Area

Percent Population Percent Population Percent Population65+ Years old 26.6% 842 27.1% 723 29.5% 72175+ Years old 13.9% 440 15.4% 409 17.5% 42685+ Years old 3.7% 117 6.0% 160 6.8% 166Claritas, Inc. (2011)

2000 2011 2015

2


Figure 2. Estimated Percent of Aging Population in the Cheyenne County Health Area

0%

5%

10%

15%

20%

25%

30%

35%

2000 2011 2014

% o

f Pop

ulat

ion

65+ Years old 75+ Years old 85+ Years old

Claritas, Inc. (2011)

Figure 3. Cheyenne County Health Area Population bySex and Age, 2011

0 100 200 300 400

Less than 18 Years

18 to 34 Years

35 to 54 Years

55 to 64 Years

65 to 84 Years

85 and over

Male Female

Claritas, Inc. (2011)

3


The racial composition of Cheyenne County is somewhat less homogenous than many rural Kansas counties. Whites make up over 96 percent of the population. Eighty-eight persons in Cheyenne County identify themselves as non-white. It’s not uncommon for non-whites to have specific health care needs that are very different than the white population. As is the case almost everywhere, the Hispanic and Latino population is increasing, albeit relatively modestly.

Table 2. 2011 Estimated Population by Single Race ClassificationPopulation Percent

White Alone 2,576 96.7%Black or African American Alone 6 0.2%American Indian and Alaska Native Alone 3 0.1%Asian Alone 12 0.5%Native Hawaiian and Other Pacific Islander Alone 1 0.0%Some Other Race Alone 48 1.8%Two or More Races 18 0.7%Total 2,664 100.0%Claritas, Inc. (2011)

Table 3. 2011 Estimated Population Hispanic or Latino by OriginPopulation Percent

Hispanic or Latino 130 4.9%Not Hispanic or Latino 2,534 95.1%Total 2,664 100.0%Claritas, Inc. (2011)

Table 4. Cheyenne County Health Area Hispanic and Latino Population Projection2000 2011 2016

Total Population 3,165 2,664 2,440Hispanic and Latino Population 82 130 144Percentage of Population 2.6% 4.9% 5.9%Claritas, Inc. (2011)

4


A relatively large proportion of the population 15 years and older is unmarried. About 63 percent of the adult population reported living as a married individual with a spouse present. Conversely, 37 percent reported being unmarried or their spouse was absent. Ten percent are widowed. Many of these individuals probably live in some other cohabitation arrangement. Still, it raises a question about the number of people living alone. Within the context of community health care needs, people living alone face sometimes tremendous challenges should illness arise or injury occur. Most often, there are only informal support structures in place to assist such individuals in times of need.

Table 5. 2010 Estimated Population Age 15+ by Marital Status

Count PercentTotal, Never Married 393 17.0%Married, Spouse present 1,453 62.7%Married, Spouse absent 36 1.6%Widowed 246 10.6%Divorced 188 8.1%Males, Never Married 258 11.1% Previously Married 138 6.0%Females, Never Married 135 5.8% Previously Married 296 12.8%Claritas, Inc. (2010)

Table 6. 2010 Estimated Population Age 25+ by Educational AttainmentCount Percent

Less than 9th grade 119 6.0%Some High School, no diploma 97 4.9%High School Graduate (or GED) 695 34.8%Some College, no degree 552 27.7%Associate Degree 173 8.7%Bachelor's Degree 296 14.8%Master's Degree 34 1.7%Professional School Degree 27 1.4%Doctorate Degree 3 0.2%Claritas, Inc. (2010)

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The income and wealth resources of many Cheyenne County residents are relatively modest. Over 32 percent of households report an annual income of less than $25,000, and half of that group lives on less than $15,000 per year. As represented by housing values, the wealth resources of many individuals and households also is relatively modest. About 26 percent of the housing stock is valued at less than $40,000. The implications of such income and wealth characteristics in the context of increasing longevity and rising health care costs raises questions as to whether all who need it can afford health insurance and health care services.

Table 7. 2010 Estimated Households by Household Income

Count PercentIncome Less than $15,000 179 15.3%Income $15,000 - $24,999 194 16.8%Income $25,000 - $34,999 203 17.6%Income $35,000 - $49,999 252 21.9%Income $50,000 - $74,999 168 14.6%Income $75,000 - $99,999 70 6.1%Income $100,000 - $149,999 65 5.6%Income $150,000 - $199,999 10 0.9%Income $200,000 - $499,999 14 1.2%Income $500,000 or more 1 0.1%

Total Estimated Households 1,153 100.0%

Estimated Average Household Income $45,403Estimated Median Household Income $35,237Estimated Per Capita Income $19,700Claritas, Inc. (2010)

Table 8. 2010 Estimated All Owner-Occupied Housing Values Count Percent

Value Less than $20,000 78 8.9%Value $20,000 - $39,999 150 17.0%Value $40,000 - $59,999 153 17.4%Value $60,000 - $79,999 124 14.1%Value $80,000 - $99,999 98 11.1%Value $100,000 - $149,999 153 17.4%Value $150,000 - $199,999 55 6.2%Value $200,000 - $299,999 44 5.0%Value $300,000 - $399,999 6 0.7%Value $400,000 - $499,999 3 0.3%Value $500,000 - $749,999 2 0.2%Value $750,000 - $999,999 3 0.3%Value $1,000,000 or more 12 1.4%

Total 881 100.0%Claritas, Inc. (2010)

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Figure 4. Per Capita Income (2004$), 2000-2010

$15,000$17,500$20,000$22,500$25,000$27,500$30,000$32,500$35,000$37,500

2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010

Real

Dol

lars

Cheyenne County Kansas

Woods & Poole, Inc. (2010)

Figure 5. Government Transfer Payments as Percent of Personal Income (2004$), 2000-2010

5%10%15%20%25%30%35%40%

2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010

Shar

e of

Inco

me

Cheyenne Kansas

Woods & Poole, Inc. (2009) As with most rural areas, Cheyenne County is relatively more dependent on transfer income, such as retirement and disability insurance benefits, medical benefits, and income maintenance. That dependence is growing over time. These financial resources can be of enormous importance to those who receive them. From an economic perspective, these payments help support the local economy. Every person legitimately entitled to receive them, should have access to this assistance.


Table 9. Cheyenne County Personal Income by Major Source2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010

Total Earnings (Millions 2004$) 37.985 36.208 25.581 34.969 18.57 33.375 27.267 39.286 39.817 40.352 40.894 Farm Earnings 4.056 5.106 -3.308 5.653 -10.644 4.006 -2.145 9.201 9.241 9.281 9.321 Agricultural Services, Other 0.266 0.234 0.18 0.194 0.197 0.223 0.207 0.23 0.233 0.236 0.24 Mining 0.548 0.554 0.459 0.465 0.182 0.499 0.629 0.655 0.672 0.691 0.709 Construction 1.769 1.8 1.447 1.263 1.87 1.575 1.684 1.71 1.737 1.763 1.789 Manufacturing 0.892 0.908 0.777 0.838 0.509 0.629 0.664 0.664 0.664 0.663 0.662 Transport, Information & Public Utility 3.589 3.256 3.123 3.103 3.118 3.422 3.906 4.048 4.125 4.204 4.285 Wholesale Trade 5.069 4.465 4.069 3.983 4.018 3.88 2.942 2.988 3.033 3.079 3.124 Retail Trade 3.634 3.025 2.532 2.364 2.352 2.035 2.269 2.307 2.337 2.366 2.396 Finance, Insurance & Real Estate 1.804 1.502 1.229 1.174 1.275 1.456 1.37 1.348 1.383 1.419 1.456 Services 3.376 2.989 2.609 2.400 2.186 2.307 2.287 2.458 2.509 2.559 2.611 Federal Civilian Government 1.028 1.049 1.024 1.052 1.058 1.06 1.058 1.074 1.089 1.104 1.119 Federal Military Government 0.245 0.258 0.319 0.443 0.451 0.505 0.469 0.479 0.489 0.5 0.511 State and Local Government 6.735 6.646 6.797 7.259 7.036 6.549 6.561 6.646 6.731 6.816 6.902Personal Income (Millions 2004$) 74.542 73.629 61.29 68.113 46.27 60.404 55.911 65.762 66.139 66.708 67.411 Wages and Salaries 26.189 23.84 22.01 21.818 22.055 21.372 21.38 27.83 28.28 28.696 29.098 Other Labor Income 5.174 4.756 4.735 5.357 5.471 5.279 5.299 6.832 6.912 7.01 7.116 Proprietors Income 6.622 7.612 -1.164 7.794 -8.956 6.724 0.588 4.624 4.625 4.646 4.68 Dividends, Interest & Rent 22.743 22.846 20.507 18.136 13.194 12.305 12.77 11.956 11.608 11.445 11.403 Transfer Payments To Persons 16.744 17.298 17.664 17.704 17.216 17.324 18.56 18.621 18.907 19.196 19.489 Less Social Insurance Contributions 4.085 3.809 3.608 3.616 3.645 3.676 3.761 5.491 5.601 5.709 5.814 Residence Adjustment 1.155 1.086 1.146 0.92 0.935 1.076 1.075 1.39 1.408 1.424 1.439Woods and Poole, Inc. (2010)

Note: Historical employment, earnings, and income data 1969-2002, and total population data 1969-2003, are from the U.S. Dept of Commerce (USDoC); employment and earnings data by private non-farm SIC industry for 2001 and 2002 are estimated from private non-farm NAICA industry data.

8


Table 10. Personal Current Transfer Receipts for Cheyenne County(thousands of dollars) 2006 2007 2008 Personal current transfer receipts ($000) 20,366 21,301 22,494 Current transfer receipts of individuals from governments 19,993 20,856 22,030 Retirement and disability insurance benefits 9,487 9,867 9,831 Old-age, survivors, and disability insurance (OASDI) benefits 9,416 9,800 9,762 Railroad retirement and disability benefits (L) (L) (L) Workers' compensation (L) (L) (L) Other government retirement and disability insurance benefits \1 (L) (L) (L) Medical benefits 9,120 9,624 10,234 Medicare benefits 6,942 7,376 7,918 Public assistance medical care benefits \2 2,120 2,202 2,263 Military medical insurance benefits \3 58 (L) 53 Income maintenance benefits 648 581 807 Supplemental security income (SSI) benefits 75 0 193 Family assistance \4 (L) (L) (L) Food stamps 82 85 94 Other income maintenance benefits \5 468 472 496 Unemployment insurance compensation 329 354 467 State unemployment insurance compensation 328 353 466 Unemployment compensation for Fed. civilian employees (UCFE) (L) (L) (L) Unemployment compensation for railroad employees 0 0 0 Unemployment compensation for veterans (UCX) 0 0 0 Other unemployment compensation \6 0 0 0 Veterans benefits 280 296 319 Veterans pension and disability benefits 264 286 308 Veterans readjustment benefits \7 (L) (L) (L) Veterans life insurance benefits 0 0 0 Other assistance to veterans \8 0 0 0 Federal education and training assistance 125 127 147 Other transfer receipts of individuals from governments \10 (L) (L) 225 Current transfer receipts of nonprofit institutions 310 295 285 Receipts from the Federal government 104 101 103 Receipts from state and local governments \11 65 64 65 Receipts from businesses 141 130 117 Current transfer receipts of individuals from businesses \12 63 150 179Bureau of Economic Analysis (2010)

9


10

Notes for Table 10: 1. Consists largely of temporary disability payments and black lung payments.2. Consists of medicaid and other medical vendor payments.3. Consists of payments made under the TriCare Management Program (formerly called CHAMPUS) for the medical care of dependents of active duty military personnel and of retired military personnel and their dependents at nonmilitary medical facilities.4. Through 1995, consists of emergency assistance and aid to families with dependent children. For 1998 forward, consists of benefits-- generally known as temporary assistance for needy families-- provided under the Personal Responsibility and Work Opportunity Reconciliation Act of 1996. For 1996-97, consists of payments under all three of these programs.5. Consists largely of general assistance, refugee assistance, foster home care and adoption assistance, earned income tax credits, and energy assistance.6. Consists of trade readjustment allowance payments, Redwood Park benefit payments, public service employment benefit payments, and transitional benefit payments.7. Consists largely of veterans readjustment benefit payments, educational assistance to spouses and children of disabled or deceased veterans, payments to paraplegics, and payments for autos and conveyances for disabled veterans.8. Consists of State and local government payments to veterans.9. Consists largely of federal fellowship payments (National Science Foundation fellowships and traineeships, subsistence payments to State maritime academy cadets, and other federal fellowships), interest subsidy on higher education loans, basic educational opportunity grants, and Job Corps payments.10. Consists largely of Bureau of Indian Affairs payments, education exchange payments, Alaska Permanent Fund dividend payments, compensation of survivors of public safety officers, compensation of victims of crime, disaster relief payments, compensation for Japanese internment, and other special payments to individuals.11. Consists of State and local government educational assistance payments to nonprofit institutions, and other State and local government payments to nonprofit institutions.12. Consists largely of personal injury payments to individuals other than employees and other business transfer payments.• All state and local area dollar estimates are in current dollars (not adjusted for inflation).(L) Less than $50,000, but the estimates for this item are included in the totals.


Table 11. Employment by Major Industry for Cheyenne County

2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010Total Employment 1,893 1,868 1,815 1,855 1,874 1,834 1,812 1,823 1,832 1,844 1,856 Farm Employment 500 504 502 497 496 493 479 481 482 484 486 Agricultural Services, Other 10 11 12 12 12 11 10 10 10 10 10 Mining 8 9 9 9 6 9 11 11 11 11 11 Construction 47 51 50 47 49 58 58 58 59 59 60 Manufacturing 46 49 48 50 28 39 47 47 46 46 45 Transport, Information & Public Utility 82 82 86 78 86 86 95 97 97 99 99 Wholesale Trade 154 148 135 131 130 125 101 101 101 102 102 Retail Trade 176 169 154 158 175 161 173 174 175 176 178 Finance, Insurance & Real Estate 136 126 111 110 123 127 105 107 109 111 113 Services 216 220 217 242 252 241 249 252 256 259 263 Federal Civilian Government 23 23 22 25 23 23 23 23 23 23 23 Federal Military Government 15 14 14 14 13 14 14 14 14 14 14 State and Local Government 281 258 254 287 277 252 256 256 256 256 257Woods and Poole, Inc. (2010) Note: Employment in number of jobs includes proprietors and part-time jobs.

11


As with most rural areas, the way people in Cheyenne County earn a living is changing. While employment in traditional industries such as agriculture, extractive industries and manufacturing has been relatively stable, a greater proportion of people are earning a living working in service industries. Perhaps consistent with the overall population decline, employment in government also declined. Cheyenne County has been on par with the state average in terms of the percentage of population living in poverty.

Figure 7. Unemployment Rate for Cheyenne County and Kansas, 2000-2009

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Kansas Department of Labor (2010)

Figure 8. Percent of People in Poverty in Cheyenne County and Kansas, 2000-2008

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2001 2002 2003 2004 2005 2006 2007 2008

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Kansas Cheyenne County

Trend

U.S. Census Bureau (2009) This information was prepared by the Office of Local Government, K-State Research and Extension. For questions or other information, call 785-532-2643.

12


Health and Behavioral Data

Introduction


Health and Behavioral Data Summary Following are a variety of data and statistics about health and behavioral characteristics in Cheyenne County that may have implications for local health care needs. The data is reported by county.

- Over time, the trend in nursing home occupancy may suggest the need to evaluate the need for community-based services. - The trend in childhood immunization rates are declining. About 27 percent of fetuses had not had adequate prenatal care. - The rates of youth tobacco use and binge drinking are fairly steady at about 10-12 percent. - Data related to persons served by selected publicly-funded services suggest a number of individuals and families in the county are in need of economic assistance. - Recent trends in hospital usage suggest a fairly steady level of demand at the Cheyenne County Hospital.


ZIP codes within the Cheyenne County Health Market Area. Source: Claritas, Inc. 2011

1


The number of nursing home beds combines all licensed nursing home beds in Cheyenne County. Over time, occupancy has generally strengthened as the total number of beds decreased. This may reflect the broader trend of persons’ preference for community-based care outside of a nursing home. Table 1. Average Occupancy of Nursing Home Beds

2004 2005 2006 2007 2008 2009Average Number of Beds 102 102 51 51 50 50Average Occupancy Rate 94.5% 90.3% 91.0% 89.0% 93.7% 96.2%Kansas Department on Aging, semi-annual reports,Kansas Hospital Association STAT Report, 2010

Average Bed Occupancy Rate in Nursing Facilities

84%

86%

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98%

2001 2002 2003 2004 2005 2006 2007 2008 2009

Rate

TREND

2


Considering available indicators of children’s welfare, a relatively small population base can lead to large percentage changes that must be interpreted cautiously. While available data are limited, the trends related to children receiving necessary immunizations appear negative. About 15 percent of fetuses had not had adequate prenatal care. The rates of youth tobacco use and binge drinking are fairly steady at about 10-12 percent. Table 2. Indicators of Children's Welfare

Health Indicators 2004 2005 2006 2007 2008 2009 2010Cheyenne 85.7% 77.3% 82.8% 71.0% 59.0% - 59.0% KS 69.3% 57.9% 51.1% 58.0% 63.0% - 63.0%Cheyenne 68.0% 50.0% 37.5% 57.9% 85.7% - 85.7% KS 81.4% 79.1% 78.4% 77.4% 77.5% - 77.5%Cheyenne 3.8% 4.8% 11.8% 10.0% 9.1% - 9.1% KS 7.3% 7.2% 7.2% 7.1% 7.2% - 7.2%

Cheyenne 0 0 0 0 0 - 0.0%

KS 40.8 46 40.5 47.1 38.5 - 38.5%Cheyenne - - 9.3% 12.6% 11.2% 12.1% 11.5%

KS - - 14.9% 13.5% 13.0% 12.6% 12.7%Cheyenne - - 9.3% 13.9% 9.6% 10.1% 10.0%

KS - - 16.7% 15.6% 15.2% 14.7% 13.7%Cheyenne 1.6 3.2 0.0 1.9 2.0 - 2.0%

KS 1.7 1.6 1.7 1.9 1.5 - 1.5%Cheyenne 0.0 0.0 0.0 0.0 0.0 - 0.0%

KS 3.0 3.0 2.9 2.7 3.4 - 3.4%Kansas KIDSCOUNT, 2010

Prenatal Care

Low Birth Weight Babies

Teen Violent Deaths (per 100,000 15-19 year-olds)

Mental Health (per 1,000)

Trend Data

Immunizations

Youth Tobacco Use

Youth Binge Drinking

Asthma (per 1,000)

Table 3 contains information about persons served by state and federally-funded services. Across the service categories reported, most appear to have improved slightly. Still, when taken together, the numbers suggest a fairly high proportion of the local population experiencing economic distress. In particular, the need for food and family assistance has increased recently.

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4

Table 3. Persons Served by Selected Public Assistance Programs in Cheyenne County

FY 2008 FY 2009 FY 2010Major ServicesTemporary Assistance for Families Avg. monthly persons 12 14 17TANF Employment Services Avg. monthly adults 3 3 5Child Care Assistance Avg. monthly children 6 3 4Food Assistance Avg. monthly persons 78 81 113Energy Assistance Annual persons 93 76 90General Assistance Avg. monthly persons 2 2 0Vocational Rehabilitation Services Avg. monthly persons 21 16 11Family Preservation Annual persons 1 2 1Reintegration/Foster Care Avg. monthly children 4 4 4Adoption Support Avg. monthly children 11 10 2Home and Community Based ServicesPhysical Disability Annual consumers 7 7 6Traumatic Brain Injury Annual consumers 1 1 0Developmental Disability Annual consumers 2 2 3Autism Annual consumers 0 0 0Institutional ServicesIntermediate Care Facility (ICF-MR) Average daily census 0 0 0State Hospital - Developmental Disability Average daily census 0 0 0State Hospital - Mental Health Average daily census 0 0 0Nursing Facility - Mental Health Average daily census 0 0 0Kansas Department of Social and Rehabilitation Services, 2010

Persons Served

In considering the selected vital statistics in Table 4, among those that stand out are that about 27 percent of newborns received less than adequate prenatal care. even a single teenage pregnancy sets a young person on a difficult life path. And, about one-half of all marriages end in dissolution. In the recent past, usage of Cheyenne County Hospital appears to have remained relatively stable (Table 6). This is evident in the number of inpatient and outpatient visits and procedures. Both Medicare and Medicaid recipients appear to be an important component of the patient base.


Table 4. Selected Vital Statistics for Cheyenne County, 2009Total 10-14 15-19 20-24 25-29 30-34 35-39 40-44 45 & Over

Live Births by Age-Group of Mother 35 0 1 8 13 10 1 2 0

Adequacy of Prenatal Care 12 36.4% 12 36.4% 4 12.1% 5 15.2%Total 10-14 15-19 20-24 25-29 30-34 35-39 40-44 45 & Over

Out-of-Wedlock Births by Age 2 0 0 2 0 0 0 0 0

10-14 yrs. 15-19 yrs. 10-14 yrs. 15-19 yrs. 10-14 yrs. 15-19 yrs. 10-14 yrs. 15-19 yrs.Teenage Pregnancies 0 1 0 0 0 0 0 1

0-4 5-14 15-24 25-34 35-44 45-54 55-64 65-84 85 & OverDeaths by Age Group 1 0 0 1 0 1 4 22 23Marriages by Number and Rate per 1,000 Population 17 5.8 10 3.4 18 6.4 21 7.7 11 4.1Marriages Dissolutions by Number and Rate per 1,000 Population 5 1.7 9 3.1 5 1.8 8 2.9 14 5.2Kansas Department of Health and Environment, 2010

Adequate Plus Adequate Intermediate Inadequate

2005 2006

2006

Abortions

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Live Births

2007 2008 2009

200920082007

Stillbirths Total Pregnancies

5


Table 5. Hospital Data for Cheyenne County2006/2007 2007/2008 2008/2009

Number of Practicing Physicians 4 5 4Persons per Physician 689 546 675

Licensed Acute Beds 16 25 16Staffed Beds-Hospital 16 25 16Staffed Beds-Nursing Home Unit - - -Admissions-Hospital 284 344 318Admissions-Nursing Home Unit - - -Admissions-Swing Beds 123 70 109Inpatient Days - Hospital 827 1343 947Inpatient Days - Nursing Home Unit - - -Inpatient Days - Swing-beds 894 465 692

Emergency Room Visits 487 511Outpatient Visits 18,741 21567 20,064Inpatient Surgical Operations 16 21 12Outpatient Surgical Operations 148 187 170

Medicare Inpatient Discharges 336 265 310Medicare Inpatient Days 1,534 1164 1,332Medicaid Inpatient Discharges 7 14 18Medicaid Inpatient Days 68 25 43Kansas Hospital Association STAT Report, 2010Kansas Statistical Abstract,2009

This information was prepared by the Office of Local Government, K-State Research and Extension. For questions or other information, call 785-532-2643.

6


Education Data

Introduction Education Data Summary Following are a variety of data and statistics about the K-12 school system in Cheyenne County that may have implications related to local health care needs. The data in this case reflects information reported by the school districts located in Cheyenne County.


ZIP codes within the Cheyenne County Health Market Area.


- Total student enrollment in Cheyenne County K-12 school districts has steadily declined since the mid-1990s. - As the student population has declined, the student-to-teacher ratio also has declined. - The trend in the student dropout rate has generally been increasing in Cheyenne County over the past decade, but is due, in part, to the declining student population. - The trend in student-on-student violence has been increasing over time. Student-on-faculty violence has been trending up recently, but the number of incidents is generally small.

Source: Claritas, Inc. 2011.

1


Cheyenne County School Districts

Kansas Department of Education, 2011

Cheylin - USD 103St. Francis - USD 297

Total student enrollment in Cheyenne County K-12 school districts has steadily declined since the mid-1990s. Enrollment was 442 in the 2010-11 school year, down from 652 in 1998-99.

Figure 1. Total Enrollment for Cheyenne County, 1998-2011

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Kansas Department of Education (2011)

As the student population has declined, the student-to-teacher ratio also has declined. This generally means that as the school-age population has declined, the district has retained staffing. The ratio of about 10 students per teacher permits fairly close attention for each of the students.

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Figure 2. Student-Teacher Ratio for Cheyenne County

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Figure 3. Dropout Rates for Cheyenne County

0.00.10.20.30.40.50.60.70.80.91.0

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Kansas Department of Education (2011) The trend in the student dropout rate has generally been increasing in Cheyenne County over the past decade. This may be due, in part, to the declining enrollment.

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4

Violence in the school is extremely disruptive to learning. The trend in student-on-student violence has been decreasing over time. Student-on-faculty violence has been trending up recently.

Figure 4. Incidents of Student-on-Student Violence

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Figure 5. Incidents of Student-on-Faculty Violence

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Kansas Department of Education (2011) Prepared by the Office of Local Government, K-State Research and Extension. For questions or other information, call 785-532-2643.


Traffic Data

Introduction


Traffic Data Summary Following are a variety of data and statistics about traffic accidents in Cheyenne County. The data is reported by county.

Cheyenne County Primary Health - The rate of traffic accidents in Cheyenne County is lower than the rate for the state as a whole, unusual for a rural county. - Each year there are about 40 total vehicle crashes in Cheyenne County. The declining trend is positive, but must be considered in the context of declining population. - In 2008, the most recent year for which data were available, there were 16 accidents involving injury and two fatalities. - Among the reasons for injury and death is the failure to use seatbelts. In over 35 percent of the incidents involving injury or death, vehicle occupants were not using seatbelts.

Market Area


1


The rate of traffic accidents in Cheyenne County exceeds the rate for the state as a whole, with deer-vehicle collisions accounting for many of the accidents. Each year there are about 40 total vehicle crashes in Cheyenne County. The declining trend is positive, but must be considered in the context of declining population. In 2008, the most recent year for which data were available, there were 16 accidents involving injury and three fatalities. Among the reasons for injury and death is the failure to use seatbelts. In over 36 percent of the incidents involving injury or death, vehicle occupants were not using seatbelts.

Table 1. 2008 Traffic Accident Facts for Cheyenne County and Kansas

Accidents Cheyenne Kansas Cheyenne KansasTotal 43 65,858 15.9 23.4Fatal Accidents 3 348 1.1 0.1Injury Accidents 11 14,866 4.1 5.3Property Damage Only 29 50,644 10.7 18.0Deer Involved 9 9,371 3.3 3.3Speed Related 4 7,917 1.5 2.8Alcohol Related 3 3,366 1.1 1.2PeopleDeaths 4 385 1.5 0.1Injuries 16 21,058 5.9 7.5% Restraint Use 63.5% 80.8%Kansas Traff ic Accident Facts, 2009

Rate per 1,000 Population

Figure 1. Total Accidents in Cheyenne County,2000-2008

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Kansas Department of Transportation, 2009

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Figure 2. Injury Accidents in Cheyenne County,2000-2008

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Figure 3. Fatal Accidents in Cheyenne County,2000-2008

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Figure 4. Property Damage Only Accidents in Cheyenne County, 2000-2008

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Figure 5. Other Crashes in Cheyenne County,2000-2008

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Deer Involved Speed Related Alcohol Related




Crime Data

Introduction Crime Data Summary Following are a variety of data and statistics about criminal activity in Cheyenne County that may have implications related to local health care needs. Most of the data only is available at a county scale and reflects the Cheyenne County boundaries.


ZIP codes within the Cheyenne County Health Market Area.


- The incidence of crime in Cheyenne County has is about one-third of the state rate over the past decade. - Property crime decreased slightly and violent crime increased slightly in 2009 from 2008. - The number of both adult and juvenile arrests has been trending up sine 2007. - The number of full-time law enforcement officials per 1,000 population in Cheyenne County has been consistently below the state rate.

Source: Claritas, Inc. 2011.

1


The incidence of crime in Cheyenne County has been only one-third of the state average over the past decade. The incidence of property crime decreased slightly in 2009 from 2008, but the incidence of violent crime was up slightly. Table 1. Crime Statistics Cheyenne County and Kansas

Number Rate per 1,000 Number Rate per 1,000 Number Rate per 1,000Cheyenne 30 10.8 2 0.7 28 10.1Kansas 93,996 37.5 10,032 4.0 83,964 33.5

Number Rate per 1,000 Number Rate per 1,000 Number Rate per 1,000Cheyenne 30 10.8 4 1.4 26 9.4Kansas 98,757 35.6 11,099 4.0 87,658 31.6Kansas Statistical Abstract, 2009

2009Crime Index Offenses Violent Crime Property Crime

Crime Index Offenses Violent Crime Property Crime2008

Index crimes include violent crimes (murder, rape, robbery, and aggravated assault/battery) plus property crime (burglary, theft, and motor vehicle theft).

Figure 1. Crime Index Offenses for Cheyenne County and Kansas

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Incomplete data for one or more years. Index crimes include violent crimes (murder, rape, robbery, and aggravated assault/battery) plus property crime (burglary, theft, and motor vehicle theft).

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The index crime arrest trend is similar to the incident rate. The number of adult and juvenile arrests had been increasing in recent years.

Figure 2. Crime Index Arrests for Cheyenne County and Kansas

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Figure 3. Number of Adult and Juvenile Arrests in Cheyenne County, 2005-2009

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Kansas Statistical Abstract, 2009 Incomplete data for one or more years.

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The number of full-time law enforcement officials per 1,000 population in Cheyenne County has been consistently below the state rate.

Figure 4. Number of Law Enforcement Officials per 1,000 Population

0.00.51.01.52.02.53.03.54.04.5

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Kansas Statistical Abstract, 2009



Cheyenne County Telephone Survey Results Kansas Rural Health Options Project

June 2011 Emily Mollohan, Research AssistantEmily Mashie, Research AssistantJohn Leatherman, Director

Funding for this report provided by: Offfice of Rural Health PolicyHealth Resources and Services Administration (Grant #5 H54RH00009-03)

Introduction In an effort to provide useful information resources to rural community and health care leaders, the Kansas Rural Health Options Project (KRHOP) has teamed with the Office of Local Government, a unit of the Department of Agricultural Economics and K-State Research and Extension, to develop this report as a component of the Kansas Rural Health Works program. KRHOP is a partnership of the Bureau of Local and Rural Health at the Kansas Department of Health and Environment, the Kansas Hospital Association, the Kansas Board of Emergency Medical Services and the Kansas Medical Society. Kansas Rural Health Works is supported by a federal grant to KRHOP (No. 5 H54 RH 00009-03) from the Health Resources and Services Administration, Office of Rural Health Policy. The purpose of this report is to share the results of a county telephone survey. The purpose of the survey was to better understand local residents health-related needs and behaviors, and to gauge community perceptions relating to health-related issues. The questions included in the survey were devised and approved by the Cheyenne County Rural Health Works Steering Committee

Cheyenne County Health Market Area The Cheyenne County Health Market Area was defined by the county boundaries. A random sample of land-line telephone numbers from the St. Francis (67756) and Bird City (67731) were contacted. All survey respondents were asked to verify they lived in Cheyenne County by reporting their residential zip code. The resulting distribution by zip code is shown below.

Geographic Distribution of Survey Respondents

Zip Code City Frequency Percent67756 St. Francis 171 80.7%67731 Bird City 41 19.3%

Total 212 100.0%

Survey Results The survey research unit of the Docking Institute, Ft. Hays State University, conducted the random telephone survey between May 31 and June 8, 2011. They collected 212 completed surveys. The cooperation rate was 74%. In addition, 172 other respondents agreed to complete the survey, but were in an age demographic that had already been fulfilled. If these additional respondents are counted, the cooperation rate would have been 83%. All but three of the respondents had lived in the county for more than one year.

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Demographics Across the demographic categories for which data were collected (Table Q1b and Table Q26), the survey respondents were generally representative of the population in some respects but not all. In most surveys of rural residents, responses typically skew toward the older population. For this survey, an effort was made to achieve representativeness across age categories. However, people in the youngest age category, 18-34, remained elusive. In emphasizing age, a roughly representative distribution was obtained (Q1b), but an unintended consequence was to over-sample female respondents (Q26). Health Care Provider Usage Regarding patterns of health care provider usage (Q2-Q4), the majority of respondents (63%) use a Primary Care Physician. Another 22% see a Physician's Assistant. Only 2% regularly use a Nurse Practitioner. Five percent of respondents reported they don’t see anyone for health care needs. About 82% of respondents have seen their primary health care provider within the past year. Two percent of respondents have not seen a doctor in the past five years. About 82% of all respondents go to a Cheyenne County-based primary care provider. The most frequent alternatives are Wray, CO (6%) and Goodland (4%). Extrapolating these rates to the entire adult population (2,259), we estimate that Cheyenne County providers are capturing 1,858 of adult visits for adult routine health care. About 401 potential adult patients are receiving their primary health care services outside of Cheyenne County. If childrens' physician usage mirrors adult usage and we extrapolate to the total county population (2,734), this would suggest 492 patients receive out-of-county services. The vast majority of respondents (99%) were satisfied with the services received from a St. Francis-based provider. General Hospital Usage A series of questions inquired about hospital usage in the past 12 months (Q5-Q6). Sixty-one percent of respondents said that they or another household member had used inpatient or outpatient hospital services within the recent past. Of those, 61% of all respondents used the Cheyenne County Hospital for services. The most frequent alternative destinations were the Goodland Regional Medical Center (8%), the Hays Medical Center (6%), or any Denver hospital (6%). The reasons cited for hospital preference varied, and included distance from home (18%), personal preference (17%), specialty services (15%), emergency (14%), family reasons (13%), and doctor referral (12%). Cheyenne County Hospital Usage and Perceptions Questions 7-8 focused on use and perceptions of the Cheyenne County Hospital. Ninety-two percent of respondents in the overall sample had prior experience with the facility. Most recently, they received outpatient treatment (58%), emergency (24%) or inpatient (13%) services. Ninety percent of those who had experience with the hospital were either satisfied or somewhat satisfied with the services received. About ten percent indicated a level of dissatisfaction for some reason.

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Bird City Clinic Usage and Perceptions Question 9 inquired about usage of the Bird City Clinic. Thirty-two percent of respondents had prior experience using the clinic. Of those, 94% indicated satisfaction with their experience. When asked whether current office hours at the clinic were adequate to meet their needs, 78% said yes, 12% said no, and 10% were unsure. Usage and Satisfaction of Other Health-Related Services Question 10 queried respondents about their use of Cheyenne County health service providers and their satisfaction with the services received. After first being asked where they most often obtain service, anyone identifying a Cheyenne County provider was also asked how satisfied they were with the service received. If the respondent indicated they used a non-local provider, they were asked if they had ever had experience with the local provider. Of the 212 respondents, the most frequently used services included pharmacy (75%), dentist (75%), chiropractor (60%), and physical therapy (43%). Respondents also were asked about their usage of services of an eye doctor. Only 6% indicated they did not need such service. Again, extrapolating to the entire adult population of the county, this would suggest there are 2,123 potential adult patients in Cheyenne County. If, as with other health service providers, the capture rate were 75%, this would potentially yield 1,592 adult patients. We can extrapolate the service capture and leakages by applying the total or adult population that used a local or non-local service provider. For those who did use Cheyenne County-based service providers, there was almost universal satisfaction with the services received. Among other service providers (Q10i), 54% of the sample had experience with the county health department and were overwhelmingly satisfied with the services received. Similar levels of satisfaction were reported by those who used ambulance service. Assisted living and long-term care services also provided a high degree of satisfaction. Transportation Assistance Respondents were asked several questions about the need for transportation assistance (Q11). Some 8% of respondents indicated that they must regularly travel outside of Cheyenne County for medical treatment. Approximately 12% percent of respondents indicated that transportation to medical appointments either within or outside of Cheyenne County represented a challenge (Q11a). We know that there are an estimated 1,238 households in the county. This would suggest that about 146 households had transportation challenges going to regular medical appointments. Community Wellness Center Questions 12a -12c asked about a community wellness center. After indicating that a full-service wellness and fitness center providing unlimited access to a range of fitness services did not currently exist in the county, respondents were asked whether the need for such a facility existed. Seventy-two percent of those responding indicated the need for such a center existed. Further, all respondents were asked whether such a center should include an indoor pool. Sixty-four percent indicated that it should include an

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indoor pool. When asked if such a center existed, whether someone from their household use it, 75% indicated they would. Finally, of those who would use a fitness center, 94% indicated they would be willing to pay a fee for access. Appendix 1 contains several tables showing the responses to these questions broken apart by demographic characteristics. The detail provided may provide insight into whether any differences of opinion exist across any age groups, gender, or income categories. Caution is needed when interpreting the results, however. The survey findings are general only across the entire sample. When breaking the responses into subgroups, the total number needed to extrapolate to the larger classes of age, gender, or income (200 responses) is insufficient. Health Service Needs Several questions inquired about survey participants perception of local health service needs. When asked about the need for a local eye doctor (Q13), 75% indicated the need for such a provider existed. When asked whether the hospital should offer maternity services (Q14), 89% believed it should. Finally, when asked whether they believed there was a need for an inpatient treatment facility for the elderly suffering from psychiatric disorders such as Alzheimer's Disease (Q15), 77% of respondents agreed. Adequacy of Services for Retirees Eighty-six percent of respondents indicated that it was their general intent to remain in Cheyenne County throughout retirement (Q16). When asked whether they believed health services in the county were adequate to sustain the needs of the elderly, 71% agreed while 25% disagreed. Additional detail broken out by demographic category is provided in Appendix 1. Caution is needed, however, when interpreting these results. Nursing Care Facilities A significant issue under active community consideration is the future the Good Samaritan Society - St. Francis Village nursing care facility. Since being destroyed by fire in October, 2010, the facility was rebuilt to a lesser capacity than previously existed. The Good Samaritan Society would now like to transfer ownership of the facility to Cheyenne County. Questions 17-20 report respondents' views on several related questions. When asked whether there was need for assisted living apartments at the facility, 88% of respondents agreed. Of those perceiving the need for assisted living apartments, 86% thought they should be added even if it required partial funding with taxes. To the extent these responses represent the general views of county residents, we would calculate that 76% of all adults in Cheyenne County would be willing to see public resources invested in adding assisted living facilities to St. Francis Village. This conclusion should be tempered, however, by realization that survey respondents are not necessarily motivated voters, and that even small changes in the wording of a question might elicit very different results. As a follow up to the assisted living question, respondents were asked whether single occupancy, private pay, skilled nursing rooms should be added to the facility. Sixty-eight percent of respondents agreed. Of those who agreed, 79% indicated they would support

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public investment to see such facilities added. This represents 54% of the adult population of Cheyenne County. Regarding the question of potential county takeover of the facility, survey participants were given the following information: " As you probably know, the local nursing home is owned by a non-profit organization, Good Samaritan Society of Sioux Falls, South Dakota. This facility is only a double occupancy, skilled nursing home with independent living apartments on site. This property is not for sale by the owner. Since the fire in October 2010, the nursing facility has been partially restored to accommodate fewer residents. The Good Samaritan Society wants to transfer ownership of the facility to the county. If the county takes ownership the facility, a tax subsidy may be required to sustain operations at this reduced capacity." Respondents were then asked, " To keep the existing facility operating, would you approve of the county assuming ownership of the facility, even if it would mean being partially funded by taxes?" Seventy-five percent answered affirmatively while 16% disagreed. Regarding public investment in expanded facilities, participants were first told: "Prior to the fire, the Good Samaritan Society had identified a need for single occupancy private pay skilled nursing rooms and assisted living apartments. These units are not dependent on governmental reimbursement sources, but are desired by individuals who are capable of paying cash. Adding these rooms would improve the financial performance of the Long Term Care Facility significantly, and provide a full range of assisted living options for the elderly in Cheyenne County including independent living apartments, assisted living apartments, double occupancy skilled nursing rooms and single occupancy private pay skilled nursing rooms. If after studying the county’s long term care needs it is determined that expanding the facility by adding private pay single occupancy skilled nursing rooms and assisted living apartments to the existing nursing home would make the facility more self sufficient in the long-term, would you approve of the county making such additions, even if it would mean being partially funded by taxes?" Seventy-eight percent of respondents agreed and 15% disagreed. Additional detail regarding these questions are shown in Appendix 1, but caution must be applied when interpreting these results. Use of the Internet Seventy-five percent of survey respondents indicated that they used the Internet (Q21). With appropriate caution about extrapolating small numbers, only about nine percent in the youngest demographic group did not use the Internet, and about 40% in the oldest demographic did. As seen in the demographic breakout, there is a significant income effect on Internet usage. Among those who did use the Internet, 74% said they had used it previously to find health-related information. Only 10% had previously used it to find locally-available health-related information or service providers. However, 84% were somewhat or very confident that if they needed local information they would be able to find it.

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Concluding Observations The survey of Cheyenne County area residents provides insight into the health-related needs and behaviors of local residents. It highlights the challenges of local healthcare providers by showing the level of service leakage. It also suggests that if residents can be persuaded to try local providers, they are likely to get a highly satisfactory level of service. Many of the inquiries into the level of distress experienced by local households suggests only smaller proportions of the citizenry are experiencing problems with such things as transportation challenges. Two points are germane here. First, small percentages extrapolated to the larger community translate into fairly high numbers of households experiencing distress. The second point that must be acknowledged are the challenges reaching the youngest age demographic, the most likely group to go without healthcare service. Regarding the central questions of public investment in new and expanded facilities, there appears to be general public support for a new wellness/fitness center and the public takeover and expansion of nursing care facilities. These results, however, should not be taken as a public mandate. Any future action should require additional study and public discussion. Still, our objective has been to provide insight into the health-related wants and needs of area residents. To the extent this can be translated into constructive action to strengthen local healthcare providers and enhance access to needed services, is a question left to the community to ponder.

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Q1. Could you please tell me your zip code?

Zip Code City Frequency Percent67756 St. Francis 171 80.7%67731 Bird City 41 19.3%

Total 212 100.0%

Q1b. What age group are you in?

Response Frequency Percent Population Percent18-24 6 2.8% 187 8.0%25-34 19 9.0% 204 9.0%35-44 20 9.4% 277 12.0%45-54 52 24.5% 479 21.0%55-64 57 26.9% 382 17.0%65-74 25 11.8% 289 13.0%75+ 33 15.6% 441 20.0%Total 212 100.0% 2,259 100.0%

Survey Census

Q2. Which of the following medical professionals do you use for most of your routine health care?

Response Frequency PercentPrimary Care Physician 133 62.7%Nurse Practitioner 4 1.9%Physician's Assistant 47 22.2%None, don't see anyone 10 4.7%Other 16 7.5%Don't know 2 0.9%Refused 0 0.0%Total 212 100.0%

Q2a. What other medical professional was identified?

Response Frequency PercentDoctor 9 56.3%Chiropractor 3 18.8%Whoever is available 4 25.0%Total 16 100.0%

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Q3. When is the last time you saw your doctor for routine health care?

Response Frequency PercentLess than 1 year ago 165 82.5%Between 1 and 2 years ago 21 10.5%Between 2 and 5 years ago 5 2.5%More than 5 years ago 4 2.0%Never - doesn’t have a doctor 3 1.5%Don't know 2 1.0%Total 200 100.0%

Q4. What city do you go to the most when you see your doctor?

Response Frequency PercentSt. Francis 151 76.6%Bird City 11 5.6%Goodland 8 4.1%Colby 5 2.5%Atwood 0 0.0%Wray, CO 11 5.6%Burlington, CO 0 0.0%Benkelman, NE 5 2.5%Don't need service 0 0.0%Other 6 3.0%Don't know 0 0.0%Refused 0 0.0%Total 197 100.0%

Q4a. What other city was provided?

Response Frequency PercentFort Collins, CO 1 17%Grand Island, NE 1 17%Sharon Springs, KS 1 17%Hays, KS 1 17%McCook, NE 1 17%Denver, CO 1 17%Total 6 100%

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Q4b. How would you describe your satisfaction with the quality of care provided by your doctor? Are you...

Response Frequency PercentSatisfied 147 90.7%Somewhat Satisfied 13 8.0%Somewhat Dissatisfied 2 1.2%Dissatisfied 0 0.0%Total 162 100.0%

Q5. Have you or any members of your household used the inpatient or outpatient services of a hospital in the last 12 months?

Response Frequency PercentYes 130 61.3%No 82 38.7%Total 212 100.0%

Q5b. What hospital or hospitals were used by you or other members of your household in the last 12 months?

Hospital Frequency PercentCheyenne County Hospital, St. Francis 110 61.1%Goodland Regional Medical Center, Goodland 14 7.8%Citizens Medical Center, Colby 7 3.9%Rawlins County Health Center, Atwood 1 0.6%Decatur County Hospital, Oberlin 0 0.0%Wray Community District Hospital, Wray, CO 5 2.8%Dundy County Hospital, Benkelman, NE 4 2.2%Kit Carson County Memorial Hospital, Burlington, CO 0 0.0%Veteran's Administration (VA) 1 0.6%Hays Medical Center 10 5.6%Any Denver Hospital 10 5.6%Other 18 10.0%Total 180 100.0%

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Q5c. What other hospital did you use?

Response Frequency PercentNorth Platte, NE 1 5.3%Prebetarian St. Lukes, Denver, CO 2 10.5%Salina Regional Medical Center 2 10.5%KU Med Center 1 5.3%St. Joseph's, Denver, CO 1 5.3%Greeley Hospital 2 10.5%Aurora Med Center, Aurora, CO 1 5.3%Ogallala Med Center, Ogallala, NE 1 5.3%University of Colorado Hospital Medical Center 1 5.3%Community Hospital in Nebraska 1 5.3%North Platte General Hospital, North Platte, NE 1 5.3%Burn Center, Greeley, CO 1 5.3%MD Anderson, Houston, TX 1 5.3%Hays Cardiac 1 5.3%Northeast Colorado Medical Center 1 5.3%East Morgan County Hospital 1 5.3%Total 19 100%

Q6a-i. Why did you or other members of your family choose a hospital in the past 12 months? Was it...

Response Frequency PercentInsurance coverage 8 1.5%Doctor referral 64 11.7%Specialty services 81 14.8%Recommended by a friend 30 5.5%Personal preference 95 17.4%Distance from home 101 18.5%Family lives close by 73 13.3%Emergency 78 14.3%Other 17 3.1%Total 547 100.0%

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Q6j. What were other reasons you or your family members chose a hospital in the past 12 months?

Response Frequency PercentRural area hard to travel not much of a choice 1 6%Personal history is over 30 years long in hospital 1 6%Surgeon was traveling 1 6%Referrals 1 6%Quality of care 1 6%Doctors 1 6%Required because of specialists 1 6%Prefer doctors in goodland 1 6%Specialty such as eye doctor 1 6%Employed by hospital, don't care for St. Francis 1 6%Avoid doctor in St. Francis 1 6%Service 1 6%Sent by hospital 1 6%Cost 1 6%They offer great care 1 6%Preferred physician 1 6%Wanted to see a specific doctor, followed him to out of county 1 6%Total 17 100%

Q7. Have you (or any member of your household) EVER used the services of the Cheyenne County Hospital?


Q8a. What type of service was obtained at your last visit to Cheyenne County hospital?

Response Frequency PercentInpatient 37 17.3%Outpatient 125 58.4%Emergency 52 24.3%Total 214 100.0%

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Q8b. How would you describe your satisfaction with your last Cheyenne County Hospital experience? Were you…


Q9. Have you or other members of your household EVER used the services of the Bird City Clinic?


Q9a. How would you describe your satisfaction with your last Bird City Clinic experience? Were you...

Response Frequency PercentSatisfied 58 84.1%Somewhat Satisfied 7 10.1%Somewhat Dissatisfied 1 1.4%Dissatisfied 1 1.4%Don't know 2 2.9%Total 69 100.0%

Q9b. Are the office hours at the Bird City Clinic adequate to meet your needs?

Response Frequency PercentYes 54 78.3%No 8 11.6%Don’t know 7 10.1%Total 69 100.0%

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Q10a1. In what city do you or other members of your household go to the dentist?

Response Frequency PercentSt. Francis 158 74.5%Goodland 9 4.2%Colby 2 0.9%Atwood 3 1.4%Wray, CO 2 0.9%Burlington, CO 0 0.0%Benkelman, NE 12 5.7%Don't need service 14 6.6%Other 10 4.7%Don't know 2 0.9%Total 212 100.0%

Q10a2. If a St. Francis dentist, regarding this service, were you...


Q10a3. If a non-local dentist, have you ever tried the services of a St. Francis dentist?


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Q10b1. In what city do you or other members of your household go to the pharmacy?

Response Frequency PercentSt. Francis 159 75.0%Goodland 24 11.3%Colby 2 0.9%Atwood 1 0.5%Wray, CO 2 0.9%Burlington, CO 0 0.0%Benkelman, NE 11 5.2%Veteran's Administration (VA) 7 3.3%Mail Order 1 0.5%Importation 0 0.0%Don't need service 3 1.4%Other 2 0.9%Don't know 0 0.0%Refused 0 0.0%Total 212 100.0%

Q10b2. If a St. Francis pharmacy, regarding this service, were you...


Q10b3. If a non-local pharmacy, have you ever tried the services of a St. Francis pharmacy?


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Q10c1. In what city do you or other members of your household go to the chiropractor?

Response Frequency PercentSt. Francis 127 59.9%Goodland 2 0.9%Colby 7 3.3%Atwood 2 0.9%Wray, CO 0 0.0%Burlington, CO 1 0Benkelman,

.5%N 0 0

Don't need se 71 33.5%Other 1 0.5%Don't know 1 0.5%Refused 0 0.0%Total 212 100.0%

.0%

Q10c2. If a St. Francis chiropractor, regarding this service, were you...


Q10c3. If a non-local chiropractor, have you ever tried the services of a St. Francis chiropractor?


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Q10d1. In what city do you or other members of your household go to the eye doctor?

Response Frequency PercentSt. Francis 5 2.4%Goodland 71 33.5%Colby 19 9.0%Atwood 1 0.5%Wray, CO 1 0.5%Burlington, CO 1 0.5%Benkelman, NE 62 29.2%Don't need service 12 5.7%Other 39 18.4%Don't know 1 0.5%Refused 0 0.0%Total 212 100.0%

Q10d2. If a St. Francis eye doctor, regarding this service, were you...


Q10e1. In what city do you or other members of your household go to for physical therapy services?


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Q10e2. If St. Francis physical therapist, regarding this service, were you...


Q10e3. If a non-local physical therapist, have you ever tried the services of a St. Francis physical therapist?


Q10f1. In what city do you or other members of your household go to for home healthcare services?


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Q10f2. If St. Francis home healthcare, regarding this service, were you...


Q10f3. If non-local home healthcare, have you ever tried the services of a St. Francis Home Healthcare provider?


Q10g1. In what city do you or other members of your household go to for massage therapy services?


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Q10g2. If St. Francis massage therapist, regarding this service, were you...


Q10g3. If non-local massage therapist, have you ever tried the services of a St. Francis massage therapist?


Q10h1. In what city do you or other members of your household go to for counseling services?


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Q10h2. If St. Francis-based counseling, regarding this service, were you...


Q10h3. If non-local counseling, have you ever tried the services of a St. Francis counseling service?


Q10i1. Have you or any other members of your household ever used the county health department services in Cheyenne County?

Response Frequency PercentYes 114 53.8%No 92 43.4%Don't Know 6 2.8%Total 212 100.0%

Q10i2. Regarding this service, were you...


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Q10j1. Have you or any other members of your household or your immediate family ever used ambulance services in Cheyenne County?

Response Frequency PercentYes 90 42.5%No 120 56.6%Don't know 2 0.9%Total 212 100.0%

Q10j2. Regarding this service, were you...


Q10k1. Has anyone in your family ever used nursing home services in St. Francis?


Q10k2. Regarding this service, were you...


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Q11. Do you or other members of your household travel outside of Cheyenne County for regular medical treatment one or more times per month?


Q11a. Is transportation to regular medical appointments either inside or outside the county a challenge for you or other members of your household?


Q12. (1) Currently, a full service wellness and fitness center providing unlimited access to a wide variety of fitness services to the ENTIRE community does not exist in Cheyenne County. Do you believe there is a need for a community wellness center in Cheyenne County that has exercise classes and equipment and offers educational and wellness programs?


Q12a. (1) If a community wellness center existed in Cheyenne County do you think it should include an indoor pool?


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Q12b. If a community wellness center existed in Cheyenne County, do you think you (or another member of your household) would use it?


Q12c. If yes above, if a community wellness center existed in Cheyenne County, would you or the household member be willing to pay a fee to use it?


Q13. Do you believe there is a need for an eye doctor in Cheyenne County?


Q14. Do you believe the Cheyenne County Hospital should offer maternity services?

Response Frequency PercentYes 188 88.7%No 11 5.2%Don't know 12 5.7%Refused 1 0.5%Total 212 100.0%

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Q15. Do you believe there is a need for an inpatient treatment facility in Cheyenne County for the elderly who suffer psychiatric problems such as Alzheimer's Disease?


Q16. (1) Is it your general intention to live in Cheyenne County throughout retirement?


Q16a. In general, do you believe Cheyenne County health services are adequate to sustain the needs of Cheyenne County retirees?


Q17. (1) Now I’m going to ask some questions regarding the nursing home in Cheyenne County. Currently there are no assisted living apartments in the county. Do you see a need for assisted living apartments to be part of the current nursing home?


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Q17a. (1) Do you believe that such a facility should be added to the existing nursing home, even if it would mean being partially funded by taxes?


Q18. (1) Currently there are no single occupancy, private pay, skilled nursing rooms in Cheyenne County. Do you see a need for single occupancy, private pay, skilled nursing rooms to be part of the current nursing home?


Q18a. (1) Do you believe that such a facility should be added to the existing nursing home, even if it would mean being partially funded by taxes?


Q19. (1) As you probably know, the local nursing home is owned by a non-profit organization, Good Samaritan Society of Sioux Falls, South Dakota. This facility is only a double occupancy, skilled nursing home with independent living apartments on site. This property is not for sale by the owner. Since the fire in October 2010, the nursing facility has been partially restored to accommodate fewer residents. The Good Samaritan Society wants to transfer ownership of the facility to the county. If the county takes ownership the facility, a tax subsidy may be required to sustain operations at this reduced capacity.

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To keep the existing facility operating, would you approve of the county assuming ownership of the facility, even if it would mean being partially funded by taxes?


Q20. (1) Prior to the fire, the Good Samaritan Society had identified a need for single occupancy private pay skilled nursing rooms and assisted living apartments. These units are not dependent on governmental reimbursement sources, but are desired by individuals who are capable of paying cash. Adding these rooms would improve the financial performance of the Long Term Care Facility significantly, and provide a full range of assisted living options for the elderly in Cheyenne County including independent living apartments, assisted living apartments, double occupancy skilled nursing rooms and single occupancy private pay skilled nursing rooms. If after studying the county’s long term care needs it is determined that expanding the facility by adding private pay single occupancy skilled nursing rooms and assisted living apartments to the existing nursing home would make the facility more self sufficient in the long-term, Would you approve of the county making such additions, even if it would mean being partially funded by taxes?


Q21. (1) Do you use the internet?


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Q21a. (1) Have you used the internet to find health-related information?


Q21b. (1) Have you used the internet to find Cheyenne County health

services information or providers?


Q21c. (1) In general, how confident are you that you can find local health-related information on the internet?

Response Frequency PercentVery confident 68 42.8%Somewhat confident 65 40.9%Not confident at all 13 8.2%Don't know 13 8.2%Total 159 100.0%

Q22. Have you lived in Cheyenne County for more than one year?


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Q23. How many people reside in your household?

Response Frequency Percent1 41 19.3%2 105 49.5%3 24 11.3%4 22 10.4%5 146 1 0.5%7 3 1.4%8 0 0.0%9 1 0.5%10 1 0.5%Total 212 100.0%

6.6%

Q24. How many children under the age of 18 living in your home?

Response Frequency Percent0 106 62.0%1 32 18.7%2 19 11.1%3 8 4.7%4 2 1.2%5 2 1.2%6 0 0.0%7 2 1.2%Total 171 100.0%

Q24a. How many children under the age of 13 living in your home?

Response Frequency Percent0 28 43.1%1 16 24.6%2 9 13.8%3 8 12.3%4 0 0.0%5 4 6.2%Total 65 100.0%

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Q24b. How many adult caregivers are in the home?

Response Frequency Percent0 0 0.0%1 10 15.4%2 53 81.5%3 1 1.5%4 1 1.5%Total 65 100.0%

Q25. What was your total family income for the last year?

Response Frequency PercentLess than $10,000 7 3.3%Between $10,000 and $20,000 24 11.3%Between $20,000 and $30,000 20 9.4%Between $30,000 and $40,000 27 12.7%Between $40,000 and $50,000 27 12.7%Between $50,000 and $60,000 26 12.3%Between $60,000 and $70,000 20 9.4%Between $70,000 and $80,000 15 7.1%Over $80,000 24 11.3%Don't know 10 4.7%Refused 12 5.7%Total 212 100.0%

Q26. What was the gender of the person being interviewed?

Response Frequency PercentFemale 143 67.5%Male 69 32.5%Total 212 100.0%

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Appendix 1

Selected Questions Disaggregated by Demographic Characteristics

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Note, when disaggregating the total results, we can no longer generalize to the entire subgroup due to having fallen below a threshold of 200

responses for any given subgroup.

Q12. (2) Do you believe there is a need for a community wellness center in Cheyenne County that has exercise classes and equipment and offers educational and wellness programs? (By age)

Response Yes Percent No Percent Don't Know Percent Total18-44 32 71.1% 11 24.4% 2 4.4% 4545-64 86 78.9% 15 13.8% 8 7.3% 10965+ 34 58.6% 12 20.7% 12 20.7% 58Total 152 72% 38 18% 22 10% 212

Use caution when interpreting results from subgroups of the survey sample.

Q12. (3) Do you believe there is a need for a community wellness center in Cheyenne County that has exercise classes and equipment and offers educational and wellness programs? (By gender)

Response Yes Percent No Percent Don't Know Percent TotalFemale 108 75.5% 20 14.0% 15 10.5% 143Male 44 63.8% 18 26.1% 7 10.1% 69Total 152 71.7% 38 17.9% 22 10.4% 212


Q12. (4) Do you believe there is a need for a community wellness center in Cheyenne County that has exercise classes and equipment and offers educational and wellness programs? (By income)

Response Yes Percent No Percent Don't Know Percent TotalUnder $40,000 55 70.5% 13 16.7% 10 12.8% 78Over $40,000 82 73.2% 21 18.8% 9 8.0% 112Total 137 72.1% 34 17.9% 19 10.0% 190


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Q12a. (2) If a community wellness center existed in Cheyenne County do you think it should include an indoor pool? (By age)

Response Yes Percent No Percent Don't Know Percent Total18-44 33 73.3% 9 20.0% 3 6.7% 4545-64 76 69.7% 26 23.9% 7 6.4% 10965+ 26 44.8% 23 39.7% 9 15.5% 58Total 135 63.7% 58 27.4% 19 9.0% 212


Q12a. (3) If a community wellness center existed in Cheyenne County do you think it should include an indoor pool? (By gender)



Q12a. (4) If a community wellness center existed in Cheyenne County do you think it should include an indoor pool? (By income) Response Yes Percent No Percent Don't Know Percent TotalUnder $40,000 46 59.0% 22 28.2% 10 12.8% 78Over $40,000 77 68.8% 29 25.9% 6 5.4% 112Total 123 64.7% 51 26.8% 16 8.4% 190


Q16. (2) Is it your general intention to live in Cheyenne County throughout retirement? (By age)



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Q16. (3) Is it your general intention to live in Cheyenne County throughout retirement? (By gender)



Q16. (4) Is it your general intention to live in Cheyenne County throughout retirement? (By income)



Q17. (2) Do you see a need for assisted living apartments to be part of the current nursing home? (By age)



Q17. (3) Do you see a need for assisted living apartments to be part of the current nursing home? (By gender)



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Q17. (4) Do you see a need for assisted living apartments to be part of the current nursing home? (By income)



Q17a. (2) Do you believe that such a facility should be added to the existing nursing home, even if it would mean being partially funded by taxes? (By age)



Q17a. (3) Do you believe that such a facility should be added to the existing nursing home, even if it would mean being partially funded by taxes? (By gender)



Q17a. (4) Do you believe that such a facility should be added to the existing nursing home, even if it would mean being partially funded by taxes? (By income)



34

Q18. (2) Do you see a need for single occupancy, private pay, skilled nursing rooms to be part of the current nursing home? (By age)



Q18. (3) Do you see a need for single occupancy, private pay, skilled nursing rooms to be part of the current nursing home? (By gender)



Q18. (4) Do you see a need for single occupancy, private pay, skilled nursing rooms to be part of the current nursing home? (By income)



Q18a. (2) Do you believe that such a facility should be added to the existing nursing home, even if it would mean being partially funded by taxes? (By age)



35

Q18a. (3) Do you believe that such a facility should be added to the existing nursing home, even if it would mean being partially funded by taxes? (By gender)



Q18a. (4) Do you believe that such a facility should be added to the existing nursing home, even if it would mean being partially funded by taxes? (By income)



Q19. (2) To keep the existing facility operating would you approve of the county assuming ownership of the facility, even if it would mean being partially funded by taxes? (By age)



Q19. (3) To keep the existing facility operating would you approve of the county assuming ownership of the facility, even if it would mean being partially funded by taxes? (By gender)



36

Q19. (4) To keep the existing facility operating should you approve of the county assuming ownership of the facility, even if it would mean being partially funded by taxes? (By income)



Q20. (2) Would you approve of the county making such additions, even if it would mean being partially funded by taxes? (By age)



Q20. (3) Would you approve of the county making such additions, even if it would mean being partially funded by taxes? (By gender)



Q20. (4) Would you approve of the county making such additions, even if it would mean being partially funded by taxes? (By income)



37

Q21. (2) Do you use the internet? (By age)

Response Yes Percent No Percent Total18-44 41 91.1% 4 8.9% 4545-64 93 88.6% 12 11.4% 10565+ 25 40.3% 37 59.7% 62Total 159 75.0% 53 25.0% 212


Q21. (3) Do you use the internet? (By gender)

Response Yes Percent No Percent TotalFemale 111 77.6% 32 22.4% 143Male 48 69.6% 21 30.4% 69Total 159 75.0% 53 25.0% 212


Q21. (4) Do you use the internet? (By income)

Response Yes Percent No Percent TotalUnder $40,000 46 59.0% 32 41.0% 78Over $40,000 98 87.5% 14 12.5% 112Total 144 75.8% 46 24.2% 190


Q21a. (2) Have you used the internet to find health-related information? (By age)

Response Yes Percent No Percent Total18-44 32 78.0% 9 22.0% 4145-64 70 75.3% 23 24.7% 9365+ 16 64.0% 9 36.0% 25Total 118 74.2% 41 25.8% 159


38

Q21a. (3) Have you used the internet to find health-related information? (By gender)

Response Yes Percent No Percent TotalFemale 85 76.6% 26 23.4% 111Male 33 68.8% 15 31.3% 48Total 118 74.2% 41 25.8% 159


Q21a. (4) Have you used the internet to find health-related information? (By income)

Response Yes Percent No Percent TotalUnder $40,000 32 69.6% 14 30.4% 46Over $40,000 78 79.6% 20 20.4% 98Total 110 76.4% 34 23.6% 144


Q21b. (2) Have you used the internet to find Cheyenne County health services information or providers? (By age)



Q21b. (3) Have you used the internet to find Cheyenne County health services information or providers? (By gender)



39

Q21b. (4) Have you used the internet to find Cheyenne County health services information or providers? (By income)



Q21c. (2) In general, how confident are you that you can find local health-related information on the internet? (By age)

Response Very Confident Percent Somewhat Confident Percent Not Confident at All Percent Don't Know Percent Total18-44 17 41.5% 21 51.2% 1 2.4% 2 4.9% 4145-64 42 45.2% 38 40.9% 5 5.4% 8 8.6% 9365+ 9 36.0% 6 24.0% 7 28.0% 3 12.0% 25Total 68 42.8% 65 40.9% 13 8.2% 13 8.2% 159


Q21c. (3) In general, how confident are you that you can find local health-related information on the internet? (By gender)

Response Very Confident Percent Somewhat Confident Percent Not Confident at All Percent Don't Know Percent TotalFemale 49 44.1% 47 42.3% 7 6.3% 8 7.2% 111Male 19 39.6% 18 37.5% 6 12.5% 5 10.4% 48Total 68 42.8% 65 40.9% 13 8.2% 13 8.2% 159


Q21c. (4) In general, how confident are you that you can find local health-related information on the internet? (By income)

Response Very Confident Percent Somewhat Confident Percent Not Confident at All Percent Don't Know Percent TotalUnder $40,000 18 39.1% 18 39.1% 7 15.2% 3 6.5% 46Over $40,000 46 46.9% 41 41.8% 6 6.1% 5 5.1% 98Total 64 44.4% 59 41.0% 13 9.0% 8 5.6% 144


40

41

Appendix 2

Cheyenne County Telephone Survey Instrument

Cheyenne County Telephone Survey FINAL

Introduction and Screener: Hi. I'm calling regarding the Cheyenne County health care survey. I'm calling from Fort Hays State University. I am asking a few questions about family and adult health care and the use of healthcare facilities in Cheyenne County on behalf of the Cheyenne County healthcare steering committee and the Kansas Rural Health Works project. I need to speak with the adult in the household at least 18 years or older with the most recent birthday. Is that you?

Your answers will remain completely confidential. May I ask you some questions?

1. First, could you please tell me your zip code?

67756 St. Francis 67731 Bird City _______ Some other city IF SOME OTHER CITY….

1a. Thank you, but we have already reached enough households from your particular community. Thanks so much for your time and have a great evening. 1b. And in what year were you born? [THIS WILL ALLOW US TO SCREEN OUT RESPONDENTS ONCE WE HAVE REACHED AGE-LEVEL QUOTAS] 1c. Thank you, but we are trying to reach a balanced number of individuals from different age groups in the area, and we have already reached enough individuals from your particular age group. Thanks so much for your time and have a great evening.

2. Ok. Which of the following medical professionals do you use for MOST of your

routine health care? [CHECKUPS, COMMON ILLNESSES, GENERAL ACHES AND PAINS]

1 Primary Care Physician 2 Nurse Practitioner 3 Physician’s Assistant 4 None, don’t see anyone 5 Other 8 Don’t Know 9 Refused 2a. What other medical professional was identified?

3. Regardless of who you use for your routine health care, for the rest of

this survey, we will refer to this person as "your doctor." When is the last time you saw your doctor for routine health care?

1 Was it less than 1 year ago 2 Between 1 and 2 years ago 3 Between 2 and 5 years ago 4 Or More than 5 years ago 5 Never – doesn’t have a doctor

1


8 Don’t Know 9 Refused [FOR Q4, IF ANSWER IS ST.FRANCIS OR BIRD CITY, RECEIVE “4b”] 4. What city do you go to the most when you see your doctor?

[WAIT FOR RESPONSE. SELECT ONLY ONE.] 1 St. Francis 2 Bird City 3 Goodland 4 Colby 5 Atwood 6 Wray, CO 7 Burlington, CO 8 Benkelman, NE 9 Don’t need service 10 Other 88 Don’t know 99 Refused

4a. What other city was provided? 4b. How would you describe your satisfaction with the quality of care provided by your

doctor? Are you… 1=Satisfied 2=Somewhat Satisfied 3=Somewhat Dissatisfied 4=Dissatisfied 8=Don’t Know 9=Refused

[FOR Q5, IF ANSWER IS YES, RECEIVE “5b” AND “6” SERIES. IF NO, GO TO Q7.] 5. Next, I have a few questions about hospital services used by you or other members of

your household. Household members are individuals who actually live in your home. Now, have you or any members of your household used the inpatient or outpatient

services of a hospital in the last 12 months? 1=Yes 2=No 8=Don’t Know 9=Refused 5b. Please tell me what hospital or hospitals were used by you or other members of your

household in the last 12 months.

[WAIT FOR RESPONSE. SELECT ALL THAT APPLY] 1=Y 0=N Cheyenne County Hospital, St. Francis 1=Y 0=N Goodland Regional Medical Center, Goodland 1=Y 0=N Citizens Medical Center, Colby 1=Y 0=N Rawlins County Health Center, Atwood 1=Y 0=N Decatur County Hospital, Oberlin 1=Y 0=N Wray Community District Hospital, Wray, CO 1=Y 0=N Dundy County Hospital, Benkelman, NE

1=Y 0=N Kit Carson County Memorial Hospital, Burlington, CO 1=Y 0=N Veteran's Administration (VA) 1=Y 0=N Hays Medical Center

2


1=Y 0=N Any Denver Hospital 1=Y 0=N Other (Specify)____________________

5c. List other hospitals here. 6a. Think of the reasons why you or other members of your household chose a hospital in

the past 12 months. Was a hospital ever chosen because of insurance coverage?

1=Yes 2=No 8=Don’t Know 9=Refused 6b. Was a hospital ever chosen because of a doctor referral?

1=Yes 2=No 8=Don’t Know 9=Refused 6c. Was a hospital ever chosen because of the specialty services the hospital offered?

1=Yes 2=No 8=Don’t Know 9=Refused 6d. Was a hospital ever chosen because it was recommended by a friend?

1=Yes 2=No 8=Don’t Know 9=Refused

6e. Was a hospital ever chosen because of personal preference? 1=Yes 2=No 8=Don’t Know 9=Refused

6f. Because of its distance from your home?


6g. Because family members lived close by? 1=Yes 2=No 8=Don’t Know 9=Refused

6h. Was a hospital ever chosen because it was an emergency?

1=Yes 2=No 8=Don’t Know 9=Refused 6i. Were there any other reasons why certain hospitals were chosen in the past 12

months? 1=Yes 2=No 8=Don’t Know 9=Refused

6j. Enter other reason here.

If Q5b1 = 1, Skip to Q8a. 7. Have you (or other members of your household) EVER used the services of the

Cheyenne County Hospital? 1=Yes 2=No 8=Don’t Know 9=Refused [IF YES, RECEIVE Q8a and Q8b. IF NO, GO TO Q9.]

8a. Recalling the most recent visit to Cheyenne County Hospital, what type of service

was obtained? [READ EACH ITEM, SELECT ALL THAT APPLY]

3


1=Y 0=N Inpatient 1=Y 0=N Outpatient 1=Y 0=N Emergency

8b. How would you describe your satisfaction with your last Cheyenne County

Hospital experience? Were you…. 1=Satisfied 2=Somewhat Satisfied 3=Somewhat Dissatisfied 4=Dissatisfied 8=Don’t Know 9=Refused

9. Have you or other members of your household EVER used the services of the Bird

City Clinic? 1=Yes 2=No 8=Don’t Know 9=Refused [IF YES, RECEIVE Q9a and Q9b. IF NO, GO TO Q10a1.]

9a. How would you describe your satisfaction with your last Bird City Clinic

experience? Were you…. 1=Satisfied 2=Somewhat Satisfied 3=Somewhat Dissatisfied 4=Dissatisfied 8=Don’t Know 9=Refused

9b. Are the office hours at the Bird City Clinic adequate to meet your needs? 1=Yes 2=No 8=Don’t Know 9=Refused [FOR ALL ITEMS IN 10 SERIES, IF ANSWER TO “a1” IS “St. Francis,” RECEIVE “a2”,

NOT "a3"] [FOR ALL ITEMS IN 10 SERIES, IF ANSWER TO "a1" IS SOME OTHER CITY, RECEIVE

"a3", NOT "a2"] 10a1. Now I am going to ask you where you or other members of your household go to

MOST OFTEN for certain medical services. Please think of your use of these services in the past two years. First, in what city do you or other members of your household go to the dentist? [WAIT FOR RESPONSE. SELECT ONLY ONE.]

1 St. Francis 2 Goodland 3 Colby 4 Atwood 5 Wray, CO 6 Burlington, CO 7 Benkelman, NE 8 Don’t need service 9 Other 10 88 Don’t know 99 Refused

10a2. How would you describe your satisfaction with those services? Were you:

1=Satisfied 2=Somewhat Satisfied 3=Somewhat Dissatisfied 4=Dissatisfied 8=Don’t Know 9=Refused

10a3. Have you ever tried the services of a St. Francis dentist?


4


10b1. What about pharmacy? [WAIT FOR RESPONSE. SELECT ONLY ONE.]

1 St. Francis 2 Goodland 3 Colby 4 Atwood 5 Wray, CO 6 Burlington, CO 7 Benkelman, NE 8 Veteran's Administration (VA) 9 Mail Order 10 Importation 11 Don’t need service 12 Other 88 Don’t know 99 Refused

10b2. How would you describe your satisfaction with those services? Were you: 1=Satisfied 2=Somewhat Satisfied 3=Somewhat Dissatisfied 4=Dissatisfied 8=Don’t Know 9=Refused

10b3. Have you ever tried the services of a St. Francis pharmacy?

1=Yes 2=No 8=Don’t Know 9=Refused 10c1. What about chiropractor services? [WAIT FOR RESPONSE. SELECT ONLY ONE.]

1 St. Francis 2 Goodland 3 Colby 4 Atwood 5 Wray, CO 6 Burlington, CO 7 Benkelman, NE 8 Don’t need service 9 Other 88Don’t know 99 Refused

10c2. How would you describe your satisfaction with those services? Were you:


10c3. Have you ever tried the services of a St. Francis chiropractor?

1=Yes 2=No 8=Don’t Know 9=Refused 10d1. What about eye doctor? [WAIT FOR RESPONSE. SELECT ONLY ONE. NOTE: NO

"10d3" OPTION HERE]

1 St. Francis 2 Goodland 3 Colby 4 Atwood 5 Wray, CO 6 Burlington, CO 7 Benkelman, NE 8 Don’t need service 9 Other 88 Don’t know 99 Refused

10d2. How would you describe your satisfaction with those services? Were you:

5



10e1. What about physical therapy services? [WAIT FOR RESPONSE. SELECT ONLY

ONE.]


10e2. How would you describe your satisfaction with those services? Were you: 1=Satisfied 2=Somewhat Satisfied 3=Somewhat Dissatisfied 4=Dissatisfied 8=Don’t Know 9=Refused

10e3. Have you ever tried the services of a St. Francis physical therapist physical therapy services? 1=Yes 2=No 8=Don’t Know 9=Refused

10f1. Home Healthcare services? [WAIT FOR RESPONSE. SELECT ONLY ONE.]


10f2. How would you describe your satisfaction with those services? Were you:


10f3. Have you ever tried the services of a St. Francis Home Healthcare

provider? 1=Yes 2=No 8=Don’t Know 9=Refused

10g1. Massage Therapy services? [WAIT FOR RESPONSE. SELECT ONLY ONE.]

1 St. Francis 2 Goodland 3 Colby 4 Atwood 5 Wray, CO 6 Burlington, CO 7 Benkelman, NE 8 Don’t need service

6


9 Other 88 Don’t know 99 Refused

10g2. How would you describe your satisfaction with those services? Were you:


10g3. Have you ever tried the services of a St. Francis massage therapist?

1=Yes 2=No 8=Don’t Know 9=Refused 10h1. Counseling services? [WAIT FOR RESPONSE. SELECT ONLY ONE.]


10h2. How would you describe your satisfaction with those services? Were you:


10h3. Have you ever tried the services of a St. Francis counseling services? 1=Yes 2=No 8=Don’t Know 9=Refused

10i1. Have you or any other members of your household ever used the county health

department services in Cheyenne County? 1=Yes 2=No 8=Don’t Know 9=Refused

[IF YES, ASK Q10i2. IF NO, GO TO Q10j1.]

10i2. How would you describe your satisfaction with those services? Were you: 1=Satisfied 2=Somewhat Satisfied 3=Somewhat Dissatisfied 4=Dissatisfied 8=Don’t Know 9=Refused

10j1. Have you or any other members of your household or your immediate family ever

used ambulance services in Cheyenne County? [EMS, EMERGENCY MEDICAL TRANSPORT]

1=Yes 2=No 8=Don’t Know 9=Refused [IF YES, ASK Q10j2. IF NO, GO TO Q10k1.]

10j2. How would you describe your satisfaction with those services? Were you:


7


10k1. Has anyone in your family ever used Nursing Home services in St. Francis?

1=Yes 2=No 8=Don’t Know 9=Refused [IF YES, ASK Q10k2. IF NO, GO TO Q11.]

10k2. How would you describe your satisfaction with those services? Were you:


11. Do you or other members of your household need to travel outside of Cheyenne

County for regular medical treatment one or more times per month? 1=Yes 2=No 8=Don’t Know 9=Refused

11a. Is transportation to regular medical appointments either inside or outside the county a challenge for you or other members of your household? 1=Yes 2=No 8=Don’t Know 9=Refused

12. Currently, a full service wellness and fitness center providing unlimited access to a

wide variety of fitness services to the ENTIRE community does not exist in Cheyenne County. Do you believe there is a need for a community wellness center in Cheyenne County that has exercise classes and equipment, and offers educational and wellness programs? 1=Yes 2=No 8=Don’t Know 9=Refused

12a. If a community wellness center existed in Cheyenne County, do you think you it

should include an indoor pool? 1=Yes 2=No 8=Don’t Know 9=Refused

12b. If a community wellness center existed in Cheyenne County, do you think you (or

another member of your household) would use it? 1=Yes 2=No 8=Don’t Know 9=Refused [IF YES, ASK Q12c. IF NO, GO TO Q13.]

12c. If a community wellness center existed in Cheyenne County, would you or the

household member be willing to pay a fee to use it? 1=Yes 2=No 8=Don’t Know 9=Refused

13. Do you believe there is a need for an eye doctor in Cheyenne County?

1=Yes 2=No 8=Don’t Know 9=Refused 14. Do you believe the Cheyenne County Hospital should offer maternity services?

1=Yes 2=No 8=Don’t Know 9=Refused 15. Do you believe there is the need for an inpatient treatment facility in Cheyenne County for the elderly who suffer psychiatric problems such as Alzheimer's Disease?

8


1=Yes 2=No 8=Don’t Know 9=Refused 16. Is it your general intention to live in Cheyenne County throughout retirement?

1=Yes 2=No 8=Don’t Know 9=Refused 16a. In general, do you believe Cheyenne County health services are adequate to sustain

the needs of Cheyenne County retirees? 1=Yes 2=No 8=Don’t Know 9=Refused

17. Now I’m going to ask some questions regarding the nursing home in Cheyenne

County. Currently there are no assisted living apartments in the county. Do you see a need for assisted living apartments to be part of the current nursing home? 1=Yes 2=No 8=Don’t Know 9=Refused

[IF YES, ASK Q17a. IF NO, GO TO Q18.] 17a. Do you believe that such a facility should be added to the existing nursing home,

even if it would mean being partially funded by taxes? 1=Yes 2=No 8=Don’t Know 9=Refused

18. Currently there are no single occupancy, private pay, skilled nursing rooms in

Cheyenne County. Do you see a need for single occupancy, private pay, skilled nursing rooms to be part of the current nursing home? 1=Yes 2=No 8=Don’t Know 9=Refused

[IF YES, ASK Q18a. IF NO, GO TO Q19] 18a. Do you believe that such a facility should be added to the existing nursing home,

even if it would mean being partially funded by taxes? 1=Yes 2=No 8=Don’t Know 9=Refused

19. As you probably know, the local nursing home is owned by a non-profit

organization, Good Samaritan Society of Sioux Falls, South Dakota. This facility is only a double occupancy, skilled nursing home with independent living apartments on site. This property is not for sale by the owner. Since the fire in October 2010, the nursing facility has been partially restored to accommodate fewer residents. The Good Samaritan Society wants to transfer ownership of the facility to the county. If the county takes ownership the facility, a tax subsidy may be required to sustain operations at this reduced capacity.

To keep the existing facility operating, would you approve of the county assuming ownership of the facility, even if it would mean being partially funded by taxes?

1=Yes 2=No 8=Don’t Know 9=Refused 20. Prior to the fire, the Good Samaritan Society had identified a need for single

occupancy private pay skilled nursing rooms and assisted living apartments. These units are not dependent on governmental reimbursement sources, but are

9


desired by individuals who are capable of paying cash. Adding these rooms would improve the financial performance of the Long Term Care Facility significantly, and provide a full range of assisted living options for the elderly in Cheyenne County including independent living apartments, assisted living apartments, double occupancy skilled nursing rooms and single occupancy private pay skilled nursing rooms.

If after studying the county’s long term care needs it is determined that expanding

the facility by adding private pay single occupancy skilled nursing rooms and assisted living apartments to the existing nursing home would make the facility more self sufficient in the long-term, would you approve of the county making such additions, even if it would mean being partially funded by taxes? 1=Yes 2=No 8=Don’t Know 9=Refused

[FOR Q21, IF ANSWER IS YES, RECEIVE “21a” “21b” AND “21c.”] 21. Do you use the Internet?

1=Yes 2=No 8=Don’t Know 9=Refused 21a. Have you used the Internet to find health-related information?

1=Yes 2=No 8=Don’t Know 9=Refused 21b. Have you used the Internet to find Cheyenne County health services information

or providers? 1=Yes 2=No 8=Don’t Know 9=Refused

21c. In general, how confident are you that you can find local health-related information on the Internet?

1=Very Confident 2=Somewhat Confident 3=Not Confident at All 8=Don’t Know 9=Refused

22. And now I have a few questions to help analyze the results of this survey.

Have you lived in Cheyenne County for more than one year? 1=Yes 2=No 8=Don’t Know 9=Refused

23. How many people reside in your household?

88=Don’t Know 99=Refused [IF 23 IS GREATER THAN 1, RECIEVE “24.”] 24. Are there any children under the age of 18 living in your home? If yes, how many?

88=Don’t Know 99=Refused [IF 24 IS GREATER THAN 0, RECIEVE “24a.” and “24b.”] 24a. Are there any children under the age of 13 living in your home? If yes, how

many? 0=None 88=Don’t Know 99=Refused

10


11

24b. How many adult caregivers are in the home? 8=Don’t Know 9=Refused

25. Was your total family income for the last year above or below $40,000?

[IF BELOW $40,000 READ THE FOLLOWING RESPONSES]

1 Was it less than $10,000, 2 between $10,000 and $20,000, 3 between $20,000 and $30,000? 4 or between $30,000 and $40,000?

[IF ABOVE $40,000 READ THE FOLLOWING RESPONSES]

5 Was it between $40,000 and $50,000, 6 between $50,000 and $60,000, 7 between $60,000 and $70,000, 8 between $70,000 and $80,000, 9 or was it over $80,000? 88 DON’T KNOW 99 REFUSED

26. That’s all that I have. Thank you for your time and have a nice ______. Interviewer will decide on the answer to this question!!! 1 Female 2 Male 3 Not Sure


Cheyenne County Health Services Directory Kansas Rural Health Options Project

June 2011 Emily Mashie, Research AssistantEmily Mollohan, Research AssistantJohn Leatherman, Director

Funding for this report provided by: Offfice of Rural Health PolicyHealth Resources and Services Administration (Grant #5 H54RH00009-03)

i

Table of Contents EMERGENCY NUMBERS............................................................ 1

NON-EMERGENCY NUMBERS................................................... 1

MUNICIPAL NON-EMERGENCY NUMBERS.............................. 1

OTHER EMERGENCY NUMBERS .............................................. 2

HEALTH SERVICES .................................................................... 5

HOSPITALS................................................................................... 5 HEALTH DEPARTMENT .................................................................. 8 MENTAL HEALTH .......................................................................... 8 MEDICAL PROFESSIONALS .......................................................... 10

Chiropractors ......................................................................... 10 Clinics .................................................................................... 12 Specialty Clinics..................................................................... 13 Dentists.................................................................................. 14 Hearing .................................................................................. 16 Optometrists .......................................................................... 17 Pharmacies............................................................................ 18 Physicians and Health Care Providers .................................. 19 Rehabilitation Services .......................................................... 22

OTHER HEALTH SERVICES..................................................... 24

ASSISTED LIVING, NURSING HOMES, LONG-TERM CARE............... 24 DISABILITY SERVICES ................................................................. 25 DOMESTIC VIOLENCE.................................................................. 26 INFORMATION AND TREATMENT CENTERS.................................... 26 EDUCATIONAL TRAINING OPPORTUNITIES.................................... 27 FOOD PROGRAM ........................................................................ 28 GOVERNMENT HEALTHCARE ....................................................... 28 HEALTH AND FITNESS CENTERS.................................................. 30 HOME HEALTH SERVICES ........................................................... 31 HOSPICE.................................................................................... 32 MASSAGE THERAPISTS............................................................... 33 MEDICAL EQUIPMENT AND SUPPLIES........................................... 34

ii

NUTRITION ................................................................................. 35 SCHOOL NURSES ....................................................................... 36 SENIOR SERVICES...................................................................... 39 VETERINARY SERVICES .............................................................. 40

LOCAL GOVERNMENT, COMMUNITY AND SOCIAL SERVICES .................................................................................. 42

ADULT PROTECTION ................................................................... 42 ALCOHOL AND DRUG TREATMENT AND SUPPORT......................... 42

Out-Patient Treatment Programs........................................... 43 In-Patient Treatment Programs ............................................. 44

CHILD PROTECTION.................................................................... 45 CHILDREN AND YOUTH................................................................ 45 EXTENSION OFFICE .................................................................... 48 FUNERAL HOMES ....................................................................... 48 HEAD START .............................................................................. 49 HOUSING ................................................................................... 49 LEGAL SERVICES........................................................................ 50 LIBRARIES, PARKS AND RECREATION .......................................... 51 PUBLIC INFORMATION ................................................................. 52 RAPE ......................................................................................... 52 RED CROSS ............................................................................... 53 SOCIAL SECURITY ADMINISTRATION ............................................ 53 SUPPORT GROUPS..................................................................... 53 TRANSPORTATION ...................................................................... 54

STATE AND NATIONAL INFORMATION, SERVICES & SUPPORT................................................................................... 56

ADULT PROTECTION ................................................................... 56 ALCOHOL AND DRUG TREATMENT PROGRAMS............................. 57 CHILDREN AND YOUTH................................................................ 59 COUNSELING.............................................................................. 61 DISABILITY SERVICES ................................................................. 63 ENVIRONMENT............................................................................ 64 FOOD AND DRUG........................................................................ 65

iii

HEALTH SERVICES ..................................................................... 66 HOSPICE.................................................................................... 67 HOUSING ................................................................................... 68 LEGAL SERVICES........................................................................ 68 MEDICAID / MEDICARE SERVICES ................................................ 69 MENTAL HEALTH SERVICES ........................................................ 69 NUTRITION ................................................................................. 71 ROAD AND WEATHER CONDITIONS.............................................. 72 SENIOR SERVICES...................................................................... 72 VETERANS ................................................................................. 74 VETERANS ADMINISTRATION ....................................................... 75

INDEX ......................................................................................... 76

1

Emergency Numbers

Police/Sheriff 911 Fire 911 Ambulance 911

Non-Emergency Numbers Cheyenne County Sheriff 785-332-8880

Municipal Non-Emergency Numbers Police/Sheriff Fire St. Francis 332-3330 332-3306 Bird City 911 734-2323

2

Other Emergency Numbers American Red Cross

602 Grand St. (Goodland) 785-890-2011

Cheyenne County Emergency Management 785-332-8522 Domestic Violence and Sexual Assault Kansas Crisis Hotline

888-END-ABUSE (888-363-2287) www.kcsdv.org/ksresources.html

Federal Bureau of Investigation (Wichita)

316-262-0031 www.fbi.gov

High Plains Mental Health 800-432-0333 Kansas Arson/Crime Hotline 800-KS-CRIME Kansas Bureau of Investigation

785-296-8200 www.accesskansas.org/kbi/

http://www.kcsdv.org/ksresources.html�

http://www.fbi.gov/�

http://www.accesskansas.org/kbi/�

3

Kansas Children's Service League 785-625-2244 (Hays, KS) 877-530-5275 Call the 24-HR Parent Helpline: 1-800-332-6378 www.kcsl.org

Kansas Division of Emergency Management (Topeka)

785-274-1409 www.accesskansas.org/kdem

Kansas Department of Social and Rehabilitation Services West Region Protection Reporting Center (Protection Report Center for Abuse)

800-922-5330 Available 24 hours/7 days per week – including holidays for elder and child abuse reports

Kansas Highway Patrol 785-899-6697 785-827-4930 (Salina) Kansas Road Conditions

877-550-KDOT (5368) www.ksdot.org 511 from cell phones

Poison Help Hotline

800-222-1222 www.kumed.com/default.aspx?id=2729 www.poison.org www.aapcc.org

http://www.kcsl.org/�

http://www.accesskansas.org/kdem�

http://www.ksdot.org/�

http://www.kumed.com/default.aspx?id=2729�

http://www.poison.org/�

http://www.aapcc.org/�

4

Suicide Prevention Hotline

800-SUICIDE (800-784-2433) www.hopeline.com

Toxic Chemical and Oil Spills 800-424-8802

http://www.hopeline.com/�

5

Health Services Hospitals

Cheyenne County Hospital 210 West 1st Street St. Francis, KS 67756 785-332-2104 www.cheyennecountyhospital.com

Cheyenne County Hospital services include: 24 Hour Emergency Services Acute & Swing Bed Care Anesthesia Cardiac Rehabilitation Chemotherapy CT scan Diagnostic Services IVP’s Laboratory Services Basic Metabolic Panel Blood Count with Smears Blood Culture CBC Complete CBC Complete with Differential Glucometer Lipid Panel Natriuretic Peptide Prothrombin Time Stool Culture

http://www.cheyennecountyhospital.com/�

6

Thyroid Stimulating Troponin Quantitative Urine Analysis Complete Vitamin D-Reference Lab Lifeline Obstetrics Anesthesia Services Breastfeeding Consultation Childhood Immunizations

C-Sections Delivery Health State Home Visitor Program Pediatric Postpartum Care Prenatal Care Recovery Well child and well woman visits Outpatient Services Outpatient Surgery Physical Therapy Physical/Aquatic Therapy Specialized Services Cardiology Mammography Oncology Ophthalmology Orthopedic Osteoporosis Podiatrist Ultrasound X-Ray

7

Goodland Regional Medical Center 220 West 2nd Street (Goodland) 785-890-3625 Rawlins County Health Center 901 East Hospital Drive (Atwood) 785-626-3211 Citizens Medical Center 100 East College Drive (Colby) 785-462-7511 www.nwkshealthcare.com Dundy County Hospital 1313 N. Cheyenne Street (Benkelman, NE) 308-423-2204 Decatur County Hospital 810 West Columbia (Oberlin) 785-475-2208 Wray Community Hospital 1017 West 7th Street (Wray, CO) 970-332-4811 Kit Carson County Memorial Hospital 286 16th Street (Burlington, CO) 719-346-5311

http://www.nwkshealthcare.com/�

8

Health Department Cheyenne County Health Department 221 West 1st Street (St. Francis) 785-332-2381

Cheyenne County Health Department services include: Adult Wellness Case Management Community Health Diabetes Support Group Emergency Preparedness Environmental Health Care Services Health Education Immunizations Weight Management WIC

Mental Health Capstone Counseling 112 East Spencer Street (St. Francis) Chelly Moore 785-332-2644

Heartland Rural Counseling Services, Inc. 111 West 12th Street (Goodland) 785-821-0781

9

High Plains Mental Health Center 723 Main Street (Goodland) 785-899-5991 www.highplainsmentalhealth.com

Meier Clinics - Christian Counseling

1015 Main Street (Goodland) 888-725-4642

Heartland Rural Counseling Services, Inc. 485 West 4th Street (Colby) 785-460-7588

New Beginnings Counseling Services 422 Smith Drive (Colby) 785-462-3308

Centennial Mental Health Center 340 Birch Street (Wray, CO) 970-332-3133 www.centennialmhc.org Centennial Mental Health Center 1291 Circle Drive (Burlington, CO) 719-346-8183 www.centennialmhc.org Hays Medical Center Senior-Focused Care Unit 201 East 7th Street, Suite 315 (Hays) Dr. James Van Doren 785-623-5161

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http://www.centennialmhc.org/�

http://www.centennialmhc.org/�

10

Medical Professionals

Chiropractors

Brett T. Poling, D.C. 709 South Benton Street (St. Francis) 785-332-3105

Patrick R. Stuart, D.C.

115 South Quincy (St. Francis) 785-332-3047 Poling Chiropractic and Family Health Center

709 South Benton (St. Francis) 785-332-3105

Unger Chiropractic Clinic 120 North Scott Street (St. Francis) 785-332-2186 Arin J. Thomas, D.C. 1401 Main Avenue (Goodland) 720-244-3452

Clifton Porterfield, D.C. 2233 Caldwell Street (Goodland) 785-899-2500

11

Gleason Chiropractic Patrick Gleason 1015 Main Street (Goodland) 785-899-2225 Poling Chiropractic

1109 Main (Goodland) 785-728-7282

Unruh Family Chiropractic 1015 Main Street (Goodland) 785-899-2225 Active Balance Chiropractic & Acupuncture 418 Main Street (Atwood) 785-626-3274 Franz Chiropractic 135 West 6th Street (Colby) 785-462-7236 Northwest Kansas Chiropractic PA 770 South Range Avenue Suite 4 (Colby) 785-460-0332 Wiley Chiropractic Health Center 990 South Range Avenue (Colby) 785-462-7577

12

Matthews Family Chiropractic 503 Chief Street (Benkelman, NE) 308-423-5626 Nygaard Chiropractic Offices 501 Main Street (Wray, CO) 970-332-3390

Clinics Cheyenne County Clinic 221 West 1st Street (St. Francis) 785-332-2682

Cheyenne County Clinic Bird City 233 West 4th Street (Bird City) 785-734-2200

Goodland Family Health Center

106 Willow Road (Goodland) 785-890-6075

Pioneer Health 910 Main Street (Goodland) 785-890-7950

Rawlins County Health Center Clinic

504 Ottawa Street (McDonald) 785-538-2559

13

Oberlin Clinic 312 State Street (Atwood) 785-626-3229

Rawlins County Health Center Clinic 707 Grant Street (Atwood) 785-626-3241

Quality Healthcare Clinic 1313 North Cheyenne Street (Benkelman, NE) 308-423-2151 Wray Clinic 1017 West 7th Street (Wray, CO) 970-332-4895

Specialty Clinics

Goodland Regional Medical: Specialist Clinic 220 West 2nd Street (Goodland) 785-890-6030 Rawlins Specialty Clinics 707 Grant Street (Atwood) 785-626-3211

14

Dentists

Melvin Dunn, D.D.S. 300 North College Street (St. Francis) 785-332-2062

Tim Poling, DDS 200 West Washington (St. Francis) 785-332-3103

Christopher Lovell, D.D.S. Dental/Orthodontics

1014 Main Street (Goodland) 785-899-3025

James Baker, D.D.S. 1009 Main Street (Goodland) 785-890-2562

Goodland Dental Arts Terry Iman D.D.S. Megan Pearce D.D.S. 504 Main Street (Goodland)

785-899-6222 Thomas J. Melcher

1014 Main Avenue (Goodland) 785-899-3025

15

Rawlins County Dental Clinic 707 Grant Street (Atwood) 785-626-8289 or 8290

Karen Thummel, D.D.S.

480 West 4th Street (Colby) 785-460-6800

Scott G. Haas, D.D.S. 770 South Range Avenue (Colby) 785-760-3922

Shawn D. Jensen, D.D.S. 1690 West 4th Street (Colby) 785-460-3999

Thomas J. Barlow, D.D.S.

505 North Franklin Avenue Suite H (Colby) 785-460-7538 Peckham Dental Clinic 718 Chief Street (Benkelman, NE) 308-423-2024

Carson & Neumann

416 Main Street (Wray, CO) 970-332-4817

Stephen F. Humphrey, D.D.S. 340 14th Street (Burlington, CO) 719-346-8266

16

Hearing Cheyenne County Health Department 221 West 1st Street (St. Francis) 785-332-2381

Precision Hearing Aid Center 1208 Main Street (Goodland) 785-899-3166 Northwest Kansas Hearing Services, Inc. 175 South Range (Colby) 785-460-2957

800-500-0206

Miracle Ear 415 Man Street (Wray, CO) 970-445-3252 Nathan J. Smith, A.U.D. 320 Cedar Street (Wray, CO) 970-332-5439

Hearing Solutions

1870½ South Range (Hays) 785-460-4327

17

Optometrists

David F. Schnee, O.D. 601 East US Highway 24 (Goodland) 785-899-5501

Newman Vision Care

Ryan Newman, O.D. 919 Main Street (Goodland) 785-890-3937

Vision Source of Goodland Danielle McAtee, O.D. 1002 Broadway (Goodland) 785-899-3654 www.eyeclinic.com

Larry Washburn

505 North Franklin Avenue (Colby) 785-462-3348 Vision Source of Colby 1005 South Range Avenue (Colby) 785-462-8231 www.eyeclinic.com

Burrows Vision Clinic, L.L.C.

617 Chief Street (Benkelman, NE) 308-345-2954 www.burrowsvision.com

http://www.eyeclinic.com/�


http://www.burrowsvision.com/�

18

Larry R. Williams, O.D. 498 15th Street (Burlington, CO) 719-346-8996

Vision Source of Burlington

Danielle McAtee, O.D. 498 15th Street (Burlington, CO) 719-346-8415 www.eyeclinic.com

Eye Care Council 800-960-EYES

Pharmacies

Krien Pharmacy 105 West Washington (St. Francis) 785-332-2177 Medical Arts Pharmacy 202 Willow Road (Goodland) 785-890-5111

Walmart Supercenter 2160 Commerce Road (Goodland) 785-899-2266

Bison Rx Compounding & Therapy

416 State Street Suite A (Atwood) 785-626-3237


19

Currier Drug 416 State (Atwood) 785-626-3214

Dillon Store Pharmacy 1605 South Range Avenue (Colby) 785-462-1310 Palace Drug Store 460 North Franklin Ave. (Colby) 785-460-7507

Benkelman Pharmacy 509 Chief Street (Benkelman, NE) 308-423-2759

Prescription Center 347 14th Street (Burlington, CO) 719-346-7705

W-B Drug Company

314 14th Street (Burlington, CO) 719-346-8851

Physicians and Health Care Providers

Charles E. Frankum, M.D. 210 West 1st Street (St. Francis) 785-332-2104

20

Cheyenne County Clinic 221 West 1st Street (St. Francis) 785-332-2682 Mary Beth Miller, M.D. Rebecca Allard, M.D. Tyler Raile, P.A.-C Kristle Raile, P.A.-C

Kimberly S. Zweygardt, CRNA

210 West 1st Street (St. Francis) 785-332-2104

Goodland Family Health Center

106 Willow (Goodland) 785-890-6075

David Younger, M.D. Jackie Jorgensen, ARNP Lisa Unruh, M.D., Pediatrician Moe Shafei, M.D.

Sarah Linton, Registered Dietician Travis Daise, M.D.

R.C. McCullough, M.D. 1122 Center Street (Goodland) 785-899-2464 Shafei Mohedine, M.D. 106 Willow Road (Goodland) 785-890-6075

21

Travis Daise, M.D. 106 Willow Road (Goodland) 785-890-6075 Rodney S. Dill, M.D. 814 South 2nd Street (Atwood) 785-626-9434 Family Center for Health Care

310 East College Drive (Colby) 785-462-6184 Bruce Kellogg, D.O. Darren Matchell, D.O. Jenny Niblock, ARNP Luetta Flanagin, ARNP Kristina Jallow, ARNP Tricia Carney, ARNP

Mekki Saba, M.D. FRCS 100 East College Drive (Colby) 785-462-7511

C. Copley, D.O.

311 North Garfield Avenue (Oberlin) 785-470-2117

22

Oberlin Clinic 902 West Columbia (Oberlin) 785-475-2221 Elizabeth Sliter, M.D. Jennifer Taylor, P.A.-C Richard May, M.D.

Stelian Andreca, M.D. Wendy Vogel, M.D.

Rehabilitation Services Golden West Community Services 108 Aspen Street (Goodland) 785-899-2322

Kansas State of Social and Rehabilitation Service 104 West US Highway 24 (Goodland) 785-899-5661

Prairie Developmental Center 208 South 4th Street (Atwood) 785-626-3688

Citizens Medical Center 100 East College Drive (Colby) 785-460-4868 Tina Harris Physical Therapy & Sports Medicine

270 North Franklin Avenue (Colby) 785-462-8008

23

Kansas State of Social and Rehabilitation Service 1135 South County Club Drive (Colby)

785-462-6769 McDonald and Collins 700 Main Street (Wray, CO) 970-332-3471

Wray Rehabilitation Center 700 Main Street (Wray, CO) 970-332-4451

Dynamic Dimensions 1778 Martin Avenue (Burlington, CO) 719-346-5367

First Step Recovery 595 14th Street (Burlington, CO) 719-346-6060

24

Other Health Services

Assisted Living, Nursing Homes, Long-term Care Good Samaritan Society St. Francis Village 820 South Dennison Street (St. Francis) 785-332-2531

Good Samaritan Center 208 West 2nd Street (Goodland) 785-890-7517 Wheat Ridge Acres Retirement Community 707 Wheat Ridge Circle (Goodland) 785-899-0100 Good Samaritan Society 650 Lake Road (Atwood) 785-626-9015

Colby Care Center

105 East College Drive (Colby) 785-462-6721

Fairview Estates

1630 Sewell Avenue (Colby) 785-462-2154

25

Prairie Senior Living Complex 1625 South Franklin Avenue (Colby) 785-462-8295

Cedar Living Center 810 West Columbia (Oberlin) 785-475-2276 Decatur Health System 810 West Columbia Street (Oberlin) 785-475-2208

Burlington Care Center

160 Pomeroy (Burlington, CO) 719-346-8077

Grace Manor Care Center 465 5th Street (Burlington, CO) 719-346-7512 Prairie Manor Good Samaritan Center 408 East 6th Street (Sharon Springs) 785-852-4244

Disability Services Developmental Services for Northwest Kansas 208 South 4th Street (Atwood) 785-626-3688

26

Prairie Developmental Center 208 South 4th Street (Atwood) 785-626-3688

Developmental Services for Northwest Kansas

1675 West 4th Street (Colby) 785-462-3012 LINK Incorporated 505 North Franklin Avenue (Colby) 785-462-7600 American Council for the Blind 800-424-8666

KS Commission for the Deaf and Hearing Impaired

800-432-0698 National Center for Learning Disabilities 888-575-7373

Domestic Violence Information and Treatment Centers Regional Prevention Center 140 W. 4th (Colby) 785-460-8177

27

Battered Women’s Crisis Center 403 East 23rd Street (Hays) 785-625-4202 Blackwell Conflict Management Consulting, LLC 103 East 27th Street (Hays) 785-621-7273 Northwest Kansas Domestic & Sexual Violence 403 East 23rd Street (Hays) 785-625-4202

General Information – Women’s Shelters www.WomenShelters.org

Kansas Children’s Service League 1-800-332-6378

KAPS-Kansas Advocacy & Protection Service 800-672-0086

Educational Training Opportunities Northwest Kansas Technical College 1209 Harrison (Goodland) 785-899-3641 www.nwktc.edu

http://www.womenshelters.org/�

28

Colby Community College 1255 South Range Street (Colby) 785-460-4690 www.colbycc.edu

Food Program Cheyenne County Food Pantry 212 East Washington (St. Francis) 785-332-3623

Genesis 350 South Range Avenue (Colby) 785-460-7930 Government Healthcare Cheyenne County Health Department 210 West 1st Street St. Francis, KS 67756

785-332-2381

MEDICAID Kansas Department of Social & Rehabilitation Services (SRS) 3000 Broadway Hays, KS 67601 785-628-1066

29

MEDICARE Social Security Administration 1212 East 27th Street Hays, KS 67601 785-625-3496

Northwest Kansas Area Agency on Aging 510 West 29th Street Suite B Hays, KS 67601 785-628-8204 www.nwkaaa.com Social & Rehabilitation Services (SRS) 3000 Broadway Hays, KS 67601 785-628-1066

Social Security Administration 1212 East 27th Street Hays, KS 67601 785-625-3496

Kansas Department on Aging (KDOA) 503 S. Kansas Avenue Topeka, KS 66603 785-296-4986 or 1-1-800-432-3535 www.agingkansas.org/

http://www.nwkaaa.com/�

http://www.agingkansas.org/�

30

Kansas Department of Health and Environment (KDHE) Curtis State Office Building 1000 SW Jackson Topeka, KS 66603 785-296-1500 www.kdheks.gov/contact.html

Elder Care Locator 800-677-1116 Home Health Complaints 800-842-0078

Health and Fitness Centers St. Francis Fitness Center Teresa Porter 122 West Washington Street (St. Francis) 785-332-2100

Herbalife Kevin Burkhalter 2627 Road 30 (Bird City) 785-426-4373 Goodland Athletic Center 808 Main Street (Goodland) 785-890-7242

http://www.kdheks.gov/contact.html�

31

Shape Up Sisters, Incorporated 1533 Clark Street (Goodland) 785-890-5700

Atwood Fitness Center 402 Vine Street Suite 1 (Atwood) 785-626-3362 Jump Start Fitness Center 415 North Franklin Avenue (Colby) 785-460-5867 Wow Workout Women 430 North Franklin Avenue (Colby) 785-460-1969 Home Health Services

Good Samaritan Society Home Care 820 South Denison Street (St. Francis) 785-332-3588 Susie Walz Home Health Care (St. Francis) 785-332-3486 Goodland Home Health 677 East 22nd Street (Goodland) 785-890-7658

32

Lincare, Inc. (Respiratory Services) 1013 Main Street (Goodland) 785-899-6848

Rescare Homecare 108 Aspen Road (Goodland) 785-728-4935

Apria Healthcare (Respiratory Services)

1255 South Country Club Drive (Colby) 785-462-8661

L&C Home Health Agency 160 East 2nd Street (Colby) 785-465-7444

Cottonwood Home Care 810 West Columbia Street (Oberlin) 785-475-2208 Kelly’s Home Medical 104 South Penn Avenue (Oberlin) 785-475-2685

Hospice Hospice Services Incorporated of Goodland 106 Willow Road (Goodland) 785-899-5788

33

Caring Hands Hospice 182 16th Street (Burlington, CO) 719-346-4860

Hospice Services Incorporated of Colby 438 North Franklin Avenue (Colby)

785-462-6710 Massage Therapists

Massage Therapy and Bodyworks 315 “S” Scott (St. Francis) 785-332-2823 Raedell’s Massage 709 South Benton (St. Francis) 785-332-4391 Bailee Guyer 1006 Main (Goodland) 785-821-2280 Britany's Natural Therapy 1616 Main Street (Goodland) 785-890-6746 Healthful Solutions 524 East Hwy. 24 (Goodland) 785-821-4442

34

Tina Harris Physical Therapy and Sports Medicine 270 North Franklin Avenue (Colby) 785-462-8008 Uptown Style Salon and Day Spa 505 East 4th Street (Colby) 785-462-2383

Medical Equipment and Supplies Krien Pharmacy 105 West Washington (St. Francis) 785-332-2177 Lincare, Inc. 1013 Main Street (Goodland) 785-899-6848 Currier Health-Mart 416 State Street (Atwood) 785-626-3214

Apria Healthcare 1255 South Country Club Drive (Colby) 785-462-8661 800-753-8661 Kelly’s Home Medical 104 South Penn Avenue (Oberlin) 785-475-2685

35

Medical Equipment and Supplies Corporations American Medical Sales and Repair 866-637-6803 Liberator Medical Supply 877-532-5936

LifeWatch USA 866-599-7363 Life Alert 877-263-9176 Freedom Phone 888-278-1868 My First Aid Company 888-404-1937 1-800-Medicine 800-281-0276 United States Medical Supply 888-828-5186 U-Scoot 888-634-5146 Nutrition Brandie Irhig, RD Cheyenne County Hospital (St. Francis) 785-332-2104 Cheyenne County Health Department 221 West First (St. Francis) 785-332-2381 St. Francis Senior Center 322 West Washington (St. Francis) 785-332-2945 Sarah Linton, RD 220 West 2nd (Goodland) 785-890-3625

36

Wiley Chiropractic Health Center 990 South Range Avenue Suite 5 (Colby) 785-462-7577

School Nurses Cheyenne County Health Department

School Consults 221 West First (St. Francis) 785-332-2381 Central Elementary School – USD 352 Carrie Peter, Nurse 1311 Main Street (Goodland) 785-890-6558

Goodland High School – USD 352 Carrie Peters, Nurse

1209 Cherry Street (Goodland) 785-890-5656

West Elementary School – USD 352 Carrie Peters, Nurse

912 West 12th Street (Goodland) 785-890-6163 Atwood High School Pam Stucynski. Public Health Nurse/ School Nurse 100 North 8th Street (Atwood) 785-626-3289

37

Rawlins County Elementary School – USD 105 Pam Stucynski, Nurse 205 North 4th Street (Atwood) 785-626-3217 Rawlins County Junior/Senior High – USD 105 100 North 8th Street (Atwood) 785-626-3289

Brewster Elementary School – USD 314 Lisa Stoll, Nurse 127 Kansas Avenue (Brewster) 785-694-2236 Brewster High School – USD 314

Lisa Stoll, Nurse 127 Kansas Avenue (Brewster) 785-694-2236

Colby Elementary School – USD 315 Amy Hutfles, Nurse

210 North Grant Avenue (Colby) 785-460-5100 Colby High School – USD 315

Amy Hutfles, Nurse 1890 South Franklin Avenue (Colby) 785-460-5300

38

Colby Middle School – USD 315 Amy Hutfles, Nurse

750 West 3rd Street (Colby) 785-460-5200 Heartland Christian School 1995 West 4th Street (Colby) 785-460-6419

Sacred Heart School 1150 West 6th Street (Colby) 785-460-2813 Thomas County Academy

710 West 3rd Street (Colby) 785-460-5075 Thomas County Learning Center 485 North Chickamauga Avenue (Colby) 785-465-7900

Sharon Springs School 521 North Main Street (Sharon Springs) 785-852-4240

Weskan Elementary School – USD 242 219 Coyote Boulevard (Weskan) 785-943-5222

39

Weskan Junior/Senior High School – USD 242 219 Coyote Boulevard (Weskan) 785-943-5222

Decatur Community Junior/Senior High – USD 294 Johanna Mason, Nurse 605 East Commercial Street (Oberlin) 785-475-2231

Oberlin Elementary School – USD 294 Johanna Mason, Nurse 201 West Ash Street (Oberlin) 785-475-2122

Senior Services

Senior Citizens Center 322 West Washington Street (St. Francis) 785-332-2945 Bird City Senior Center 122 West Bressler Street (Bird City) 785-734-2273

Senior Progress Center 165 Fike Park Street (Colby) 785-460-2901

40

Brewster Senior Center 327 Kansas Avenue (Brewster) 785-694-2645 Golden Age Recreation Center

217 North Penn Avenue (Oberlin) 785-475-3222 Kanorado Senior Citizen 212 Main Street (Kanorado) 785-399-2348 NWKS Area on Aging 301 West 13th (Hays) 800-432-7422

Elder Abuse Hotline 800-842-0078

Veterinary Services

Republican Valley Veterinary Services Highway 36 (St. Francis)

785-332-2262 Prairieland Animal Clinic 204 North Caldwell Street (Goodland) 785-899-7338

41

Lyle A. Dixson, DVM North Highway 25 (Atwood) 785-626-3316 Tri-State Veterinary Services 11951 Highway 25 (Atwood) 785-626-3316

Colby Animal Clinic

810 East 4th Street (Colby) 785-460-8621 Countryside Veterinary Clinic 1829 Highway 83 (Oberlin) 785-475-3808

42

Local Government, Community and Social Services

Adult Protection

Kansas Department of Social and Rehabilitation Services West Region Protection Reporting Center – i.e. PROTECTION REPORT CENTER FOR ABUSE 1-800-922-5330 Available 24 hours/7 days per week – including holidays

Cheyenne County Sheriff

212 East Washington Street (St. Francis) 785-332-8800

St. Francis Police Department 209 West Washington Street (St. Francis) 785-332-3330

Alcohol and Drug Treatment and Support

Narcotics Anonymous 104 West Webster (St. Francis) 785-342-0082

43

Fred Waters Associates 502 Decatur Avenue (McDonald) 785-538-2356

Alcoholics Anonymous 1275 West 6th Street (Colby) 785-462-2906

Regional Prevention Center

140 West 4th Street (Colby) 785-460-8177 Wray Rehabilitation Center 700 Main Street (Wray, CO) 970-332-4451 First Step Recovery 595 14th Street (Burlington, CO) 719-346-6060

Out-Patient Treatment Programs

Smoky Hill Foundation 209 E. 7th Street Hays, KS 67601 Located at the old Hadley Hospital 785-625-5775 or 625-5521 or 1-800-757-2180

44

High Plains Mental Health Center 208 E. 7th Street Hays, KS 67601 Located at old Hadley Hospital 785-625-2871

In-Patient Treatment Programs

Heartland RADAC – Regional Alcohol and Drug Assessment Center

3000 Broadway (SRS Building) Hays, KS 67601

Heartland RADAC is a licensed alcohol and drug treatment program that provides assessment and referral services for individuals seeking substance abuse services. Heartland RADAC facilitates access to treatment services. If financial assistance is needed for in-patient treatment, contact Heartland RADAC Center at 913-789-0951 or 1-1-800-281-0951

www.hradac.com www.hradac.com/resources.htm New Chance, Inc. Will accept Medicaid Title 19 2500 Wyatt Earp Blvd. Dodge City, KS 67801 620-225-0476

http://www.hradac.com/�

http://www.hradac.com/resources.htm�

45

Valley Hope Centers Requires private insurance – no Medicare or Medicaid

Norton, KS Halstead, KS Atchison, KS 785-1-877-5101 316-830-2041 913-967-1618 or 1-800-544-5101

Child Protection

Kansas Children’s Service League 1-800-332-6378

Kansas Department of Social and Rehabilitation Services West Region Protection Reporting Center – i.e. PROTECTION REPORT CENTER FOR ABUSE 1-800-922-5330 Available 24 hours/7 days per week – including holidays

Children and Youth Capstone Counseling 112 East Spencer (St. Francis) 785-772-5041

Lactation Consultant-Cheyenne County Hospital Lori Raile, RN, BSN 221 West First (St. Francis) 785-332-2104

46

Cowboy & Cowgirl Academy 1228 Colorado Avenue (Goodland) 785-890-5437

Melissa’s Little Red Caboose Day Care

311 South 5th Street (Atwood) 785-626-3066 Heartland Child Care 120 West Third Street (Colby) 785-734-2509 Puddle Duck Preschool 520 West 5th Street (Colby) 785-460-2603 Smart Start Northwest Kansas 460 North Garfield Avenue (Colby) 785-465-9103

Child Support Application www.kschild.com 1-1-888-757-2445

Assistance for Families Department of Social and Rehabilitation Services (SRS) 3000 Broadway Hays, KS 67601 785-628-1066 www.srskansas.org

http://www.kschild.com/�

47

Healthwave Low or no cost health plan for Kansas children within stipulated income guidelines – some low income parents may also qualify. 1-1-800-792-4884 P.O. Box 3599 Topeka, KS 66601 www.kansashealthwave.org

Kansas Children's Service League 785-625-2244 KCSL Parent Hotline – 1-800-332-6378 www.kcsl.org Kansas Department of Health and Environment 800-332-6262

Kansas Society for Crippled Children 800-624-4530

Parents Anonymous Helpline 800-332-6378 Talking Books 800-432-2858 Youth Crisis Runaway Line 800-448-4663

http://www.kansashealthwave.org/�


48

Extension Office Sunflower Extension District Office 212 East Washington (St. Francis) 785-332-3171

813 Broadway #301 (Goodland) 785-890-4880 Funeral Homes Knodel Funeral Home 202 South Benton Street (St. Francis) 785-332-3131

Bateman Funeral Home 211 West 11th Street (Goodland) 785-890-6600 Koons Funeral Home 211 North Main Avenue (Goodland) 785-890-3900 Williams Funeral Home 109 North 2nd Street (Atwood) 785-626-3895 Harrison Chapel 190 South Franklin Avenue (Colby) 785-462-2331

49

Kernsenbrock Funeral Chapel 745 South Country Club Drive (Colby) 785-462-7979

Head Start

Cheyenne County Head Start 222 West Webster Street (St. Francis) 785-332-3110

Housing Cheyenne Manor (Low rent housing authority) 200 North Ash (St. Francis) 785-332-3934 Bird City Housing Lebow Manor (Bird City) 785-734-2407

Kansas Housing Resources Corporation 785-296-2065 www.housingcorp.org

US Department of Housing and Urban Development

Kansas Regional Office 913-551-5462 www.hud.gov/local/index.cfm

http://www.housingcorp.org/�

http://www.hud.gov/local/index.cfm�

50

Legal Services

James M. Milliken 101 West Washington (St. Francis) 785-332-2101 Kari M. Gilliland 202 West Washington (St. Francis) 785-332-2101 County Attorney 785-332-8826

Kevin Berens 101 West Washington (St. Francis) 785-332-2101 Michael J. Day

112 West Washington Street (St. Francis) 785-332-3323

Northwest Kansas Area Agency on Aging at Hays 510 West 29th Street Suite B (Hays) 785-628-8204 www.nwkaaa.com Older Kansans Information Service Legal representation in specific areas of concern – funded by Area Agency on Aging and Federal funds. 1-800-432-7422 and leave message or call direct 1-800-723-6953 or 785-625-4514 May also call ElderLaw Hotline 1-888-353-5337

http://www.swkaaa.org/�

51

Libraries, Parks and Recreation Greene Field 100 College Street (St. Francis)

Riverside Recreation Golf Course Highway 36 (St. Francis) 785-332-3401

St. Francis City Park

300 Block of East Washington (St. Francis) St. Francis Library

121 North Scott (St. Francis) 785-332-3292 St. Francis Swimming Pool 207 South Cherry (St. Francis) 785-332-3410

Bird City Public Library

110 East Bressler Street (Bird City) 785-734-2203 Western Prairie RC&D 915 East Walnut, Suite 3 (Colby) 785-462-2602

52

Public Information

City of St. Francis Mayor: 785-332-2833 (Scott Schultz) Clerk: 785-332-3142 (Mary Lampe)

St. Francis Chamber of Commerce 212 West Washington Street (St. Francis) 785-332-2961

Bird City City Hall 111 East Bressler Street (Bird City) 785-734-2616

City of Bird City Mayor: 785-734-2616 (Troy Burr) Clerk: 785-734-2616 (DeAnza Ambrosier)

Rape

Domestic or Sexual Violence Crisis Center or 24 Hour Crisis Line 785-625-3055

Northwest Kansas Domestic and Sexual Violence Services 403 East 23rd Street

Hays, KS 67601 785-625-4202

53

Red Cross

American Red Cross 602 Grand Street (Goodland) 785-890-2011 Social Security Administration

1212 East 27th Street Hays, KS 67601 785-625-3496 www.ssa.gov

Support Groups See also Alcohol and Drug Cheyenne County Health Department 221 West First (St. Francis) 785-332-2381

Alzheimer's Support Group

Meetings are at 7 pm the first Monday of each month at the Northwest Kansas Area Health Education Center. 217 E. 32nd Street Hays, KS 785-625-9006

http://www.ssa.gov/�

54

American Cancer Society Heather West, Community Manager – Health Initiatives 785-472-4075 [email protected] Kim Peach, Community Manager – Development 785-222-3327 Narcotics Anonymous Info Line

P.O. Box 1361 (Hays) 785-621-4350

Diabetic Support Group: Heart of Kansas Family Health Care, Inc. 1905 19th Street (Great Bend)

620-792-5700

High Plains Independence Incorporated 785-625-8865 Patient Service Center - centralized 1-877-227-1618 [email protected]

Transportation General Public Transportation 165 Fike Park Street (Colby) 785-443-9208

mailto:[email protected]�

mailto:[email protected]�

55

Goodland General Public Transportation 208 West 15th Street (Goodland) 785-899-5082

Non-Emergency Medical Transportation (NEMT) To schedule pick-up phone: 1-888-561-8747 Must be a Medicaid recipient. Must call 48 hours in advance for transportation – must be medical (nothing dental or optical). Client will be picked up approximately one hour before an appointment and will pick client up for return trip one hour after being called/client's appointment is completed. If traveling more than 50 miles – physician must give preapproval for transportation.

56

State and National Information, Services & Support

Adult Protection

Adult Protection Services 1-800-922-5330 www.srskansas.org/SD/ees/adult.htm

Domestic Violence and Sexual Assault (DVACK) 1-800-874-1499 www.dvack.org

Elder and Nursing Home Abuse Legal www.resource4nursinghomeabuse.com/index.html Kansas Coalition Against Sexual and Domestic Violence 1-888-END-ABUSE (363-2287) www.kcsdv.org/ksresources.html

Kansas Department on Aging Adult Care Complaint Program 1-800-842-0078

National Center on Elder Abuse (Administration on Aging) www.ncea.gov/NCEAroot/Main_Site?Find_Help/Help_Hotline.aspx

http://www.srskansas.org/SD/ees/adult.htm�

http://www.dvack.org/�

http://www.resource4nursinghomeabuse.com/index.html�

http://www.kcsdv.org/ksresources.html�

http://www.ncea.gov/NCEAroot/Main_Site?Find_Help/Help_Hotline.aspx�

http://www.ncea.gov/NCEAroot/Main_Site?Find_Help/Help_Hotline.aspx�

57

National Domestic Violence Hotline 1-800-799-SAFE (799-7233) 1-800-787-3224 (TTY) www.ndvh.org

National Sexual Assault Hotline 1-800-994-9662 1-888-220-5416 (TTY) www.4woman.gov/faq/sexualassualt.htm

National Suicide Prevention Lifeline 1-800-273-8255 Poison Center 1-800-222-1222

Sexual Assault and Domestic Violence Crisis Line 1-800-701-3630

Social and Rehabilitation Services (SRS) 1-888-369-4777 (HAYS) www.srskansas.org Suicide Prevention Helpline 1-785-841-2345

Alcohol and Drug Treatment Programs

A 1 A Detox Treatment 1-800-757-0771

http://www.ndvh.org/�

http://www.4woman.gov/faq/sexualassualt.htm�

http://www.srskansas.org/�

58

AAAAAH 1-800-993-3869

Abandon A Addiction 1-800-405-4810

Able Detox-Rehab Treatment 1-800-577-2481 (NATIONAL)

Abuse Addiction Agency 1-800-861-1768 www.thewatershed.com

AIC (Assessment Information Classes) 1-888-764-5510

Alcohol and Drug Addiction Treatment Programs 1-800-510-9435

Alcohol and Drug Helpline 1-800-821-4357

Al-Anon Family Group 1-888-4AL-ANON (425-2666) www.al-anon.alateen.org

Mothers Against Drunk Driving 1-800-GET-MADD (438-6233) www.madd.org

http://www.thewatershed.com/�

http://www.al-anon.alateen.org/�

http://www.madd.org/�

59

National Council on Alcoholism and Drug Dependence, Inc. 1-800-NCA-CALL (622-2255) www.ncadd.org

Recovery Connection www.recoveryconnection.org Regional Prevention Centers of Kansas 1-800-757-2180 www.smokyhillfoundation.com/rpc-locate.html

Children and Youth

Boys and Girls Town National Hotline 1-800-448-3000 www.girlsandboystown.org

Child Abuse Hotline 1-800-922-5330

Child Abuse National Hotline 1-800-4-A-CHILD (422-4453) www.childabuse.com Child Find of America 1-800-426-5678

Child Help USA National Child Abuse Hotline 1-800-422-4453

http://www.ncadd.org/�

http://www.recoveryconnection.org/�

http://www.smokyhillfoundation.com/rpc-locate.html�

http://www.girlsandboystown.org/�

http://www.childabuse.com/�

60

HealthWave P.O. Box 3599 Topeka, KS 66601 1-800-792-4884 1-800-792-4292 (TTY) www.kansashealthwave.org

Heartspring (Institute of Logopedics) 8700 E. 29TH North Wichita, KS 67226 www.heartspring.org

Kansas Big Brothers/Big Sisters 1-888-KS4-BIGS www.ksbbbs.org

Kansas Children’s Service League (Hays) 785-625-2244 1-877-530-5275 www.kcsl.org

Kansas Department of Health and Environment 785-296-1500 www.kdheks.gov Kansas Society for Crippled Children 106 W. Douglas, Suite 900 Wichita, KS 67202 1-800-624-4530 316-262-4676 www.kssociety.org


http://www.heartspring.org/�

http://www.ksbbbs.org/�


http://www.kdheks.gov/�

http://www.kssociety.org/�

61

National Runaway Switchboard 1-800-RUNAWAY www.1800runaway.org/

National Society for Missing and Exploited Children 1-800-THE-LOST (843-5678) www.missingkids.com

Counseling Capstone Counseling 112 East Spencer (St. Francis) 785-332-2644

Care Counseling Family counseling services for Kansas and Missouri 1-888-999-2196

Castlewood Treatment Center for Eating Disorders 1-888-822-8938 www.castlewoodtc.com

Catholic Charities 1-888-468-6909 www.catholiccharitiessalina.org

http://www.1800runaway.org/�

http://www.missingkids.com/�

http://www.castlewoodtc.com/�

http://www.catholiccharitiessalina.org/�

62

Central Kansas Mental Health Center 1-800-794-8281 Will roll over after hours to a crisis number.

National Hopeline Network 1-800-SUICIDE (785-2433) www.hopeline.com

National Problem Gambling Hotline 1-800-552-4700 www.npgaw.org Samaritan Counseling Center 1602 N. Main Street Hutchinson, KS 67501 620-662-7835 http://cmc.pdswebpro.com/ Self-Help Network of Kansas 1-800-445-0116 www.selfhelpnetwork.wichita.edu

Senior Health Insurance Counseling 1-800-860-5260 www.agingkansas.org

Sunflower Family Services, Inc. (adoption, crisis pregnancy, conflict solution center) 1-877-457-5437 www.sunflowerfamily.org


http://www.npgaw.org/�

http://cmc.pdswebpro.com/�

http://www.selfhelpnetwork.wichita.edu/�


http://www.sunflowerfamily.org/�

63

Disability Services American Association of People with Disabilities (AAPD) www.aapd.com

American Council for the Blind 1-800-424-8666 www.acb.org Americans with Disabilities Act Information Hotline 1-800-514-0301 1-800-514-0383 (TTY) www.ada.gov

Disability Advocates of Kansas, Inc. 1-866-529-3824 www.disabilitysecrets.com

Disability Group, Inc. 1-888-236-3348 www.disabilitygroup.com

Disability Rights Center of Kansas (DRC) Formerly Kansas Advocacy & Protective Services 1-877-776-1541 1-877-335-3725 (TTY) www.drckansas.org

http://www.aapd.com/�

http://www.acb.org/�

http://www.ada.gov/�

http://www.disabilitysecrets.com/�

http://www.disabilitygroup.com/�

http://www.drckansas.org/�

64

Kansas Commission for the Deaf and Hearing Impaired 1-800-432-0698 www.srskansas.org/kcdhh

Kansas Relay Center (Hearing Impaired service) 1-800-766-3777 www.kansasrelay.com National Center for Learning Disabilities 1-888-575-7373 www.ncld.org

National Library Services for Blind & Physically Handicapped www.loc.gov/nls/ 1-800-424-8567

Environment

Environmental Protection Agency 1-800-223-0425 913-321-9516 (TTY) www.epa.gov Kansas Department of Health and Environment Salina 785-827-9639 Hays 785-625-5663 Topeka 785-296-1500 www.kdheks.gov

http://www.srskansas.org/kcdhh�

http://www.kansasrelay.com/�

http://www.ncld.org/�

http://www.loc.gov/nls/�

http://www.epa.gov/�

http://www.kdheks.gov/�

65

Milco Environmental Services 320 West 4th Street (Colby) 785-460-1956 Northwest Local Environmental Protection Group 350 South Range Avenue Suite 4 (Colby) 785-462-8636

Food and Drug

Center for Food Safety and Applied Nutrition 1-888-SAFEFOOD (723-3366) www.cfsan.fda.gov/ www.healthfinder.gov/docs/doc03647.htm

U.S. Food and Drug Administration 1-888-INFO-FDA 1-888-463-6332 www.fsis.usda.gov/ USDA Meat and Poultry Hotline 1-888-674-6854 1-800-256-7072 (TTY) www.fsis.usda.gov/

Poison Hotline 1-800-222-1222

http://www.cfsan.fda.gov/�

http://www.healthfinder.gov/docs/doc03647.htm�

http://www.fsis.usda.gov/�

http://www.fsis.usda.gov/�

66

Health Services

American Cancer Society 1-800-ACS-2345 www.cancer.org

American Heart Association 1-800-AHA-USA-a www.americanheart.org

American Health Assistance Foundation 1-800-437-2423 www.ahaf.org

American Stroke Association 1-888-4-STROKE www.american heart.org

Arthritis Foundation, Kansas Chapter 1-800-283-7800 www.arthritis.org/chapters/kansas/ Center for Disease Control and Prevention 1-800-311-3435 www.cdc.gov/hiv/

Elder Care Helpline www.eldercarelink.com

http://www.cancer.org/�

http://www.americanheart.org/�

http://www.ahaf.org/�

http://www.arthritis.org/chapters/kansas/�

http://www.cdc.gov/hiv/�

http://www.eldercarelink.com/�

67

Eye Care Council, Inc. 1-800-960-EYES www.seetolearn.com

Kansas Foundation for Medical Care 1-800-432-0407 www.kfmc.org

National Health Information Center 1-800-336-4797 www.health.gov/nhic

National Institute on Deafness and Other Communication Disorders Information Clearinghouse 1-800-241-1044 1-800-241-1055 (TTY) www.nidcd.nih.gov

Hospice

Southwind Hospice, Inc. www.southwindhospice.com 785-483-3161

Kansas Hospice and Palliative Care Organization 1-800-658-8898 www.lifeproject.org/ash.htm

http://www.seetolearn.com/�

http://www.kfmc.org/�

http://www.health.gov/nhic�

http://www.nidcd.nih.gov/�

http://www.southwindhospice.com/�

http://www.lifeproject.org/ash.htm�

68

Housing

Kansas Housing Resources Corporation 785-296-2065 www.housingcorp.org

US Department of Housing and Urban Development Kansas Regional Office 913-551-5462 www.hud.gov/local/index.cfm

Legal Services

Kansas Attorney General 1-800-432-2310 (Consumer Protection 1-800-828-9745 (Crime Victims’ Rights) www.ksag.org/home

Kansas Bar Association 785-234-5696 www.ksbar.org

Kansas Department on Aging 785-432-3535 785-291-3167 (TTY) www.agingkansas.org

http://www.housingcorp.org/�

http://www.hud.gov/local/index.cfm�

http://www.ksag.org/home�

http://www.ksbar.org/�


69

Kansas Legal Services 1-800-723-6953 785-233-4028 (TTY) www.kansaslegalservices.org

Medicaid / Medicare Services

Kansas Health Wave 800-792-4884 or 800-792-4292 (TTY) www.kansashealthwave.org

Kansas Medical Assistance Program Customer Service 800-766-9012 www.kmpa-state-ks.us/

Medicare Information 800-MEDICARE www.medicare.gov

U.S. Department of Health and Human Services Centers for Medicare and Medicaid Services 800-MEDICARE (800-633-4227) or 877-486-2048 (TTY) www.cms.hhs.gov

Mental Health Services Alzheimer's Association 1-800-272-3900 or 1-866-403-3073 (TTY) www.alz.org

http://www.kansaslegalservices.org/�


http://www.kmpa-state-ks.us/�

http://www.medicare.gov/�

http://www.cms.hhs.gov/�

http://www.alz.org/�

70

Developmental Services of Northwest Kansas 1-800-637-2229

Kansas Alliance for Mentally Ill (Topeka, KS) 785-233-0755 www.namikansas.org

Make a Difference 1-800-332-6262

Mental Health America 1-800-969-6MHA (969-6642)

National Alliance for the Mentally Ill Helpline 1-800-950-NAMI (950-6264) or 703-516-7227 (TTY) www.nami.org

National Institute of Mental Healthcare 1-866-615-6464 or 1-866-415-8051 (TTY) www.nimh.nih.gov

National Library Services for Blind and Physically Handicapped 1-800-424-8567 www.loc.gov/nls/music/index.html State Mental Health Agency KS Department of Social and Rehabilitation Services 785-296-3959 www.srskansas.org

http://www.namikansas.org/�

http://www.nami.org/�

http://www.nimh.nih.gov/�

http://www.loc.gov/nls/music/index.html�


71

Suicide Prevention Hotline 1-800-SUICIDE [784-2433] www.hopeline.com

Nutrition American Dietetic Association 1-800-877-1600 www.eatright.org

Department of Human Nutrition Kansas State University 785-532-5500 www.humec.k-state.edu/hn/ Eating Disorders Awareness and Prevention 1-800-931-2237 www.nationaleatingdisorders.org

Food Stamps Kansas Department of Social and Rehabilitation Services (SRS) 1-888-369-4777 or Local SRS office www.srskansas.org/ISD/ees/food_stamps.htm

Kansas Department of Health and Environment 1000 SW Jackson, Suite 220 Topeka, KS 66612 785-296-1320 www.kdheks.gov/news-wic/index.html


http://www.eatright.org/�

http://www.humec.k-state.edu/hn/�

http://www.nationaleatingdisorders.org/�

http://www.srskansas.org/ISD/ees/food_stamps.htm�

http://www.kdheks.gov/news-wic/index.html�

72

Road and Weather Conditions

Kansas Road Conditions 866-511-DOT [511-5368] http://kdot1.ksdot.org/divplanning/roadrpt/

Senior Services Alzheimer's Association 1-800-487-2585

American Association of Retired Persons (AARP) 1-888-OUR-AARP (687-2277) www.aarp.org Americans with Disabilities Act Information Line 1-800-514-0301 or 1-800-514-0383 [TTY] www.usdoj.gov/crt/ada

Eldercare Locator 1-800-677-1116 www.eldercare.gov/eldercare/public/home.asp

Home Buddy 1-866-922-8339 www.homebuddy.org

Home Health Complaints Kansas Department of Social and Rehabilitation Services (SRS) 1-800-842-0078

http://kdot1.ksdot.org/divplanning/roadrpt/�

http://www.aarp.org/�

http://www.usdoj.gov/crt/ada�

http://www.eldercare.gov/eldercare/public/home.asp�

http://www.homebuddy.org/�

73

Kansas Advocates for Better Care Inc. Consumer Information 1-800-525-1782 www.kabc.org Kansas Department on Aging 1-800-432-3535 or 785-291-3167 (TTY) www.agingkansas.org/index.htm

Kansas Foundation for Medical Care, Inc. Medicare Beneficiary Information 1-800-432-0407 Kansas Tobacco Use Quitline 1-866-KAN-STOP (526-7867) www.kdheks.gov/tobacco/cessation.html

Older Kansans Employment Programs (OKEP) 785-296-7842 www.kansascommerce.com

Older Kansans Information Reference Sources on Aging (OKIRSA) 1-800-432-3535

Senior Health Insurance Counseling for Kansas 1-800-860-5260 www.agingkansas.org/SHICK/shick_index.html

http://www.kabc.org/�

http://www.agingkansas.org/index.htm�

http://www.kdheks.gov/tobacco/cessation.html�

http://www.kansascommerce.com/�

http://www.agingkansas.org/SHICK/shick_index.html�

74

SHICK 1-800-860-5260 www.agingkansas.org/SHICK

Social Security Administration 785-296-3959 or 785-296-1491 (TTY) www.srskansas.org

Veterans Federal Information Center 1-800-333-4636 www.FirstGov.gov

U.S. Department of Veterans Affairs 1-800-513-7731 www.kcva.org Education (GI Bill) 1-888-442-4551 Federal Information Center 1-800-333-4636 www.FirstGov.gov

Health Resource Center

877-222-8387

Insurance Center 800-669-8477

http://www.agingkansas.org/SHICK�


http://www.firstgov.gov/�

http://www.kcva.org/�

http://www.firstgov.gov/�

75

Mammography Helpline

888-492-7844

Memorial Program Service [includes status of headstones and markers]

800-697-6947 Other Benefits

800-827-1000 Telecommunications Device for the Deaf/Hearing Impaired

800-829-4833 (TTY) www.vba.va.gov

U.S. Department of Veterans Affairs

1-800-513-7731 www.kcva.org

Veteran Special Issue Help Line Includes Gulf War/Agent Orange Helpline

800-749-8387

Veterans Administration Benefits Information and Assistance 800-827-1000

http://www.vba.va.gov/�

http://www.kcva.org/�

76

Index

A

Abuse, 2, 3, 40, 42, 44, 45, 56, 58, 59

Adult Protection, 42, 56 Alcohol, 42, 44, 53, 57, 58 Assisted Living, 24

C

Children, 3, 27, 45, 47, 59, 60, 61

Chiropractic, 10, 11, 12, 36 Chiropractors, 10 Clinics, 12, 13 Counseling, 8, 9, 45, 61, 62,

73

D

Dentists, 14 Disability, 25, 63 Domestic Violence, 2, 26, 27,

52, 56, 57 Drug, 19, 42, 44, 53, 57, 58,

59, 65

E

Environment, 30, 47, 60, 64, 71

F

Fitness, 30, 31 Food, 28, 65, 71 Food Program, 28 Funeral, 48, 49

G

Gambling, 62 Government, 28, 42

H

Head Start, 49 Health Care Providers, 19 Health Department, 8, 16, 28,

35, 36, 53 Hearing, 16, 26, 64, 75 Home Health, 30, 31, 32, 72 Hospice, 32, 33, 67 Hospital, 5, 7, 35, 43, 44, 45 Housing, 49, 68

L

Legal Services, 50, 68, 69

M

Massage, 33 Medicaid, 28, 44, 45, 55, 69 Medical Equipment, 34, 35

77

Mental Health, 2, 8, 9, 44, 62, 69, 70

N

Nursing Home, 24, 56 Nutrition, 35, 65, 71

O

Optometrists, 17

P

Pharmacies, 18 Physical Therapy, 6, 22, 34 Physicians, 19 Poison, 3, 57, 65 Police, 1, 42 Pregnancy, 62 Public Information, 52

R

Rape, 52 Recreation, 40, 51

Rehabilitation, 3, 5, 22, 23, 28, 29, 42, 43, 45, 46, 57, 70, 71, 72

Road and Weather, 72

S

School Nurses, 36 Senior, 9, 25, 35, 37, 39, 40,

62, 72, 73 Social Security, 29, 53, 74 Suicide, 4, 57, 62, 71 Support Groups, 53

T

Transportation, 54, 55

V

Veterans, 74, 75 Veterinary, 40, 41 Violence, 26, 27, 52, 56, 57

Y

Youth, 45, 47, 59


It is the policy of Kansas State University Agricultural Experiment Station and Cooperative Extension Service that all per-sons shall have equal opportunity and access to its educational programs, services, activites, and materials without regard to race, color, religion, national origin, sex, age or disability. Kansas State University is an equal opportunity organization.

Issued in furtherance of Cooperative Extension W ork, Acts of May 8 and June 30, 1914, as amended. Kansas State Uni-versity, County Extension Cuncils, Extension Districts, and United States Department of Agriculture Cooperating, Fred A. Cholick, Dean, College of Agriculture.

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